27.2 HIV testing and counselling for PMTCT
In this section you will learn about the advantages and challenges of testing and counselling HIV-infected pregnant mothers. For pregnant women, knowing their HIV status may help them to make informed decisions about their pregnancy, in particular if they are identified as being HIV positive. Your role in this process is to inform them about the advantages of receiving ANC, HIV testing and counselling services at the health post. HIV-infected pregnant mothers will then be able to decide whether to receive appropriate and timely interventions to reduce the risk of HIV transmission to their unborn baby. The interventions available to them are described in Box 27.1.
Box 27.1 Interventions for PMTCT available in Ethiopia
Antiretroviral treatment/prophylaxis
If a pregnant mother is HIV positive, the risk of HIV transmission to her baby can be greatly reduced by administering a single ARV drug, or a combination of several drugs (these were introduced in Study Session 22). For the purposes of PMTCT, ART is taken for a short period between the end of pregnancy and at early postpartum time. It is possible that the HIV-infected mother is also eligible to start antiretroviral treatment (this depends on her clinical stage; WHO HIV clinical staging was introduced in Study Session 21).
Breastfeeding
Another route by which HIV can be transmitted to the infant is through breastmilk. One of your duties is to provide counselling on safe infant feeding, and this will be discussed further in Section 27.6.
Family planning
Family planning counselling for mothers who are HIVpositive is another means of preventing the transmission of HIV to their children. This is done through preventing unwanted pregnancies. You will be expected to counsel and inform pregnant mothers about family planning in the context of HIV.
An additional advantage of PMTCT includes the fact that the mother will receive education on the importance of giving birth in a setting where standard precautions for infection prevention and safer obstetric practices are implemented. This ensures safe delivery for the mother and her child, not only in the context of HIV/AIDS, but also in case other complications arise during labour.
PMTCT counselling and HIV testing also contributes to the prevention of HIV transmission between adults, by spreading information about HIV/AIDS amongst the community. Mothers who are HIV positive and continue to receive follow-up and ongoing healthcare for themselves and their HIV-exposed infant usually transmit this information to relatives and/or friends. In order to help with dissemination of information on HIV prevention, you should encourage mothers to disclose their status to partners and family members. In addition, this helps them to get support from their family, and reduces stigma and discrimination from other members of their community.
A supportive partner and family will have a positive effect on how a pregnant mother engages with PMTCT; improving the life outcomes for both the mother and her child.
As a health worker, you may come across pregnant women who are reluctant to undergo HIV testing and counselling for PMTCT. Indeed, when confronted with a life-changing situation (such as knowing your HIV status), women may take into account many personal and community-related factors before making a decision on whether to take a test for HIV and counselling for PMTCT.
When you discuss these intervention measures with them, you should be aware of the most common challenges associated with HIV testing and counselling programmes for women in this situation. They may experience diagnosis-related stigmatisation, or discrimination from their family and community. They will be concerned about the reaction of their partner, and this is often the main obstacle to testing and counselling. HIV testing and counselling for couples encourages mutual support and reduces the stigma and discrimination that might result from being HIV positive. Indeed, the support of the male partner is essential for a pregnant woman who is about to take advantage of PMTCT, if the new situation is to be accepted by the family.
27.1 Transmission of HIV from mother to child