Prevention of Mother-To-Child- Transmission (PMTCT) of HIV

Question 1

The transmission of HIV from an HIV-positive mother to her child during __________ , __________, __________ or __________ is called mother-to-child transmission (MTCT).

Answer 1

pregnancy

labour

delivery

breastfeeding

Question 2

In the absence of any interventions, the risk of transmission is _____% in non-breastfeeding populations and ________% if breastfeeding occurs.

Therefore, Breastfeeding by an infected mother adds an additional ______% risk

Answer 2

15−30%

15-45%

5-20% risk

Question 3

Overall, _________ accounts for 40% of all MTCT transmission in the absence of any interventions.

This rate can be reduced to levels below 5% with effective interventions in breastfeeding population and to less than 2 % in __________ infants.

Answer 3

breastfeeding

formula-fed infants.

Question 4

The development of _________________ for the diagnosis of HIV in 1989 made it easier to distinguish between babies infected before or during birth and those infected during infancy.

This assisted in the more accurate estimates of the risk of transmission through breastfeeding, which was still unknown but was initially believed to be (low or high?).

Answer 4

Polymerase Chain Reaction (PCR)

low.

Question 5

88% of HIV infections in children are as a result of _____________

Answer 5

mother-to- child transmission (MTCT)

Question 6

Without ARV drugs during pregnancy, risk of transmission from mother to infant is 1 in 4

Pediatric AIDS Clinical Trials Group (PACTG) 076 found that by giving ___________ to the pregnant woman during pregnancy, labor, and delivery, and to her newborn, transmission could be reduced to 8%

Answer 6

zidovudine (ZDV)

Question 7

Currently, the risk of perinatal transmission can be less than 2%
(1 in 50) with:
_________

_________ as appropriate

_________

Answer 7

Highly effective ARV therapy (HAART) Elective Cesarean section
Formula feeding

Question 8

Timing of Perinatal HIV Transmission: Non-Breastfeeding Women

Intrauterine (before 36 weeks) ~______% of cases
● Virologic detection of HIV in newborn at ______days of life

Peripartum ~_____% of cases
●Onset of ______________
●Mother-to-fetus ______________
●Labor and ______________

Most transmission occurs close to or during labour and delivery (L&D)

Answer 8

20% ; 1–2

80; placental separation

microtransfusions

rupture of membranes

Question 9

Factors that enhance HIV transmission
Obstetric Factors

Mode of delivery: _______ delivery (if Viral load >_______ copes/ml)

Intra-partum ___________

Obstetric procedures like:
early rupture of membranes,
routine ___________,
________ delivery or ________ delivery, invasive foetal monitoring during delivery

Answer 9

Vaginal ; 1,000

haemorrhage; episiotomies,

vacuum ; forceps

Question 10

Factors that enhance HIV transmission
Infant factors

_________
_________ for gestation age
_________ or ________ pregnancy
______ feeding
Mixed feeding (breast milk with water, formula, other liquids or solids)
Oral _________ e.g. oral thrush, mouth ulcers, gastritis

Answer 10

Pre-maturity
Small
Twin or multiple
Breast
Oral lesions

Question 11

Twin or multiple pregnancy

______ twin - increased risk compared to ______ twin

Individual genetic susceptibility

Answer 11

First

second

Question 12

Factors that enhance HIV transmission
Postnatal Factors
About 10-18% additional risk of transmission from ____________

Risk highest in __________ but continues throughout ___________

Answer 12

breastfeeding

early infancy

breastfeeding

Question 13

Timing of HIV transmission postnatally

Transmission can occur anytime during breastfeeding – from the ________ after delivery through colostrum/early milk and later months through mature milk until __________________________ ends.

The rate of post natal transmission of HIV is estimated to be constant at 0.8% per month throughout the period of breastfeeding.

Answer 13

first days

all breast milk exposure ends.

Question 14

Timing of HIV transmission postnatally
Currently, it is not possible to distinguish in a breastfed child whether an infection that is not detectable by PCR at birth but becomes detectable by PCR around 4-6 weeks was acquired during the intrapartum period or whether it was acquired through colostrum or early breastfeeding .

