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Breastfeeding Issues, RX If Mother N Baby in Hiv
Breastfeeding Issues, RX If Mother N Baby in Hiv
LESSON PLAN
ON
COUNSELLING: BREASTFEEDING ISSUES,
PROPHYLAXIS FOR MOTHER AND BABY IN HIV/AIDS
Submitted on – 18/04/2021
IDENTIFICATION DATA
TOPIC - COUNSELLING: BREASTFEEDING ISSUES, PROPHYLAXIS FOR MOTHER AND CHILD IN HIV/AIDS.
SIZE OF GROUP - 5
DURATION - 45 MINUTES
PREVIOUS KNOWLEDGE OF THE STUDENTS: - Students have prior knowledge about the topic “COUNSELLING: BREASTFEEDING
ISSUES, PROPHYLAXIS FOR MOTHER AND CHILD IN HIV/AIDS ” from their B Sc Nursing program as well as from clinical experience gained
during M Sc Nursing.
1
GENERAL OBJECTIVE: - At the end of the teaching, students will be able to gain knowledge regarding the topic “COUNSELLING:
BREASTFEEDING ISSUES, PROPHYLAXIS FOR MOTHER AND CHILD IN HIV/AIDS.”
Student teacher’s point of view-After the session the student teacher will be able to refine skill of teaching and will acquire depth
knowledge.
SPECIFIC OBJECTIVES: - At the end of the teaching students will be able to:-
To introduce the topic
To announce the
topic To define
HIV/AIDS
To describe the incidence of HIV/AIDS in neonates
To describe the pathophysiology of HIV/AIDS
To explain about the care and assessment of HIV infected pregnant women.
To describe the initial assessment of HIV infected pregnant women.
To explain about the criteria for ART Initiation.
To discuss about the indications for CPT in pregnancy
To explain about ART for HIV infected pregnant women.
To discuss about the principles of management in ART Treatment.
To discuss about the ART regimen for pregnant women having prior exposure to NNRTIs
To discuss about the ART in pregnant women already receiving the ART
To explain about ARV Prophylaxis for infants ART in pregnant women already receiving the
ART.
To explain about the CPT for infants
2
To discuss about the interventions for women diagnosed with HIV infection in labour and
postpartum.
To explain about the intrapartum management in HIV infected pregnant women.
To describe about the care during the postnatal period
To explain about the infant feeding practices
To describe about the principles of infant feeding for HIV infected pregnant women
To discuss about the counsel and follow- up mother- baby pair after discharge
to discuss about few research
articles to conclude the topic.
3
S. SPECIFIC OBJECTIVE TIME CONTENT
No. TEACHING LEARNING ACTIVITY AV AIDS EVALUATION
4
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
3 To define 1 DEFINITION OF HIV/AIDS. Student teacher PPT Define HIV/AIDS
HIV/AIDS min The HUMAN IMMUNODEFICIENCY VIRUS (HIV) targets cells of the will be able to
immune system, called CD4 cells, which help the body respond to define HIV/AIDS.
infection. Within the CD4 cell, HIV replicates and in turn, damages
and destroys the cell. Without effective treatment of a combination
of antiretroviral (ARV) drugs, the immune system will become
weakened to the point that it can no longer fight infection and
disease.
ACCORDING TO WHO
Children living with HIV continue to be left behind by the global AIDS
response. In 2019, only 53% (950 000) of the 1.8 million children living
with HIV (aged 0–14 years) globally were diagnosed and on treatment,
compared to 68% of adults. The remaining 850 000 children living with
HIV have not been diagnosed and are not receiving life-saving HIV
treatment. Two thirds of the missing children are aged 5–14 years and
do not routinely attend traditional health facilities. Engaging
communities and the families of people living with HIV, tuberculosis and
other related diseases and offering family services are needed in order
to find and start on treatment those missing children.
