Session: 4 Role of Maternal and Child Health Services in the prevention of HIV infection in infants and young children Dr.Pushpalatha, Assistant Professor, Dept of Pediatrics, Vani Vilas Hospital, Bangalore

PPTCT programs need to be integrated as an essential part of MCH care. All mothers and infants will benefit from the integration of PPTCT into existing care services.

Maternal and child health services MCH programmes facilitate PPTCT by providing: MCH programmes facilitate PPTCT by providing: Essential antenatal care Essential antenatal care Family planning services Family planning services ARV prophylaxis ARV prophylaxis Safer delivery practices Safer delivery practices Counseling and support for the woman’s chosen infant feeding method Counseling and support for the woman’s chosen infant feeding method

Many elements of PPTCT programmes parallel and complement initiatives of MCH services. Many elements of PPTCT programmes parallel and complement initiatives of MCH services. Some of the essential components of MCH are: Some of the essential components of MCH are: Essential obstetric care Essential obstetric care Safe abortion services Safe abortion services Strengthening of FRUs and emergency obstetric care Strengthening of FRUs and emergency obstetric care Promotion of institutional deliveries and 24 hr delivery services at PHCs and CHCs Promotion of institutional deliveries and 24 hr delivery services at PHCs and CHCs Baby friendly hospitals Baby friendly hospitals

At present, these services are provided under the RCH program, which also includes services for the prevention and control of RTIs/STIs, which have an important role in prevention of HIV At present, these services are provided under the RCH program, which also includes services for the prevention and control of RTIs/STIs, which have an important role in prevention of HIV

Comprehensive MCH services Recognize that the best approach to preventing HIV infection in infants and children begins with prevention of primary infection in parents-to-be. Recognize that the best approach to preventing HIV infection in infants and children begins with prevention of primary infection in parents-to-be. Provide information to prevent unintended pregnancies in both HIV infected women and high- risk women with unknown status Provide information to prevent unintended pregnancies in both HIV infected women and high- risk women with unknown status Provide education in early recognition and treatment of STIs Provide education in early recognition and treatment of STIs Provide education in risk reduction for MTCT Provide education in risk reduction for MTCT

Link and refer clients to community services that include the following elements: Link and refer clients to community services that include the following elements: Treatment for chronic primary care conditions including asthma, hypertension and DM Treatment for chronic primary care conditions including asthma, hypertension and DM HIV testing and counseling HIV testing and counseling Nutritional care Nutritional care ARV treatment ARV treatment Economic assistance Economic assistance Psychosocial and/or spiritual support Psychosocial and/or spiritual support

Educate clients about how to recognize symptoms of opportunistic infections and measures they can take to prevent such infections Educate clients about how to recognize symptoms of opportunistic infections and measures they can take to prevent such infections Educate clients about how to recognize early symptoms of HIV infection in the infant or child Educate clients about how to recognize early symptoms of HIV infection in the infant or child

Integration of PPTCT within postnatal MCH services Effective integration of PPTCT within postnatal MCH services is likely to increase community acceptance of PPTCT programmes and strengthen maternal care, infant care and family care. Effective integration of PPTCT within postnatal MCH services is likely to increase community acceptance of PPTCT programmes and strengthen maternal care, infant care and family care.

Maternal Care- protecting mother’s health by providing medical and psychosocial support. Infant Care- growth and development nutritional support,immunization and early HIV testing. Family Care- provides social support,testing and counselling for family members;referrals to community services.

The PPTCT program The 4 prongs of comprehensive care in PPTCT are: The 4 prongs of comprehensive care in PPTCT are: Primary prevention of HIV infection Primary prevention of HIV infection Prevention of unintended pregnancies in HIV infected women Prevention of unintended pregnancies in HIV infected women Prevention of HIV transmission from HIV infected women to their infants Prevention of HIV transmission from HIV infected women to their infants Provision of treatment, care and support to HIV infected women, their infants and their families Provision of treatment, care and support to HIV infected women, their infants and their families

Without intervention, the risk of MTCT is 25-40% Without intervention, the risk of MTCT is 25-40% Combination interventions can reduce the MTCT rate by upto 40% in breast feeding populations Combination interventions can reduce the MTCT rate by upto 40% in breast feeding populations Because ARV prophylaxis alone does not provide long term benefit to the mother’s infection, on going care and support are needed Because ARV prophylaxis alone does not provide long term benefit to the mother’s infection, on going care and support are needed MCH services can act as an entry point to the range of services that can provide care and support to HIV positive women and affected family members MCH services can act as an entry point to the range of services that can provide care and support to HIV positive women and affected family members Linkages to community services provide enhanced care and support. Linkages to community services provide enhanced care and support.