Why???

Answer 14

Due to persistence of maternal antibodies and the presence of a “window period” during which infection is undetectable using currently available technology.

Question 15

Comprehensive approach to prevention of MTCT
The prevention of mother-to-child transmission of HIV involves all persons of reproductive age group. It is based on the WHO four-pronged approach, which are:
________ prevention of HIV infection in women of _____________________

Prevention of ____________ among HIV positive women

Prevention of ______________ from infected mothers to their infants

Provision of _______________, care and support to HIV-infected mothers, their infants and family

Answer 15

Primary ; reproductive age and their partners

unintended pregnancies

HIV transmission

appropriate treatment

Question 16

HIV-infected CD4 cells have a greater capacity to replicate in (breast milk or blood?) than in (breast milk or blood?).

Answer 16

breast milk

blood

Question 17

A protein called ________ or ________ in breast milk was recently shown to have the capacity to neutralizes HIV and may protect babies from acquiring HIV from their infected mothers

Answer 17

Tenascin-C

TNC

Question 18

Primary Prevention of HIV
Primary prevention of HIV infection in women of reproductive age and their partners include the:
Use of the “ABC” approach to enhance safer and responsible sexual behaviour and practices. This includes the following:
A = ____________
B = ____________
C = ________ use

Answer 18

Abstinence

Be faithful

Condom use

Question 21

Elimination of Mother-to-Child-Transmission (EMTCT) of HIV
This initiative has become one of the greatest public health achievements possible when _______, in June 2015 became the first country in the world to be certified by WHO to have successfully eliminated transmission of HIV from mother to child.
Since then, more countries in the word have succeeded in eliminating HIV transmission from mother to child.

Answer 21

Cuba

Question 22

Factors that enhance HIV transmission:
Viral Factors:
Virulence of the transmitted strain

•HIV-____ is more aggressive and more easily transmitted than HIV-___
•Subtype-____ is more aggressive and more easily transmitted than other sub types

Answer 22

HIV-1

HIV-2

Subtype-C

Question 23

Factors that enhance HIV transmission:
Maternal Factors

High Viral Load
_________ infection
________ stage of ________

Low ________ counts
Nutrient deficiencies : ________ , ________

Other co-infections
______, _______, bacterial vaginosis, ______

Placental problems: ________, ________

Answer 23

Acute infection ; Advanced stage ; AIDS

CD4 ; Vitamin A ; anaemia

STIs ; malaria ; TB

abruption ; chorioamnionitis

Question 24

Minimum of Package of care - Antenatal care
Provision of quality antenatal care
At least _____ antenatal visits
Vitamin & micronutrient supplementation
Screening and treatment of STI’s
Screening and treatment for anemia (iron and folate supplementation) + routine de-worming
Intermittent presumptive treatment for malaria x 3 starting from ______ trimester
Provision of routine HIV counseling and testing services.
Commence all HIV positive women on ________-Option _____
Infant feeding counseling to guide informed choice

Answer 24

4

2nd

HAART

Option B+

Question 25

ARV-prophylaxis options recommended for HIV-infected pregnant women Mother Antepartum _____-daily AZT starting from as early as _____weeks of gestation and continued during pregnancy. At onset of labour, _______ and initiation of twice daily ______ + ______ for ____ days postpartum. (Note: If maternal AZT was provided for more than 4 weeks antenatally, omission of the sd-NVP and AZT + 3TC tail can be considered; in this case, continue maternal AZT during labour and stop at delivery)

Answer 25

twice ; 14 weeks sd-NVP ; AZT ; 3TC 7 days

Question 26

ARV-prophylaxis options recommended for HIV-infected pregnant women Infant Irrespective of mode of infant feeding Daily ______ or twice daily _______ from ______ until ______________of age.