Summary of Maternal ART (Life Long) and Infant ARV Prophylaxis for
Different Clinical Scenarios
7
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
HIV infected pregnant women require joint management from both the HIV
care team (for her HIV condition) and the Obstetric team (for successful
outcomes of pregnancy). HIV infected pregnant women require all
components of good antenatal care, including iron-folate supplementation,
anaemia management, baseline CD4 count, screening of TB, prevention and
management of OIs, STI treatment, special Obstetric practices especially
during labour and delivery, ART initiation and its continuation, counselling for
infant feeding options, post natal care, follow-up, family planning and
contraception. Postpartum care and follow-up for the well- being of mother
and infant, as well as adherence to ART and other care, to prevent HIV
transmission during breastfeeding is important.
8
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
9
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
o Double the dose if anaemia persists.
Counselling on nutrition, rest, warning signs, ART linkages-CD4 testing
if HIV positive and ART, birth planning, institutional delivery, exclusive
breastfeeding within an hour of delivery, safe sex, HIV-specific advice and
contraception.
From the HIV care aspect for pregnant women, the initial assessment
follows standard adult ART guidelines including:
8 To explain 2 Criteria for ART Initiation Student teacher PPT What is criteria
about the mins will be able to for ART
criteria for ART Initiation of ART in pregnant women needs to be done at the earliest explain about Initiation?
Initiation. and after adequate treatment preparedness for adherence to the criteria for
maintain her own health and also to prevent HIV virus transmission to ART Initiation.
the unborn baby.
In HIV infected pregnant women the dictum should be “do not delay ART
initiation”. The eligibility criteria for initiating ART in HIV positive pregnant
women are as below:
Initiate lifelong ART in all pregnant women with confirmed HIV
11
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
infection regardless of WHO clinical stage or CD4 cell count. TDF +
3TC + EFV is recommended as first-line ART in pregnant and
breastfeeding women, (including pregnant women in the first
trimesterofpregnancyandwomen of childbearing age).
StartingCo-trimoxazoleinpregnancy
Co-trimoxazole should be started if CD4 count is ≤ 250 cells/mm3 and
continued through pregnancy, delivery and breastfeeding as per
national guidelines (Dose: Double strength tablet – 1 tab daily).
Ensure that pregnantwomen take theirfolate supplementsregularly.
10 To explain 3 ART FOR HIV INFECTED PREGNANT Student teacher PPT What are the
about ART for mins will be able to ART treatment in
HIV infected
WOMEN discuss ART for HIV infected
pregnant All HIV infected pregnant women (irrespective of CD4 count/Clinical HIV infected pregnant
women. stage) should receive lifelong ART. pregnant women?
women.
This treatment serves two key purposes:
12
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
There are several regimens recommended for use as first-line ART regimen for
adults in India.
However,incaseofHIVinfectedpregnantwomenrequiringART,the
recommendedfirst-lineregimenis Tenofovir (TDF) (300 mgs) + Lamuvidine
(3TC) (300 mg) + Efavirenz (EFV) (600 mg).
13
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
First line ART for pregnant and breastfeeding women and ARV drugs for
their infants
14
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
12 To discuss about 1 ARTRegimen for Pregnant Women having PriorExposureto NNRTIs Student teacher PPT What are ART
the ART regimen min will be able to regimen for
for PPTCT
for pregnant discuss ART pregnant women
women having HIV infected pregnant women who have had previous exposure to Sd regimen for having prior
prior exposure NVP (or EFV) for PPTCT prophylaxis in prior pregnancies, an NNRTI- pregnant exposure to
to NNRTIs based ART regimen such as TDF+3TC+EFV may not be fully effective women having NNRTIs ?
prior exposure
due to persistence of archived mutation to NNRTIs. Thus, these women
to NNRTIs
will require a protease-inhibitor based ART regimen viz:
16
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
17
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
decreases during pregnancy. After delivery,body fluidchanges normalise
to the non-pregnant state, and CD4 levels may rise by 50-100 cells/ul.
Therefore, a decrease in absolute CD4 count in a pregnant woman
receiving ART in comparison to CD4 values prior to pregnancy may
not necessarily indicate immunologic decline and should be
interpreted with caution
18
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
19
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
14 To explain 4 ARV PROPHYLAXIS FOR INFANTS BORN TO MOTHERS RECEIVING LIFE- Student teacher PPT explain about
about ARV mins LONG ART will be able to ARV Prophylaxis
Prophylaxis for Infant ARV prophylaxis is required for all infants born to HIV infected women explain about for infants ART in
infants ART in receiving ART to further reduce pre-partum and postpartum HIV transmission, ARV Prophylaxis pregnant women
pregnant in addition to the protection received from the mother’s ART regimen. Infant for infants. already receiving
women already ARV prophylaxis provides added protection from early postpartum the ART.
transmission, particularly in situations where women started ART late in
receiving the
pregnancy, have less than optimal adherence to ART and have not achieved
ART.
full HIV viral suppression.
