Model Answer
0 min readIntroduction
Human Immunodeficiency Virus (HIV) infection remains a significant global public health concern, with mother-to-child transmission (MTCT) being a major route of pediatric HIV infection. Globally, an estimated 1.5 million children are living with HIV (UNAIDS, 2022 data). Effective interventions exist to reduce MTCT to less than 1%, but access and implementation remain challenges, particularly in resource-limited settings. India has made substantial progress in reducing MTCT rates through the implementation of the Prevention of Mother-to-Child Transmission (PMTCT) program, but continued efforts are crucial to achieve elimination. This answer will detail the measures employed to reduce MTCT of HIV.
Understanding Mother-to-Child Transmission (MTCT)
MTCT can occur during pregnancy, labor and delivery, or breastfeeding. The risk varies depending on viral load, immune status of the mother, and interventions implemented. The transmission risk is highest during delivery when the infant is exposed to maternal blood and vaginal fluids.
Measures to Reduce MTCT
1. Prevention of HIV Infection in Women of Reproductive Age
- Safe Sex Practices: Promoting consistent condom use and reducing risky sexual behaviors.
- Voluntary Counseling and Testing (VCT): Encouraging regular HIV testing for all women of reproductive age.
- Prevention of Sexual Violence: Addressing gender-based violence, which increases the risk of HIV acquisition.
2. Prevention of Unintended Pregnancies in HIV-Positive Women
- Family Planning Services: Providing access to a range of contraceptive methods, including long-acting reversible contraceptives (LARCs).
- Counseling on Reproductive Choices: Offering comprehensive counseling on the risks and benefits of pregnancy for HIV-positive women.
3. Interventions During Pregnancy and Delivery
- Antiretroviral Therapy (ART): This is the cornerstone of PMTCT. All pregnant women living with HIV should initiate ART regardless of CD4 count and continue lifelong. The WHO recommends a first-line regimen of tenofovir, lamivudine, and dolutegravir (TLD).
- Monitoring Viral Load: Regular viral load monitoring during pregnancy is crucial to assess ART effectiveness. Viral suppression (<50 copies/mL) significantly reduces transmission risk.
- Elective Cesarean Section: Recommended for women with a high viral load (≥1000 copies/mL) near delivery to minimize infant exposure during vaginal birth.
- Intrapartum ART Prophylaxis: Intravenous zidovudine (Zidovudine) can be administered during labor to further reduce transmission risk, especially in cases of incomplete viral suppression.
4. Postnatal Care for Mother and Child
- Continued ART for Mother: Lifelong ART for the mother is essential for her health and to prevent onward transmission.
- ART Prophylaxis for Infant: Infants born to HIV-positive mothers receive ART prophylaxis for a specified duration, typically 4-6 weeks, depending on the mother’s viral load and ART status.
- Infant HIV Testing: Infant HIV testing is performed using PCR (Polymerase Chain Reaction) at 4-6 weeks and again at 6 months to confirm HIV status.
- Safe Infant Feeding Practices: Exclusive breastfeeding is generally recommended for the first 6 months if the mother is on effective ART and virally suppressed. If viral suppression cannot be guaranteed, formula feeding is recommended.
- Monitoring and Follow-up: Regular monitoring of both mother and child is crucial to ensure adherence to ART and detect any potential complications.
The Indian PMTCT Program
India’s PMTCT program, launched in 2002 and strengthened over the years, provides free ART and testing services to pregnant women living with HIV. The program follows the WHO guidelines and has significantly reduced MTCT rates. The National AIDS Control Organisation (NACO) oversees the implementation of the program.
| Intervention | Details |
|---|---|
| HIV Testing in Pregnancy | Integrated into antenatal care (ANC) services; routine opt-out approach. |
| ART for Pregnant Women | Lifelong ART for all HIV-positive pregnant women, irrespective of CD4 count. |
| Infant Prophylaxis | Based on maternal viral load and ART status. |
| Infant HIV Testing | PCR testing at 4-6 weeks and 6 months. |
Conclusion
Reducing mother-to-child transmission of HIV requires a comprehensive and integrated approach encompassing prevention, testing, treatment, and ongoing care. The success of PMTCT programs hinges on early identification of HIV-positive pregnant women, prompt initiation of ART, adherence to treatment, and access to quality healthcare services. Continued investment in PMTCT programs, coupled with addressing social and economic determinants of health, is essential to achieve the global goal of eliminating MTCT of HIV and ensuring a healthy start for all children. Strengthening surveillance systems and addressing gaps in access to care, particularly in vulnerable populations, remain critical priorities.
Answer Length
This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.