A SEMINAR PRESENTATION

ON

PREVENTION OF MOTHER TO CHILD TRANSMISSION of HIV/AIDS; ROLES OF

NURSES IN PERINATAL CARE.

BY

IDOWU REUBEN BABASOLA

CON/2021/052

TO

OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITALS COMPLEX,

COLLEGE OF NURSING,

WESLEY GUILD UNIT.

SEPTEMBER, 2023.
 TABLE OF CONTENTS

LIST OF ABBREVIATIONS (OR) SYMBOLS

1. INTRODUCTION.

2. HUMAN IMMUNODEFICIENCY VIRUS/ ACQUIRED IMMUNE DEFICIENCY

SYNDROME

3. SIGNS AND SYMPTOMS OF HIV/AIDS

4. MOTHER TO CHILD TRANSMISSION OF INFECTIONS

5. METHODS OF PREVENTION
• Prevention before delivery
• Prevention during delivery
• Prevention after delivery
• Factors that influence Prevention of Mother to Child Cross Transmission

6. ROLES OF NURSES IN THE PREVENTION OF MOTHER TO CHILD

TRANSMISSION OF HIV/AIDS IN PERINATAL CARE

7. CONCLUSION.

8. REFERENCE.
 LIST OF ABBREVIATIONS (OR) SYMBOLS

ART: Antiretroviral therapy

ARV: Antiretroviral

AIDS: Acquired immune deficiency syndrome

CBS: Community based support

ECS: Elective Caesarean Section

EBF: Exclusive breastfeeding

EFF: Exclusive formula feeding

HAART: Highly active ART

HIV: Human immunodeficiency virus

HIV-1: Human immunodeficiency virus type 1

HIV-2: Human immunodeficiency virus type 2

MTCT: Mother-to-child transmission

PMTCT: Prevention of mother-to-child transmission

UNICEF: United Nations Children's Emergency Fund

UNAIDS: The Joint United Nations Program on HIV and AIDS

WHO: World Health Organization

 INTRODUCTION

The pandemic of the acquired immune deficiency syndrome (AIDS) is caused

by the human immunodeficiency virus type 1 (HIV-1).
There are two main strains of HIV: HIV-1 which is the more common type and
has caused the majority of infections and AIDS cases and is what is usually implied
when mention of HIV is made generally. HIV-2 is a rarer form of the virus and is
concentrated in selected countries mainly in West Africa.
Given the simplicity of the virus, they mutate much more easily than more
complex forms of life and hence have been known to differ from individual to
individual and even to mutate within an individual over the course of the disease.
There are other more obscure forms of the virus in humans and primates but these two
are responsible for the global epidemic (WHO 2016.)
AIDS represents one of the most serious health crises in the world; there are 34
million people infected worldwide, with more than 15.4 million about half of the
population being women (WHO 2014).
The growth of AIDS cases among women has as a consequence, the increase
in mother-to-child transmission (MTCT) of HIV infection hence MTCT is considered
the most common etiology for pediatric AIDS. Almost all AIDS cases in children
under 13 years of age have vertical trans- mission of HIV as their source of infection
(Cruz et al. 2013).
Without preventive interventions approximately one-third of infants born to
HIV-positive mother’s contract the virus, becoming infected during their mother’s
pregnancy, childbirth or breastfeeding. The rate of MTCT transmission of HIV,
without any intervention, stands at around 25.5%, and it is possible to reduce this to
levels between 0% and 2%, by means of preventive interventions. (Cruz et al. 2013.)
Currently, HIV infection is incurable. However effective antiretroviral (ARV)
drugs can control the virus and help prevent transmission. Also the risk of MTCT can
be reduced by interventions that include ARV prophylaxis given to women during
pregnancy and labour and to the infant in the first weeks of life. Recently WHO
advised HIV-positive mothers to avoid breastfeeding if they were able to afford,
prepare and store formula milk safely. With these interventions it is good news that
new HIV infection among children were reduced by 58% from 2000-2014 in the
western world. (UNAIDS 2015.)
On the other hand, 95% of vertical transmission of HIV occurs in resource
limited areas. Every minute an infected infant is born in spite of the fact that vertical
transmission is largely preventable, mainly because translating knowledge into
practice is not always feasible. This has led to continuous growing numbers of
children with HIV, thereby making pediatric HIV a looming problem rapidly draining
the already burdened health care system of these countries. (Lala & Merchant 2010.)
This seminar aims to provide a comprehensive understanding of HIV/AIDS,
from its historical context to the latest developments in research and treatment as well
as the Roles of Nurses in the prevention of Mother to Child transmission of
HIV/AIDS in Perinatal care.
 HUMAN IMMUNODEFICIENCY VIRUS/ ACQUIRED IMMUNE
DEFICIENCY VIRUS