ARV prophylaxis to the infant must be given in accordance with the current
National PPTCT Guidelines. For all the exposed infants, Syp. NVP has to be
given for 6 weeks and these children have to be linked to the EID
programme. The ART provision shall depend on the result of EID.
The infant ARV prophylaxis where mothers are receiving ART is: Daily NVP for 6
weeks (i.e. till the first immunization visit for the infant), regardless of whether
the infant is exclusively breastfed or receives exclusive replacement feeding.
All Infants born to women who are receiving ART / maternal triple ARV
prophylaxis / who present directly-in-labor and receive intra partum ARV
prophylaxis should be started on daily NVP prophylaxis at birth and continue
for a minimum of 6 weeks (i.e., till the first immunization visit for the infant).
This regardless of whether the infant is exclusively breastfed or receives
replacement feeding it helps in reducing the risk of postpartum HIV
transmission.
Dose and Duration of Infant Daily NVP Prophylaxis
20
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
21
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
have passed since birth.
Daily infant NVP prophylaxis should continue for atleast 12 weeks,
by which time the mother should be linked to appropriate ART
services.
23
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
16 To discuss about 2 INTERVENTIONS FOR WOMEN Student teacher PPT What are the
the mins will be interventions for
intervensions
DIAGNOSED WITH HIV INFECTION IN able to women
for LABOUR AND POSTPARTUM explain diagnosed with
women There is a significant percentage of pregnant womenwith unknown HIV status about HIV infection in
diagnosed with
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TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
HIV infection presenting directly- in-labour for delivery (un-booked cases). Any pregnant the labour and
in labour and woman who presents in active labour with unknown HIV status should be intervent postpartum.
postpartum. offered the routine screening of HIV, with opt-out option as per National ions for
Guidelines. Screening usingWholeBloodFingerPrickTestinthe delivery/labour women
wardshould be undertaken
diagnose
Pregnant Women in Labour Who are Found Positive in HIV-
d with
screening Test should be
HIV
o Initiated on ART (TDF+3TC+EFV) immediately. infection
o ThenextdaytheCounsellorshouldvisitthepost-natalwardofferpre-test in labour
Counselling,counsel andadviseforexclusive breastfeedingforfirst and
6months, if shehas alreadystarted breastfeeds; if not she must be postpart
counselled on optionfor breast vs replacementfeeding but must adhere to um.
either exclusivebreastfeedingorexclusivereplacementfeedingthefirstsix
months.Thereafter,theLab techwillconfirmtheHIVstatusby3rapidanti-
bodytests.BloodsampleforCD4testingshallbe drawnof all HIV
confirmedcases by Labtech andS/he willpersonally carry the sample to
CD4 lab and bring the report along with a month’s supply of
ARTtaking her spouse or buddy along withher/himunder extreme
circumstances whenthepost-partum motherisunable to reach the ART
Centre within the next 2 days for Pre-ART Registration and Adherence
Counselling. However,sheshouldbe motivatedandfollowed-
upforensuring she reportsto the ARTCentre within 30 days. The ICTC
Counsellor and Lab Technician after confirming her status the next
daywillensureno
interruptioninthecontinuationARToncethefirstdosewasgiventothe HIV
positive pregnant womenin the labour-room and the nextday in the
post-natal ward.
The broad principle is “as far as possible direct-in-labour women must
be seen by ART Medical Officer” at the earliest opportunity but this
should not lead to delaying in ART initiation. All efforts should be
made that at
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TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
least she is seen by the facility Medical Officer.
Womenwho are screened and found HIVInfected during labour or
justafter delivery should be given a Top Priority for Clinical Management
and CD4 Assessment in the ART Centre.