Answer 26

NVP AZT birth 4 to 6 weeks

Question 27

P-3 Intrapartum Care Delivery in a health facility* Safe delivery Avoid prolonged _____________ and avoid routine ____________________ unless medically indicated Minimize use of invasive procedures-________ , ___________ , ___________ or aggressive ___________ Cleanse vagina with 0.25% ___________ solution with every vaginal examination

Answer 27

rupture of membranes artificial rupture of membranes episiotomy ; vacuum delivery forceps delivery ; neonatal suction chlorhexidine

Question 28

NB: Chlorhexidine vaginal douches have been shown to reduce the incidence of _______________________ , but not of _______________ unless ????????

Answer 28

some neonatal and maternal infections, HIV transmission The membranes are ruptured for longer than four ho

Question 29

P-3 Elective Caesarian section Elective Caesarian section (before the onset of labour or the rupture of membranes) significantly __________ mother-to-child transmission of HIV This intervention is not routinely offered because of ____________ to support this intervention on a wide scale Risk of post-operative ______________ in the woman. High __________ rates and _____________ in low resource settings

Answer 29

reduces Lack of resources morbidity and mortality High fertility rates ; HIV seroprevalence

Question 30

For women on ART, caesarean section is probably only indicated in women with a ________________________________\ at time of delivery.

Answer 30

detectable viral load (Viral load >1,000copies/ml)

Question 31

HIV Transmission and Cesarean Delivery ● Cesarean section recommended: ● For women with HIV RNA levels >_______ near time of delivery ● For women with ____________ HIV RNA levels ● Schedule at ____ weeks

Answer 31

>1,000 ; unknown 38 weeks

Question 32

● Benefits of Cesarean is unclear after _______ or ___________ : base decision on clinical factors ● Benefits of Cesarean unclear for women with HIV RNA levels ________ on combination ARVs

Answer 32

ROM ; onset of labor: <1,000

Question 33

Management of Membrane Rupture ● Risk of transmission with rupture of membranes (ROM) increases with ______ ● If labor is progressing and membranes are intact, avoid ____________ and ________________

Answer 33

time artificial ROM ; invasive monitoring

Question 34

Women scheduled for Cesarean who present with premature rupture of membranes (PROM): individualize management ● Duration of rupture, progress of labor ● HIV RNA level, current ARV regimen

Answer 34

….

Question 35

ARV prophylaxis for the HIV exposed Infant. When NVP is not available and AZT has to be used, _____ should be monitored closely for early detection of ________

Answer 35

HB Anaemia

Question 36

NVP-??

Answer 36

Nevirapine

Question 37

Special situations for extended ARV prophylaxis for HIV exposed Infants at High Risk of MTCT Breastfed infants who are at high risk of acquiring HIV should continue infant prophylaxis for an additional _________ (total of ___________ of infant prophylaxis) using AZT (______ daily) and NVP (_______ daily).

Answer 37

6 weeks 12 weeks twice daily once daily

Question 38

High-risk infants are defined as those: Born to women with established HIV infection who have received ___________________________ at the time of delivery OR Born to women with established HIV infection with __________________________________ before delivery, if viral load measurement available; OR Born to women with ___________________________ during pregnancy or breastfeeding; OR Identified for the first time during the ____________ period, with or without a ____________________________.

Answer 38

less than four weeks of ART viral load >1000 copies/mL in the four weeks incident HIV infection postpartum period, with or without a negative HIV test prenatally.

Question 39

___________________ prophylaxis is recommended for HIV-exposed infants from 6 weeks of age and should be continued until HIV infection has been excluded by an age-appropriate HIV test 12 weeks after complete cessation of breastfeeding.

Answer 39

Cotrimoxazole

Question 40

Complementary feeding- the ______________________________________________________________________________________ when breast milk/formula becomes insufficient to satisfy all the nutritional requirements of the infant. This usually occurs around _________ of age.

Answer 40

addition of any food, whether manufactured or locally prepared, to breast milk or formula 6 months

Question 42

Early cessation of breastfeeding- the mother _________________ including __________ before she would have otherwise done. This can occur as early as the ___________ of life and anytime before ____________ of age.

