1. Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) Maternal and Newborn Health Training Package Session 11: HIV and Maternal & Newborn Health

2. Four Prongs of a Comprehensive PMTCT Approach  Primary prevention targeting girls and young women  Prevention of unintended pregnancies among HIV-positive women  HIV testing and access to ARVs for HIV-positive mothers/prevention of transmission of HIV from an HIV-positive woman to infant during pregnancy, labor, childbirth, and breastfeeding  Follow on care and support to mothers and families

3. PMTCT cascade Taken from Global e learning

4. HIV and Reproductive & Maternal Health  Women/girls most affected by HIV/AIDS  HIV and childbearing complications: leading cause of death of women of reproductive age  HIV-positive pregnant women: 8x more likely to die  Postpartum women with HIV: higher risks of developing puerperal sepsis  MM: increased over past 20 years in eight sub- Saharan countries with high HIV prevalence

5. HIV and Newborn Health  Vast majority of newly infected children are newborns  Maternal status affects newborn survival – Increased risk of stillbirth and death – More likely to be very LBW and preterm  High risk of passing infection to newborn when women becomes infected during pregnancy or while breastfeeding  Interactions of HIV, infections, and indirect effects (greater poverty) = poor newborn outcomes  Confusing information about feeding choices: spillover negative effect on non-HIV mothers and infants

6. HIV Interactions and MNH: Double Trouble  HIV + Malaria  HIV + Tuberculosis (TB)  HIV + Sexually Transmitted Infections (STI)  HIV + AIDS-Related Pneumonia  HIV + Nutritional Deficiencies  HIV + Neonatal Infections

7. PMTCT Treatment Regimens  Option B+: HIV-positive pregnant women are initiated on lifelong ART  Change from previous regimens  Newborns of HIV-positive women: daily ARV prophylaxis (NVP or AZT) from birth through age 4-6 weeks of age, regardless of infant feeding method  Early Infant Diagnosis of HIV Infection: 4-6 weeks of age or earliest opportunity

8. Pregnant Women and Access to Treatment Regimens  Pregnant women in developing countries: – Only 38% received HIV counseling and testing – 57% received effective ARV drugs – while increased from 48% in 2010 – access to ARV drugs was LOWER compared to general population adults (despite fact that coverage of HIV testing in pregnant women generally higher than other adult population)

9. Why Options B/B+ Important  Option B+ in Malawi: change of regimen and larger strategy to integrate ART and PMTCT  Greater equity and reach  Opportunity to roll out “treatment as prevention,” which can have significant impact in reducing new HIV infections due to sexual transmission among sero-discordant partners

10. Responses to HIV  While progress to expand access to HIV testing and ART, pregnant women have lower access  And….other pillars have made comparatively poor progress, including: – Preventing new HIV infections among women – Preventing unintended pregnancies among women with HIV – Providing CST services to women with HIV and their families

11. Barriers to Uptake and Retention in HIV Services and PMTCT  Supply – Poor quality of care, disrespect, and abuse of HIV-positive pregnant women during ANC and delivery; inadequate skills and availability of staff – Poor treatment due to fragmented services; stock-outs of drugs and supplies – Delays in service provision; weak referral systems, poor linkages  Demand – HIV-related stigma and discrimination; psychological factors – Lack of knowledge of ART benefits; not having symptoms of HIV – Women’s limited autonomy and access to social support; financial constraints, geographic distance