1. Prevention of Mother to Child Transmission Antiretroviral Drugs to Prevent MTCT

2. Presentation Objectives By the end of the presentation you should be able to: explain strategies for the prevention of MTCT; describe the different types of antiretroviral drugs for PMTCT.

3. Types of ARVs There are various types of ARV for the prevention of mother to child transmission including: –Nevirapine –Zidovudine Short course prophylactic regimens of –zidovudine alone –zidovudine plus lamivudine –nevirapine alone intrapartum

4. Choice of ARV Regimen Regimen should be determined by –Feasibility –Efficacy –Acceptability –Cost Nevirapine (single dose) –Demonstrated efficacy in clinical trials (HIVNET 012 and SAINT) –Low cost and ease of use –Resistance?

5. Lessons Learned and Future Challenges

6. Lessons Learned and Recommendations Introducing ARV and/or replacement feeding options to reduce MTCT is a complex process Costs and benefits need to be carefully assessed Strategy should be tailored to suit local conditions –HIV prevalence rates –Risks of replacement feeding –The state of the existing health system and MCH services –Maturity of the epidemic –Attitudes toward HIV in the community

7. Integrated PMTCT Services PMTCT services are (or should be) integrated into Maternal and Child Health clinics. Implications: –Staff workload increases –‘new’ skills are needed –Enhanced ANC for all women

8. Issues to Consider when Planning MTCT Interventions Effective primary prevention programs and family planning services Adequate and functioning antenatal care programs Access to confidential VCT services Follow-up care for mother and infant Regulation and supply of ARV and breastmilk substitutes

9. Future Challenges for PMTCT Ensuring that basic services are ready to integrate the new interventions Rising need for VCT services Reorganization of pre-, peri-, and post- natal care and family planning Making decisions about infant feeding Remaining questions about ART, infant feeding, and MTCT Care for orphans Stigma and discrimination