Answer 42

stops all breastfeeding suckling first weeks 12 months

Question 43

Exclusive breastfeeding (EBF)-infant receives _______________ and no other liquids or solids including _______________________ , except prescribed medications such as ________ , _______ supplements or ___________ .

Answer 43

only breast milk water, tea, and commercial formula, vitamins ; mineral supplements ; medicine.

Question 44

Formula feeding (FF)- use of _____________________ feeding which is formulated industrially in accordance with applicable __________

Answer 44

commercial infant feeding Codex

Question 45

HIV-free survival- child is _______ and does ____________ HIV infection. Home-modified animal milk- a ______________ prepared at _____ from _______________________ by ________ and _____________ and ____________

Answer 45

alive ; does NOT acquire breast milk substitute ; home fresh or processed animal milk diluting with water adding sugar micronutrients.

Question 46

Mixed feeding or partial breastfeeding- feeding _________________________________ prior to six months of age. Postnatal transmission (PNT) – mother-to-child-transmission of HIV occurring _______ delivery through ______________.

Answer 46

breast milk and other liquids and or solids after ; breastfeeding.

Question 47

Replacement feedings- feeding infants with ________________ or __________________ instead of _____________ until the child is fully fed on family food.

Answer 47

commercial infant formula home modified animal milk breastfeeding

Question 48

Weaning-period when the child is transitioned from ________ to a diet ___________________________.

Answer 48

breastfeeding completely devoid of any breast milk.

Question 49

Feeding guidelines for HIV-positive infants If an infant is discovered to be HIV positive, mothers are encouraged to ______________________ for the first _________ and _______________ for up to ______________ while _________ feeding is being introduced.

Answer 49

exclusively breastfeed 6 months continue breastfeeding 2 years

Question 50

Studies have shown that early cessation of breastfeeding for HIV positive infants can ______rease mortality compared with an extended breastfeeding period.

Answer 50

Increase

Question 51

Advice for HIV-positive mothers in high-income countries National health agencies and the WHO 2013 guidelines recommend that HIV-positive mothers in high-income countries: avoid ___________: risk of HIV transmission is far greater than the risk of _____________ feeding

Answer 51

breastfeeding replacement feeding

Question 52

_______________ feed: the only infant feeding method that does not expose an infant to HIV

Answer 52

replacement

Question 53

Replacement feeding means giving a _________________________ (prepared from powder and boiling water) or ____________________________ (boiled with added water, sugar and micronutrients) instead of breast milk. In regions of the world where clean water and facilities are available; it is usually promoted as the only option.

Answer 53

baby commercial infant formula home- modified animal milk

Question 54

The risk of transmitting HIV to her infant during breastfeeding is higher in certain conditions such as: •When the woman is __________ •When she has _________ , a breast _________, or other similar conditions •When the child has _________ in the mouth •When breastfeeding is _________

Answer 54

more ill mastitis ; abscess ulcers ; prolonged

Question 55

Breast milk substitute provides protection against infection T/F

Answer 55

F Unlike breastfeeding, it does not provide protection against infections.

Question 56

Early Infant Diagnosis (EID) All HIV–exposed infants should have initial DNA PCR testing at _________ of age (or earliest opportunity thereafter) and __________ after ____________________________________.

Answer 56

12 weeks 6 weeks complete cessation of breastfeeding.

Question 57

Children with advanced and symptomatic HIV infection (CD4 < 200 or < 14%, or Stage 3 or 4 disease), (should or should not?) be given live vaccines (______,_______,________,_________, and __________ vaccine).

Answer 57

Should not BCG, varicella-zoster, OPV, measles and yellow fever

Question 58

________ polio vaccine may cause disease in HIV infected children. Symptomatic HIV infected children should therefore be given the _________ polio vaccine (intramuscular).

Answer 58

Oral Inactivated

Question 59

HIV EXPOSED INFANTS what do you do?? Breastfeeding : Replacement feeding:

Answer 59

Daily NVP for 6 weeks then EID at 6-8th week 6weeks of NVP or twice daily AZT