HIV (Human Immunodeficiency Virus) is a complex retrovirus that primarily targets

and infects a specific type of immune cell called CD4+ T cells, which are crucial for
orchestrating the body's immune response against infections. HIV is composed of two main
types: HIV-1 and HIV-2, with HIV-1 being the most common and virulent strain worldwide.

When an individual becomes infected with HIV, the virus enters the bloodstream and
begins to replicate within CD4+ T cells. This viral replication gradually depletes the
population of these critical immune cells, weakening the immune system's ability to respond
to pathogens effectively. As a result, HIV-infected individuals become more susceptible to a
range of infections and diseases that a healthy immune system would normally control.

AIDS (Acquired Immunodeficiency Syndrome) represents the advanced stage of HIV

infection. The diagnosis of AIDS is typically made based on specific criteria, including either
a severe drop in the CD4+ T cell count below a certain threshold (usually below 200
cells/mm³) or the occurrence of one or more AIDS-defining illnesses.
These illnesses can include opportunistic infections like tuberculosis, Pneumocystis
jirovecii pneumonia (PCP), and certain types of fungal, bacterial, or viral infections.
Additionally, specific types of cancer, such as Kaposi's sarcoma and non-Hodgkin
lymphoma, are considered AIDS-defining conditions.

A hallmark feature of AIDS is the profound weakening of the immune system, leaving
the individual highly vulnerable to a range of infections and diseases that would typically be
controlled by a healthy immune system. It's important to note that not all individuals living
with HIV will progress to AIDS; timely access to antiretroviral therapy (ART) can effectively
control viral replication, slow disease progression, and help maintain or restore immune
function.
 SIGNS AND SYMPTOMS OF HIV/AIDS

HIV (Human Immunodeficiency Virus) infection and AIDS (Acquired Immunodeficiency

Syndrome) can present with a wide range of signs and symptoms, which may vary from
person to person and can change over the course of the disease. It's important to note that not
everyone infected with HIV will immediately develop symptoms, and some individuals may
remain asymptomatic for many years. HIV progresses to AIDS when the immune system
becomes severely compromised. Here are some of the medical signs and symptoms
associated with HIV/AIDS:

Early HIV Infection (Acute HIV):

 Flu-like Symptoms: Within 2 to 4 weeks of initial infection, some people may
experience flu-like symptoms, which can include fever, chills, sore throat, swollen
lymph nodes, and fatigue.
 Rash: A rash, often on the trunk of the body, can develop during acute HIV infection.
 Muscle and Joint Pain: Muscle aches and joint pain are common during the early
stages of HIV infection.
 Oral Ulcers: Painful mouth sores and ulcers can occur.

Asymptomatic Stage:
 No Symptoms: Many people with HIV do not experience any noticeable symptoms
during this stage, which can last for several years or longer.

Advanced HIV Infection:

 Persistent Swollen Lymph Nodes: Swollen lymph nodes, particularly in the neck,
armpits, and groin, can be a sign of ongoing immune system activation.
 Frequent Infections: Recurrent or severe infections, such as pneumonia, tuberculosis
(TB), or fungal infections, can occur due to a weakened immune system.
 Chronic Diarrhea: Prolonged diarrhea that is difficult to treat may develop.
 Weight Loss: Unexplained and unintentional weight loss is common in advanced
HIV/AIDS.
 Fatigue: Profound fatigue and weakness may be present.
 Skin Problems: Skin issues like rashes, skin lesions, and fungal infections can become
more common.

