MOTHER TO CHILD TRANSMISSION OF HIV

Approximately one-third of the women who are infected with HIV can pass it to their babies.

Cause

Time of transmission

  • During pregnancy (15-20%)
  • During time of labour and delivery (60%-70%)
  • After delivery through breast feeding (15%-20%)

Pre-disposing factors

  • High maternal viral load
  • Depleted maternal immunity (e.g. very low CD4 count)
  • Prolonged rupture of membranes
  • Intra-partum haemorrhage and invasive obstetrical procedures
  • If delivering twins, first twin is at higher risk of infection than second twin
  • Premature baby is at higher risk than term baby
  • Mixed feeding carries a higher risk than exclusive breastfeeding or use of replacement feeding

Investigations

  • Blood: HIV serological test
  • HIV DNA PCR testing of babies

Management

All HIV services for pregnant mothers are offered in the MCH clinic. After delivery, mother and baby will remain in the MCH postnatal clinic till HIV status of the child is confirmed, then they will be transferred to the general ART clinic.

The current policy aims at elimination of Mother-to-Child Transmission (eMTCT) through provision of a continuum of care with the following elements:

  • Primary HIV prevention for men, women and adolescents
  • Prevention of unintended pregnancies among women living with HIV
  • Prevention of HIV transmission from women living with HIV to their infants
  • Provision of treatment, care and support to ALL women infected with HIV, their children and their families.