Protocol for Women Presenting Directly-in-Labour (Unbooked Cases)
26
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
intra partum ART and regularly thereafter, should be started on daily
NVP prophylaxis at birth and continued for a minimum of 6 weeks.
These needs to be extended to 12 weeks as mother has not received
adequate duration of ART to suppress viral replication. However, EID
should be carried out at 6 weeks as per guidelines.
ARV Prophylaxis for Infants Born to Women who did not
Receive Any ART (Home Delivery)
Incaseof infants who areborn to HIV infected mothers who did not
receive any antenatal or pre-partum ART, or in cases where maternal
HIV infection is detected after the birth ofthe infant (home delivery):
o InfantsshouldbestartedondailySyNVPprophylaxisattheirfirstcontact
withhealthservices.
o DailyinfantNVP prophylaxiscanbe startedevenifmore than72hours
have passedsince birth.
17 To explain 3 Labour and delivery in the HIV infected Student teacher PPT What are the
about the mins will be able to interventions for
intrapartum
pregnant women explain intrapartum
management in Intra-partum Management intrapartum management in
HIV infected
27
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
pregnant The women’s sero-status should be recorded in the RCH/MCH Card (Antenatal management in HIV infected
women. card) and maternity register. Health care workers should check the woman’s HIV HIV infected women ?
status and details of the ART drugs during pregnancy. If her HIV status is unknown women.
and she is in the first stage of labour, offer HIV counselling andtesting using Whole
Blood Finger PrickTesting.Iffound positive, sheshould beadministered the first dose of
ARTandadvisedforconfirmationofteststhroughICTCCounsellorandLabtechnicianthe
followingday.Sheshould be counselled onExclusive Breast Feeds (EPF) tothe babyforthe
first six months andthe babyshould begivenSy Niverapine for a minimum of 6 weeks
and another 6 weeks continuation if need be.
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TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
being post-partum fever.
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TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
Avoid routine episiotomy as far as possible.
Suctioning the newborn with a nasogastric tube should be
avoided unless there ismeconium staining of the liquor.
18 To describe 3 Care during the postnatal period Student teacher PPT What are the
about the care mins will be able to interventions for
during the Within an Hour of Delivery describe about the HIV infected
postnatal period the care during women during
Infants born to HIV-infected mothers should receive NVP prophylaxis the postnatal the postnatal
immediately after birth. period women ?
Infants after delivery should be put on the mother’s abdomen for skin
contact to be established which helps in bonding and maintenance of
baby’s body temperature as well as helps initiation of breast milkwithin 1 hour
of birth.
Infants should be given exclusive breastfeeds for the first six months
preferably. Exclusive replacement feeding may be done only if the mother
has died or has a terminal illness or decides not to breastfeed despite
adequate counselling. (See chapter 11 for updated guidelines on infant
feeding).
If the mother has not made a decision about feeding yet, she should be counselled to
give exclusive breastfeeds for the first 6 months which is the preferred option,
followed by complementary feeds after 6 months. No abrupt weaning to be done
after6months.
Counsel and support parent to give infant NVP prophylaxis using the
syringe/dropperprovided.
Emphasize on washing the equipment with clean boiled water after every use.
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TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
between 18 months to 2 years when baby’s survival has been
ensured).
Post-partumFollow-upandCareExtendsBeyondtheSix-weeks
PostpartumPeriodandIncludes:
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TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
despite following any other Family Planning Method (Dual
Protection).
19 To explain about 2 INFANT FEEDING PRACTICES Student teacher PPT What are the
the infant mins (EXCLUSIVE BREASTFEEDING OR EXCLUSIVE REPLACEMENT FEEDING) will be able to infant feeding
feeding practices Support exclusive breastfeeding for a minimum period of 6 months and explain about practices in HIV
continuation of breastfeeds for 1 year in EID negative babies, and up to 2 years the infant AIDS newborn?
in EID positive babies with initiation of Pediatric ART. Weaning foods should be feeding
introduced from 6 months onwards in all babies whether breast fed or practices
replacement feeds fed.
