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    Issues On HIV and STI Among Pregnant Women: DR Helen Madamba, MD MPH-TM Fpogs Fpidsog

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    Jeffrey Ramos
    The document discusses issues related to HIV and STIs among pregnant women. It notes that unprotected sex and IV drug use are main modes of HIV transmission. It provides recommendations from the Philippine Obstetrical and Gynecological Society on prevention of mother-to-child transmission of HIV. This includes HIV screening of pregnant women, use of antiretroviral drugs, management of delivery, infant feeding options, and importance of follow up care.

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    Issues On HIV and STI Among Pregnant Women: DR Helen Madamba, MD MPH-TM Fpogs Fpidsog

    Uploaded by

    Jeffrey Ramos
    39 views32 pages
    The document discusses issues related to HIV and STIs among pregnant women. It notes that unprotected sex and IV drug use are main modes of HIV transmission. It provides recommendations from the Philippine Obstetrical and Gynecological Society on prevention of mother-to-child transmission of HIV. This includes HIV screening of pregnant women, use of antiretroviral drugs, management of delivery, infant feeding options, and importance of follow up care.

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    The document discusses issues related to HIV and STIs among pregnant women. It notes that unprotected sex and IV drug use are main modes of HIV transmission. It provides recommendations from the Philippine Obstetrical and Gynecological Society on prevention of mother-to-child transmission of HIV. This includes HIV screening of pregnant women, use of antiretroviral drugs, management of delivery, infant feeding options, and importance of follow up care.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    39 views32 pages

    Issues On HIV and STI Among Pregnant Women: DR Helen Madamba, MD MPH-TM Fpogs Fpidsog

    Uploaded by

    Jeffrey Ramos
    The document discusses issues related to HIV and STIs among pregnant women. It notes that unprotected sex and IV drug use are main modes of HIV transmission. It provides recommendations from the Philippine Obstetrical and Gynecological Society on prevention of mother-to-child transmission of HIV. This includes HIV screening of pregnant women, use of antiretroviral drugs, management of delivery, infant feeding options, and importance of follow up care.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 32

    Issues on HIV

    and STI
    among
    Pregnant
    Women

    Dr Helen Madamba, MD MPH-TM FPOGS FPIDSOG


    HVMadamba 2015

    UN Millenium Development Goals


    HVMadamba 2015

    Unprotected penetrative sex and IV drug


    use are main modes of HIV transmission

    March 2015 DOH NEC AIDS registry


    HVMadamba 2015

    Region 7 is 3rd in terms of regional


    distribution of reported HIV cases
    HVMadamba 2015

    http://cnnphilippines.com/regional/2015/06/08/Cebu-City-highest-in-HIV-prevalence.html#.VXbuY6SEHt0.facebook
    HVMadamba 2015

    Philippine HIV
    testing
    centers on
    googlemaps

    https://www.google.com.ph/maps/search/hiv+testing+center+philippines/@11.6978351,122.6217542,6z/data=!3m1!4b1
    HVMadamba 2015

    There are many other


    notable advocates
    working to stop the HIV
    epidemic to achieve the
    goal of GETTING TO ZERO:
    zero new infections,
    zero AIDS-related deaths
    zero discrimination.
    HVMadamba 2015

    Philippine Obstetrical and Gynecological


    Society (Foundation) Inc
    Clinical Practice Recommendation on Prevention
    of Mother to Child Transmission of HIV Infection

    HIV Screening
    Antiretroviral Drugs
    Management of Delivery
    Infant Feeding
    Contraception

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    HIV Screening
    Antenatal infections package
    HIV screening
    Hepatitis B virus
    Syphilis
    Rubella
    Urinary tract infection
    Papsmear for HPV

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    HIV Screening
    Preliminary Counselling Dialogue

    Part of thorough assessment of her


    status in relation to her pregnancy
    Routine interview + standard
    counselling about HIV
    Strictly confidential
    Opt out - and still receive
    the same standard care

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    HIV Screening
    Post-test counselling

    If the test is negative


    Recommend repeat test 6 months
    later to account for window period
    Counsel patient and her partner to
    maintain healthy lifestyle, including
    low risk sexual relationship

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    HIV Screening
    Post-test counselling

    If the test is positive:


    HIV viral load, CD4 cell count etc
    Antiretroviral drug therapy
    Planned cesarean section
    scheduled around 38-39 weeks to
    avoid labor and vaginal delivery

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    HIV Screening
    Post-test counselling

    If the test is positive:


    Infant formula feeding instead of
    breast milk feeding
    Antiretroviral drug therapy for and
    serial HIV testing of infant
    Contraception, healthy lifestyle,
    safe sex counselling.

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    HIV Screening
    Post-test counselling

    If the test is positive:


    Importance of long-term follow up
    care
    Need to refer to other specialists
    (e.g. adult and/or pediatric
    infectious disease)

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    Anti-retroviral (ARV) Drugs


    Anti-retroviral (ARV) treatment and
    prophylaxis to prevent maternal-
    to-child transmission (MTCT) of HIV
    Determine stage of HIV using WHO
    CLINICAL STAGING OF HIV IN
    WOMEN.
    Determine CD4 cell count

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    Anti-retroviral (ARV) Drugs

    Determine whether patient


    requires ARV treatment or just
    prophylaxis using the eligibility
    criteria based on WHO clinical
    stage and CD4 cell count.