AIDS-Defining Illnesses:
 Opportunistic Infections: Individuals with AIDS are highly susceptible to
opportunistic infections, including Pneumocystis jirovecii pneumonia (PCP),
cryptococcal meningitis, cytomegalovirus (CMV) infection, and Mycobacterium
avium complex (MAC) infection, among others.
 Cancers: Certain cancers, such as Kaposi's sarcoma, non-Hodgkin lymphoma, and
invasive cervical cancer, are considered AIDS-defining conditions.
 Neurological Symptoms: Advanced HIV infection can lead to cognitive impairment,
memory problems, and neurological symptoms.

It's important to emphasize that not all individuals with HIV will progress to AIDS,
especially with early diagnosis and appropriate antiretroviral therapy (ART). Regular medical
check-ups, monitoring of CD4+ T cell counts and viral load, and adherence to treatment are
critical for managing HIV and preventing the progression to AIDS. If you suspect you may
have been exposed to HIV or are experiencing symptoms related to HIV/AIDS, seek medical
advice and testing promptly.
 MOTHER TO CHILD TRANSMISSION OF INFECTIONS

Mother-to-child transmission (MTCT) of infections, also known as vertical transmission,

refers to the transmission of infectious agents from a pregnant person (mother) to their
unborn child (fetus or newborn) during pregnancy, childbirth, or breastfeeding. This
transmission can occur in various ways, depending on the specific infection.

Routes of Transmission:
 In Utero (During Pregnancy): Some infections can cross the placenta, infecting the
fetus while it is still in the womb. This can occur with HIV, rubella, and
toxoplasmosis, among others.
 During Childbirth (Perinatal): Infections may be transmitted during the process of
childbirth, especially if the baby comes into contact with the mother's infected blood
or genital secretions. HIV and hepatitis B are examples of infections that can be
transmitted perinatally.
 Postnatally (Through Breastfeeding): Some infections, such as HIV and CMV
(Cytomegalovirus), can be transmitted through breastfeeding if the mother is infected.
However, the risk can often be mitigated with antiretroviral therapy for HIV or other
preventive measures.

In summary, mother-to-child transmission of infections refers to the transmission of various

infectious agents from an infected pregnant person to their unborn child.
METHODS OF PREVENTION OF MOTHER TO CHILD
TRANSMISSION OF HIV/AIDS

Results from recent studies are discussed under subtopics of various prevention methods used
in PMTCT in three phases of pregnancy. Though practice differ from country to country, the
general recommendations for both the developed and developing and resource restrained
settings are discussed. However it is im- portant to note that MTC of HIV-1 may happen at
any time of pregnancy, hence an understanding of the time and mechanisms of transmission
is crucial for de- signing intervention strategies.

•Prevention before delivery:

In the pre-delivery phase of pregnancy, the use of ARTs is the major way of re- ducing
MTCTs. Treatment of women and their children with antiretroviral during the course of
pregnancy and breastfeeding has dramatically lowered the risk of MTCT, by reducing
maternal viral burden and by providing prophylaxis to the infant.
There is a positive link between maternal prenatal viral load and the risk of both in utero
and intrapartum transmission. (Milligan & Overbaugh 2014, Chap- pell& Cohn 2014.). ARV
drugs suppress viral replication in the body assisting the individual's immune system to
strengthen and regain the capacity to fight-off in- fections.
WHO recommends that, antiretroviral treatment should begin as soon after diagnosis as
possible for those who are HIV infected (see appendix 4). Providing ART to all pregnant and
breast feeding women living with HIV serves three synergistic purposes: improving
individual health outcomes, preventing MTCT of HIV, preventing the horizontal transmission
of HIV from the mother to an uninfected sexual partner (WHO 2015).
ARVs also decrease viral mutations and can reduce mother-to-child transmission of HIV
either by lowering plasma viral load in the mother and providing post-ex- posure prophylaxis
for the newborn. Initially, monotherapy which is the use of a single antiretroviral agent
usually consisting of single-dose Nevirapine providedto the mother and infant near birth
could decrease transmission by half, presum- ably by reducing both intrapartum (during
labor/delivery) and early breast milk infections.(Milligan & Overbaugh 2014.)