The infant feeding guidelines for HIV-exposed and infected infants age 0 to 6
months has been up dated in 2011. After 6 months of age, complementary
foods should be introduced just like for other infants of this age
Recommendations for infant feeding in HIV exposed and infected
infants < 6 months of age
The 2011 National Guidelines on Feeding for HIV-exposed and infected infants
< 6 months old recommends:
Exclusive breastfeeding for at least 6 months.
Only in situations where breastfeeding cannot be done (maternal
death, severe maternal illness) or individual mother’s choice (at her
own risk), then exclusive replacement feeding may be considered.
Exclusive breastfeeding is the preferred feeding option for HIV-
exposed infants LESS THAN 6 months of age. However, it is recognized
that for some women, breastfeeding may not be possible – for
example in situations of maternal death and severe maternal illness in
which case Exclusive Replacement Feeding should be done only when
AFASS criteria is fulfilled:
AFASS criteria for Exclusive Replacement Feeding
Mothers known to be HIV-infected, if insist on opting for exclusive
33
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
replacement feeding which is contrary to the WHO/NACO’s guidelines
of giving exclusive breastfeeds for first 6 months, are doing so at their
own risk. They should be counselled not to give any breast feeds
during the first six months. MIXED FEEDING should NOT be done
during the first 6 months. (Feeding a baby with both breast feeds and
replacement feeds in the first 6 months is known as mixed feeding
which leads to mucosal abrasions in the gut of the baby facilitating HIV
virus entry through these abrasions).
When opting for Exclusive Replacement Feeding, they should fulfil the AFASS
criteria given below-
Safe water and sanitation are assured at the household level and in
the community, and can prepare clean feeds.
The mother or other caregiver can reliably afford to provide sufficient
replacement feeding (milk), to support normal growth and
development of the infant, and can sustain it un-interruptedly for
first 6 months at least.
The mother or caregiver can prepare it frequently enough in a clean
manner so that it is safe and carries a low risk of diarrhoea and
malnutrition.
The mother or caregiver can, in the first six months exclusively
give replacement feeding, and is feasible.
The family is supportive of this practice, and accepts it without
forcing her to breastfeed during the first 6 months.
34
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
For breastfeeding infants diagnosed HIV negative, breastfeeding
should be continued until 12 months of age ensuring the mother is
on ART as soon as possible.
The EID is repeated for the 3rd time (when previous 2 EIDs have been
negative) after 6 weeks of stopping breast feeds, repeat EID i.e., Rapid
test followed by DBS (if Rapid Test turns positive) send DBS test. If DBS
is positive, do a WBS test. If WBS test is positive, Paediatric ART
should be initiated in ART centre. However, confirmation test for HIV
has to be done at 18 months using 3 Rapid Tests for all babies
irrespective of the earlier EID status or the fact that Paediatric ART has
already been initiated.
For breastfeeding infants who have been diagnosed HIV positive,
paediatric ART should be started and breastfeeding to be
continued ideally until the baby is 2 years old.
Breastfeeding should stop once a nutritionally adequate and safe diet
without breast milk can be provided.
Breastfeeding shout NOT be stopped ABRUPTLY.
Points to be Followed for Babies on EBF
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No. OBJECTIVE TIME CONTENT ACTIVITY
36
TEACHING AV EVALUATION
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No. OBJECTIVE TIME CONTENT ACTIVITY
according to comfort level of mother and infant.
In situations where women opt for replacement feeding or where
breastfeeding is not possible (maternal death or sickness), two options
are available:
1. Locally available animal milk (unmodified)
2. Commercial infant feeding formula.
20 To describe 2 Student teacher PPT What do you
about the min Principles of Infant Feeding for HIV will be able to know about the
principles of Infected Pregnant Women describe about principles of
infant feeding The 10 principles of infant feeding options for HIV infected pregnant the principles of infant feeding for
for HIV infected women and their infants are: infant feeding HIV infected
pregnant for HIV infected pregnant women
women 1. All HIV infected pregnant women should have PPTCT pregnant ?
interventions provided early in pregnancy as far as possible.
women
2. Exclusive breastfeeding is the recommended infant feeding choice in
the first 6 months, irrespective of the fact that mother is on ART
early or infant is provided with ARV prophylaxis for 6 weeks.
3. MIXED FEEDING SHOULD NOT BE DONE AT ANY COST WITHIN THE
FIRST 6 MONTHS (Feeding breast-feeds and replacement feeds
simultaneously in the first 6 months).
