Measures to interrupt mother-to-child transmission of HIV
Measures to interrupt mother-to-child transmission of HIV include the following.
(i) Prevention of HIV infection in pregnant women
(ii) Early detection of HIV-infected pregnant women
(c) Establishing an effective health care delivery system
(iv) Contraceptive and reproductive health services
(v) Informed consent for termination of pregnancy or sterilization of pregnant HIV-infected women
(vi) Interventional treatment (pharmacological interruption)
(vii) Behavioral interventions (partner reduction, condom use, drug treatment, etc.)
(viii) Obstetric interventions (avoidance of invasive procedures)
(ix) Change in feeding practices
(i) Prevention of HIV infection in pregnant women
Premarital medical examination should be done for HIV antibody testing, especially in areas with high HIV prevalence and among key populations. If one partner is found to be infected with HIV, they should be advised to avoid pregnancy. After marriage, couples should practice safe sex and refrain from drug use. HIV antibody testing should also be done before preparing for pregnancy and during the perinatal period.
(2) Early detection of HIV infection and provision of HIV Voluntary Counseling & Testing (VCT) services
For women taking steps to reduce mother-to-child transmission, they need to know and accept their HIV status.
Widespread availability of acceptable VCT and HIV testing services is important for identifying women who need antiretroviral treatment. Ideally, everyone should be able to take advantage of these services. People who know they are infected are likely to be motivated to be mindful of their health and thus change their behaviors and lifestyles and seek early medical care. They are able to make informed choices about sex, childbirth and infant feeding; they are able to take steps to protect partners who may not yet be infected. Those who test negative can be counseled on how to protect themselves and their children from infection, and help people recognize that there are more people in the community who are living with HIV but do not have any outward signs. It is important to emphasize that counseling and testing must be done with informed consent and confidentiality. Therefore, many countries, especially in areas with particularly high HIV prevalence, offer counseling and testing as part of programs to reduce mother-to-child transmission of HIV to all women receiving prenatal services (routine voluntary prenatal counseling and testing), etc.
In addition, it is important to prevent exclusion and discrimination against people living with HIV. In some places, women are reluctant or simply unlikely to take advantage of services offered to them, including VCT, if they fear discrimination, violent attacks, or even possible murder as a result of their infection. Therefore, special attention should be paid to fostering non-discriminatory attitudes among medical personnel toward HIV-infected patients and their families.
(iii) Establishing an effective health care delivery system to provide good health care services for mothers and infants
The provision of a wide range of good health care services to mothers and infants before, during, and after delivery, as well as counseling, reproductive health services, and medical care for HIV-infected women and their children, are part of the basic health care services. A good HIV mother-to-child interruption intervention program can only be ensured if the health care system is functioning effectively and can provide the above services.
Good health care services should be
● easy to seek care and protect personal privacy.
● services are standardized and fees are reasonable
● medical personnel do not discriminate against patients
● There is some continuity in the services provided
Smooth information exchange and easy referral between different medical, health care or management units.
The service quality can be constantly improved through frequent technical supervision and evaluation of the service status.
● The ability to listen to the needs and opinions of the people served, etc.
(iv) Contraception and reproductive health
HIV-infected women should avoid pregnancy as a fundamental measure to prevent mother-to-child transmission of HIV. The contraceptive methods provided should be safe, effective and voluntary.
(v) Termination of pregnancy or sterilization can prevent intrauterine transmission.
Pregnant women with HIV infection should be given individual medical guidance to practice contraception, abortion and induction of labor to terminate pregnancy or sterilization.
(vi) Interventional treatment
In recent years, it has become possible to interrupt mother-to-child transmission of HIV-1 through drugs, such as AZT long course therapy, or combination of drugs, long-term or short-term programs. The simple and inexpensive Nevirapine (NVP) monotherapy can be promoted for remote and rural areas. A joint Uganda/US study showed that a single dose of NVP administered separately to women in labor and newborns within 3 days of birth reduced perinatal transmission of HIV-1 by 47% at a total cost of less than $4.00. Many studies of AZT have been conducted in Thailand. For example, administering two anti-HIV drugs, AZT and 3TC, to mothers with diagnosed HIV infection after 34 weeks of pregnancy and continuing AZT to the newborn for one month after birth reduced the chance of mother-to-child transmission of HIV to 2.8% (AZT alone had an infection rate of 7% to 8%) at a cost of $43 per patient per month, reducing mother-to-child transmission by However, the effect of the intervention varies by drug regimen and feeding method (artificial feeding can be very safe in Thailand).
There is information that PMTCT rates range from 1 to 2 percent with combination prevention programs to 8 to 10 percent with general intervention programs. For example.
● Using a 1-month course of AZT, breastfeeding until 6 months of age, with an HIV-positive mother, the infant infection rate is usually 18%.