•Prevention during delivery:

Elective caesarean section (ECS) before the onset of labour has decreased the risk of
HIV transmission by approximately 50% (Navéér et al. 2011). ECS reduces MTCT rates by
preventing the neonate from coming into direct contact with in- fected maternal fluids and
secretions during labour since the majority of HIV transmission appears to occur near or at
the time of delivery when foetal expo- sure to maternal body fluids is most likely. (Madger et
al. 2005).
The recommen- dation is that ECS is carried out before the mother goes into labour and
mem- brane rupture and this is to take place at 2-3 weeks before expected date of de- livery.
All ARTs should still be taken in regular doses before the operation and antibiotic
prophylaxis is same as in non HIV infected mothers (Navéér et al. 2011)
ECS is beneficial compared to vaginal delivery because the risk of transmission may
increase during complicated vaginal delivery, for instance when instrumental procedures are
necessary, when labour is prolonged, or when a long time passes between the rupture of the
membranes and delivery. These complications are more common in first time deliveries.
Practicalities such as the possibility of prior planning, daytime delivery and the availability of
experienced staff, are factors in favour of an elective caesarean section (Navéér et al. 2011).
Vaginal delivery is not recommended for HIV infected mothers however given the cost
and risk of complications such as thrombosis, infection and hemorrhage in- volved in any
major operation, and the lack of resources to manage such compli- cations especially in
developing countries, the routine use of caesarean sections may not provide an increase
benefit when post-operational mortality rates are taken into account In such inevitable cases
ways to increase the safety of vaginal birth are of particular relevance.
The requirement is that the mother should have no history of previous uncomplicated
vaginal deliveries, and should be on a well- functioning antiretroviral treatment, with
undetectable viral load and no obstetric risk factors.

•Prevention after delivery:

WHO recommends all mothers, regardless of their HIV status to practice Exclu- sive
breastfeeding( EBF) ́ ́which means no other liquids or food are given – in the first six months
of life to achieve optimal growth, development, and health’’.

Thereafter infants should receive nutritionally adequate and safe complementary foods
while breastfeeding continues up to 24 months or beyond. However, given the need to reduce
the risk of HIV transmission to infants and minimizing the risk of other causes of morbidity
and mortality, the guidelines also state that “when replacement feeding is acceptable,
feasible, affordable, sustainable, and safe”, Exclusive Formula Feeding (EFF) which implies
avoidance of breastfeeding by HIV-infected mothers is recommended.(WHO 2010.) Hence in
the developed countries where healthy and affordable replacement formula feeding is
available

HIV positive mothers are strongly counselled not to breastfeed their infants. Thus infants
are fed with formula milk or donated breast milk while at the same time the mother receives
anti-lactation medication. This seems to be the surest way to prevent infants from contacting
maternal virus in breastmilk.(HIV tukikeskus 2015.)
 ROLES OF NURSES IN THE PREVENTION OF MOTHER TO
CHILD TRANSMISSION OF HIV/AIDS IN PERINATAL CARE

Nurses play a vital role in the prevention of mother-to-child transmission (PMTCT) of

HIV/AIDS in perinatal care. Their involvement is crucial in ensuring the well-being of both
the pregnant individual living with HIV and their unborn child. Here are key roles that nurses
undertake in PMTCT:

1. Antenatal Counseling and Education:

 Nurses provide education and counseling to pregnant individuals about
HIV/AIDS, its transmission, treatment, and the importance of PMTCT
interventions.
 They ensure that expectant mothers understand the significance of HIV testing
during pregnancy and the potential risks to their infants if they are HIV-
positive.

2. HIV Testing and Counseling:

 Nurses administer HIV tests during prenatal care visits and encourage routine
testing for all pregnant individuals.
 They provide pre-test and post-test counseling to address concerns, discuss
results, and help patients make informed decisions.