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TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
breastfeeding (remember it is lifelong ART for the mother).
6. For breastfeeding infants diagnosed HIV negative, breastfeeding
should be continued until 12 months of age ensuring the mother
is on ART as soon as possible.
7. The EID is repeated for the 3rd time (when previous 2 EIDs have
been negative) after 6 weeks of stopping breast feeds, repeat
EID i.e., Rapid test followed by DBS (if Rapid Test turns
positive) send DBS test. If DBS is positive, do a WBS test. If WBS
test is positive, Paediatric ART should be initiated in ART
centre. However, confirmation test for HIV has to be done at 18
months using 3 Rapid Tests for all babies irrespective of the
earlier EID status or the fact that Paediatric ART has already
been initiated.
38
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
ART.
4. Counsel motherto have adequate rest,nutrition and to take iron-
folate during the lactation period, ensure enough proteins and fluids
in the diet.
5. Familysupport: involvehusband andfamilymembers
tohelpoutwithbaby caresothatshecan rest and recuperate, and to
remind her of her ART and infant ARVprophylaxis.
6. Counsel mother for her post-natal checkup at 6 weeks to
coincide with the infant’s first immunization visit.
7. Discuss and ensure contraception Copper-T( Cu-T) insertion and
condom use as dual protection at subsequent visits.4
8. Arrange forthe mother on ARTto be followed with the ARTCentre.
9. ANMs/ASHAs/Counsellors/ORWswillfollow-upthemotherandbaby
withinaweekofdischarge formother’sprogress,supportinfant feeding
practice,ensureadherencetoinfant NVPprophylaxis at home, general
counselling advice and infant follow-up.
Counselling for Issues of Infant to the Parents/ Caregivers:
39
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
6. Stop NVP prophylaxis at 6 weeks for babies given exclusive
replacement feeding. Infants who are diagnosed DBS positive, are to
be referred to the ART Centre for Whole Blood Specimen (WBS)
collection. If WBS is also positive, then the infant will be initiated on
Paediatric ART,irrespective of CD4 %.
40
TEACHING AV EVALUATION
S. SPECIFIC LEARNING AIDS
No. OBJECTIVE TIME CONTENT ACTIVITY
Results: Results revealed undetectable levels of viral load in 58.3
per cent of women with ART compared to 30.7 per cent of women
with PT. No women on ART had viral load more than 10,000
copies/ml, whereas seven (26.9%, P=0.07) women receiving PT had
this viral load. Median CD4 count of women on PT (483 cells/μl)
was high compared to the women on ART (289 cells/ μl). At the
end of 18 months follow up, only two children were HIV positive,
whose mothers were on PT. One had in utero transmission;
infection detected within 48 h of delivery, while the other child was
infected post partum as HIV was detected at six months follow up.
41
TEACHING AV EVALUATION
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23 To conclude 2 CONCLUSION
the topic mins
All pregnant women should be tested for HIV as early as possible in
pregnancy. Repeat testing is recommended in the third trimester for
pregnant women with initial negative tests who are known to be at risk
of acquiring HIV.
42
BIBLIOGRAPHY
John P. Cloherty, MANUAL OF NEONATAL CARE, 7th edition,Lippincott publication, page no: 622-624.
Lange,Neonatology management, procedures,on call problems,diseases and drugs, 5th edition, page no: 711-715.
Ghai O.P etal, Ghai essentials of paediatrics, 6th edition, page no: 220-225.
Wong L. Donna etal, Wong’s essentials of paediatric Nursing, 6th edition, page no: 1019-1024.
NET REFERENCES
https://bestpractice.bmj.com/topics/en-gb/556
WHO
https://www.who.int/hiv/pub/guidelines/arv2013/art/artpregnantwomen/en/#:~:text=Infants%20of%20mothers%20w ho%20are,or
%20twice%2Ddaily%20AZT).
NACO PTTCT
https://www.who.int/hiv/pub/guidelines/arv2013/art/artpregnantwomen/en/#:~:text=Infants%20of%20mothers%20w ho%20are,or
%20twice%2Ddaily%20AZT).
43