● With a 1-month AZT regimen, non-breastfeeding, and an HIV-positive mother, the rate of infection in the infant is usually 10%.
● Both AZT and 3TC given at the beginning of labor and continued to the newborn 1 week postpartum can reduce HIV infection to 11% in 6-week-old infants.
● HIV infection in breastfed 6-week-old infants can be reduced to 9% if the drugs are administered from 36 weeks of gestation until 1 week postpartum.
Therefore, drug intervention programs need to be developed based on maternal specificity and affordability, feasibility, efficacy and price of formulas, with attention to drug resistance issues. In China, the program of preventive application of antiretroviral drugs for HIV-infected pregnant women is free of charge: the recommended program is pregnancy + delivery + postpartum neonatal (zidovudine (AZT) + nevirapine (VELP, NVP) combination): that is, pregnant women take AZT 300 mg orally twice daily from 28 weeks of gestation until delivery, and AZT 300 mg orally every 3 hours during delivery until delivery. mg orally every 3 hours during labor until the end of labor; additional NVP 200 mg for the mother after delivery; NVP 2 mg/kg (or 0.2 ml/kg of suspension) for the infant within 72 hours after birth as a single dose, up to a maximum of 6 mg (or 0.6 ml of suspension); AZT 2 mg/kg for the newborn after birth, every 6 hours, if the mother has been on the drug for 4 weeks or more Infant dosed for 1 week; if maternal dosing is for less than 4 weeks, infant dosing should continue for 6 weeks.
In the absence of conditions or antiretroviral drugs during pregnancy/before delivery, a prophylactic regimen of a single dose of NVP 200 mg for the mother after delivery and a single dose of NVP 2 mg/kg (or 0.2 ml/kg in suspension) for the infant within 72 hours of birth is used.
When choosing the drug regimen for prevention of mother-to-child transmission of HIV, the maternal self, whether the maternal and husband have used antiretroviral drugs in the past and the duration of drug use, possible drug resistance and toxic side effects should be fully considered.
(vii) Behavioral interventions
Both pregnant women and their husbands should adopt safe sex practices, reduce sexual partners, change poor lifestyle, detoxification, smoking cessation, personal hygiene, nutrition and rest, etc.
(viii) Obstetric interventions
The best way of delivery should be chosen, avoiding invasive operations, unnecessary lateral incision, forceps, etc. When needed, caesarean section, vaginal douche (which can flush out the virus), or vaginal douche with chlorhexidine during vaginal delivery can be used to prevent infection in the birth canal and to clean the newborn’s skin, nasal cavity, oral cavity in the ear, eye, trachea and stomach secretions as much as possible. Avoid blood transfusion as much as possible. Avoid cross-infection.
(ix) Changing feeding patterns
Changing feeding practices is a complex issue. Breastfeeding, once widely advocated as the best way to feed infants, has been a cornerstone of child health and survival strategies for the past 20 years and has played a major role in reducing infant mortality in many parts of the world. However, to reduce transmission due to breastfeeding, alternative feeding by avoiding breastfeeding, or breastfeeding for short periods of time, or heating and processing breast milk, or using milk, infant formula, etc. should be practiced as much as possible. A reasonable assessment of whether local alternative feeding conditions are safe needs to be made before deciding on alternative feeding. For example, is infant formula already available? Can a long-term supply of infant formula be ensured? Are qualified formula, milk substitutes, and feeding and sterilizing utensils consistently available? Do people have access to clean water and fuel for boiling? Are feeders adequately trained and equipped with appropriate hygiene knowledge and skills (including attention to personal hygiene, scientific preparation of milk and proper addition of complementary foods, cleaning and sterilizing bottles, etc.). Infant infections, malnutrition and death may occur if substitutes are not used properly, or if poor quality breast milk substitutes are used, or if qualified substitutes are not available for a long time. Therefore, alternative feeding can only be recommended if the conditions for alternative feeding are safe and secure.
In recent years, China has gained some experience in interrupting mother-to-child transmission. For example, in 2003, Beijing Ditan Hospital successfully interrupted mother-to-child transmission in two HIV-positive pregnant women by giving anti-HIV drugs to the pregnant women before delivery, choosing caesarean section, giving anti-HIV oral solution to the newborns within two hours after birth, and providing health education and counseling to the mothers and recommending artificial feeding.
In 2004, the Ministry of Health and the Ministry of Finance issued the Measures for the Administration of Free and Reduced Cost Drug Treatment for AIDS and Common Opportunistic Infections, which stipulates that “free mother-to-child interruption drugs and infant testing will be provided to HIV-infected pregnant women”, providing a reliable guarantee for the prevention of mother-to-child transmission of AIDS and mother-to-child interruption intervention.