3. Initiating Antiretroviral Therapy (ART):

 Nurses play a key role in ensuring that HIV-positive pregnant individuals are
initiated on ART promptly and adhere to the prescribed treatment regimen.
 They monitor medication adherence and educate patients about the importance
of taking medications consistently to suppress the virus

4. Monitoring Viral Load and CD4 Counts:

 Nurses assist in regular monitoring of viral load and CD4 counts to assess the
effectiveness of ART.
 They ensure that any necessary adjustments to treatment are made to maintain
viral suppression.

5. Promoting Safe Practices During Pregnancy and Childbirth:

 Nurses educate HIV-positive pregnant individuals about safer delivery
practices, such as elective cesarean sections if indicated, to reduce the risk of
transmission during childbirth.
 They emphasize the importance of following healthcare recommendations to
minimize exposure to HIV.

6. Administering Prophylactic Medications:

 Nurses may administer prophylactic medications such as antiretroviral drugs
or antibiotics to the newborn immediately after birth to further reduce the risk
of transmission.

7. Breastfeeding Counseling:
 Nurses provide guidance on infant feeding options, taking into consideration
the mother's HIV status, national guidelines, and available resources.
  They support mothers in making informed choices regarding breastfeeding
and alternative feeding methods.

8. Promoting Family-Centered Care:

 Nurses encourage involvement of partners and family members in the PMTCT
process, including HIV testing and counseling, to create a supportive
environment.
 They address any social and cultural factors that may affect adherence to
PMTCT interventions.

9. Follow-Up Care for Mother and Child:

 Nurses ensure that both the mother and newborn receive regular follow-up
care to monitor their health and well-being.
 They provide ongoing support, counseling, and guidance to promote
adherence to treatment and infant care practices.

10. Data Collection and Reporting:

 Nurses maintain accurate records of PMTCT interventions and outcomes to
contribute to healthcare system data and improve program effectiveness.
 They report cases to relevant authorities as required by healthcare regulations.

Nurses are at the forefront of PMTCT efforts, working closely with other healthcare
professionals to ensure that pregnant individuals living with HIV receive comprehensive care
and support. Their dedication and expertise are instrumental in reducing the risk of mother-
to-child transmission and improving the health outcomes of both mothers and their infants.
 CONCLUSION

In conclusion, the prevention of mother-to-child transmission (PMTCT) of HIV/AIDS is

a critical component of comprehensive healthcare for pregnant individuals living with HIV.
This multifaceted approach involves healthcare providers from various disciplines, with
nurses playing a central and indispensable role in perinatal care.
Their responsibilities in PMTCT are not only pivotal but also life-saving, contributing
significantly to the well-being of both the mother and the newborn.
Nurses are the frontline caregivers who offer guidance, education, and emotional support to
pregnant individuals throughout their journey from prenatal care to childbirth and postnatal
care.
Their responsibilities encompass antenatal counseling and education, HIV testing and
counseling, initiation and monitoring of antiretroviral therapy (ART), safe delivery practices,
administration of prophylactic medications to the newborn, breastfeeding counseling, and
ongoing follow-up care for mother and child.
Nurses facilitate informed decision-making, promote adherence to treatment regimens,
and create a supportive and non-judgmental environment for expectant mothers living with
HIV. Their commitment to family-centered care ensures that partners and family members
are engaged, making PMTCT a collective effort.
In addition to their direct patient care roles, nurses are diligent record-keepers, ensuring
that accurate data on PMTCT interventions and outcomes are maintained and reported. This
data is instrumental in evaluating program effectiveness and guiding future improvements in
PMTCT strategies.
The responsibilities of nurses in perinatal care extend beyond clinical tasks; they encompass
compassion, empathy, and a deep commitment to the health and well-being of their patients.
Through their dedication, expertise, and tireless efforts, nurses contribute significantly to
the global goal of reducing mother-to-child transmission of HIV/AIDS, ultimately helping to
create healthier, brighter futures for both mothers and their newborns. Their role in PMTCT
exemplifies the profound impact that healthcare professionals can have on the lives of those
affected by this challenging but preventable health issue.
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