Prevention of Mother to Child Transmission

Antiretroviral Drugs to Prevent MTCT

UNICEF/Pirozzi

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.

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

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?

Lessons Learned and Future Challenges

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

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

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

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