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    Eligibility Criteria for initiating ART


    or ARV prophylaxis in HIV-
    infected pregnant women
    based n CD4 count and WHO
    clinical stage
    WHO CD4 CELL CD4 COUNT AVAILABLE
    CLINICAL COUNT NOT CD4 ≤ 350 CD4 > 350
    STAGE AVAILABLE
    1 ARV ART ARV
    Prophylaxis prophylaxis
    2 ARV ART ARV
    Prophylaxis prophylaxis
    3 ART ART ART
    4 ART ART ART
    POGS Clinical Practice Recommendations on PMTCT
    HVMadamba 2015

    Anti-retroviral (ARV) Drugs


    Assure initiation and/or
    maintenance of
    antiretroviral therapy (ART)
    or ARV
    The choice of ARV to be
    given to a pregnant
    patient and her newborn
    depends on different
    clinical scenarios.

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    Anti-retroviral (ARV) Drugs


    Different Clinical Scenarios

     Woman already receiving ARV


    treatment for her own health –
    continue.
     ARV-naïve HIV-infected pregnant
    woman
    With indication for own health, start
    ARV regardless of AOG
    ARV prophylaxis started at 14 weeks
    AOG

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    Anti-retroviral (ARV) Drugs


    Eligibility for ARV Prophylaxis

    Option A: maternal AZT + infant


    ARV prophylaxis
    Option B: maternal triple ARV
    prophylaxis until delivery or if
    breastfeeding, until 1 week after all
    exposure to breast milk ended
    Option B+: start triple ARVs as soon
    as diagnosed and continued for
    life
    POGS Clinical Practice Recommendations on PMTCT
    HVMadamba 2015

    Anti-retroviral (ARV) Drugs


    Advantages of Option B+

    Simplify PMTCT program


    requirements – no need for CD4
    testing to determine ARV eligibility
    Extended protection from mother-
    to-child transmission
    Strong and continuing prevention
    benefit against sexual transmission
    in sero-discordant couples and
    partners
    POGS Clinical Practice Recommendations on PMTCT
    HVMadamba 2015

    Anti-retroviral (ARV) Drugs


    Advantages of Option B+

    Earlier treatment for woman’s


    health and avoiding risks of
    stopping and starting triple ARVs
    especially in settings of high fertility
    Simple message to communities
    “once ARV started,
    it is taken for life.”
    POGS Clinical Practice Recommendations on PMTCT
    HVMadamba 2015

    Anti-retroviral (ARV) Drugs

    Explain to the mother that ARVs


    can be procured from the
    following treatment hubs all over
    the archipelago

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    Anti-retroviral (ARV) Drugs


    HIV Treatment Hubs in Philippines

    Google maps
     https://www.google.com.ph/maps

    Search
    “HIV treatment hubs”
     https://www.google.com.ph/maps/s
    earch/hiv+treatment+hubs/@12.0789
    5,121.8959891,6z/data=!3m1!4b1
    HVMadamba 2015

    Management of Delivery

    risks of transmission during delivery


    cesarean section vs vaginal
    delivery
    antiretroviral drugs through labor
    and delivery
    immediate postpartum
    care

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    Management of Delivery
    Essential Intrapartum Newborn Care (EINC)

     Thoroughly dry newborn infant


    × vigorous suctioning
     Skin to skin bonding should be
    encouraged
    × Delayed clamping of umbilical cord is NOT
    recommended.
     Latching on is done ONLY IF
    breastfeeding has been chosen.

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    Infant Feeding
    avoid breastfeeding, danger of
    mixed feeding
    continuing ARV medications
    replacement feeding:
    acceptable, feasible, affordable,
    sustainable and safe (AFASS)
    risks, follow up and other options
    for replacement feeding
    relieve breast engorgement
    POGS Clinical Practice Recommendations on PMTCT
    HVMadamba 2015

    Contraception

    SAFER SEX is any sexual


    practice that reduces the chance
    of transmitting HIV and any other
    sexually transmitted (STIs) from one
    person to another

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    Contraception
    Best protection obtained by:
    Correct and consistent use of condoms
    during every sexual act
    Choosing sexual activities that do not
    allow semen, fluid from the vagina, or
    blood to enter the mouth, vagina or
    anus of the partner
    Reducing the number of partners

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    Contraception
    Condoms
    Lactational Amenorrhea
    Spermicides
    Intrauterine device
    Fertility awareness methods
    Hormonal contraception
    Female sterilization

    POGS Clinical Practice Recommendations on PMTCT


    HVMadamba 2015

    Prevention of HIV Infection


    of Health Care Workers

    Standard precautions
    Post-exposure prophylaxis
    Hospital infection control

    POGS Clinical Practice Recommendations on PMTCT


    Issues on HIV and STI
    among Pregnant
    Women
    Dr Helen Madamba, MD MPH-TM FPOGS FPIDSOG

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