WHO’s four prong approach to PMTCT

IV. Provision of Care and Support to Women Infected With HIV, Their Infants, and Their Families

The comprehensive care of all people living with HIV/AIDS, including HIV-positive women and their exposed or HIV-positive infants and children with her spouse is the fourth prong of PMTCT.

a) HIV Testing and Counselling in the Context of PMTCT

Women are particularly vulnerable to HIV infection and face multiple challenges in making decisions concerning their reproductive lives. Through counselling, women can be empowered to make informed choices concerning their sexual and reproductive health (RH). Specific PMTCT interventions depend on upon women's knowledge of their HIV status. Therefore, you should note the following important points during HCT services:

• Play a vital role in identifying women who are HIV-positive to provide appropriate services for themselves and their family.
  
• Help women who are HIV-negative and empower them to remain negative.
  
• Serve as an entry point to comprehensive HIV/AIDS treatment, care, and support to the mother and whole family.
  
• Help women identify their status and take steps to reduce behaviours that increase the risk of HIV infection or transmission.
  
• Be available to all women in reproductive age, particularly, to pregnant, parturient and lactating women.
  
• Need to be available to male partners as well.
  

All women of childbearing age presenting to Maternal, Newborn and Child Health (MNCH) should receive information through group education on the following issue:

• Prevention and treatment of HIV/AIDS including STIs.
  
• Family planning.
  
• Prevention of HIV in infants and young children including interventions for PMTCT (ART during pregnancy, ARV prophylaxis for infants born to HIV-infected women).
  
• Safer sex practices and risk reduction.
• The benefit of HIV testing at every pregnancy and partner testing.
• Pre-test information, HIV testing, post-test counselling and follow-up services.

b) Advantages of Testing and Counselling in the Context of PMTCT

For HIV-negative women:

• Helps them remain uninfected.
  
• Helps them to have HIV-free babies.
  
• Help them receive the FP methods of their choice.
  
• Help them receive information on the importance of delivery by a skilled birth attendant.
  

For HIV-positive women:

The following points should be raised when counselling HIV-positive mother.

• Effect of pregnancy on HIV and effect of HIV on pregnancy outcomes.
  
• The risk of transmission of HIV to the infant.
  
• Treatment options and intervention methods.
  
• Infant feeding options.
  
• Disclosure of the result to the partner.
  
• Follow up of the mother and infant.
  
• Further fertility and contraceptive option.
  

Here, let the woman make informed decisions about FP and receive appropriate and timely interventions to reduce MTCT including ARV treatment to reduce MTCT, infant feeding counselling and support and information and counselling on FP. Also, advise her to:

• Receive information on the importance of giving birth in a setting where standard precautions for infection prevention and safer obstetric practices are implemented.
  
• Secure early access to HIV treatment, care, and support services.
  
• Receive information and counselling on the prevention of HIV transmission to others.
  
• Receive follow-up and ongoing health care for themselves and their HIV-exposed infants.
  
• Disclose their results to partners and family members.
  

c) Integrated Approaches to HIV Testing in MNCH Settings

There are two methods to HIV testing in the MNCH setting. Each approach provides information to the client about HIV, the benefits and risks of testing.

• Opt-in: after the woman has received information about HIV and testing and individual counselling, she is given the choice of refusing or consenting to an HIV test. This option is presented in a neutral, supportive manner. Women who "opt in" explicitly request to be tested, and their informed consent (written or oral)is clearly established. The opt-in approach requires an active step by the individual woman to agree to be tested.
• iOpt-out: HIV testing is offered as a routine part of a standard package of care. Women are given the opportunity to decline the test should they choose to do so. The opt-out approach emphasises that HIV testing is a routine component of MNCH services. However, testing is still voluntary under the opt-out approach; women have a right to refuse testing. Issues that are preventing a woman from accepting testing should be explored. Opt-out testing is also sometimes referred to as "provider-initiated testing and counselling" (PITC) because the provider routinely initiates offering HIV testing and counselling as part of care.

Opt-out testing is the BEST approach for testing because it:

• Normalises HIV testing by integrating it into ANC services, offering HIV testing at each pregnancy.
• Increases the number of women who receive testing and PMTCT interventions.
• Improves access to HIV/AIDS services, increasing ART coverage.
• Reduces stigma when integrated in the ANC set-up.

Pre-Test Information (Counselling):

The purposes of a pre-test information session are to:

• Provide basic information about HIV/AIDS and MTCT of HIV, including prevention.
  
• Describe the benefits of testing.
  
• Explain the testing process.
  
• Discuss the importance of partner testing and discordance.
  
• Counsel on risk reduction.
  
• Introduce MNCH/PMTCT care and support services (ART for the HIV+ mother and ARV prophylaxis for the infant).
  
• Encourage clients to share such information with other community members.
  

Use different teaching aids for better understanding (refer your health education module) and follow the steps to implement them.

Post-Test Counselling:

The result of HIV testing should always be offered in person in a confidential setting. Along with the result, appropriate post-test information, counselling, or referral should also be offered.

Knowing your own sero-status does not indicate the status of your partner, although rare, there is a possibility of being couples with a discordant result. If your partner is HIV-negative, the two of you will need to be faithful to each other. If your partner is HIV-positive or you do not know his status, or if you have sex with more than one partner, you can protect yourself from HIV. I would like to make you aware that if you get HIV infection while pregnant or breastfeeding, the chances of transmitting HIV to your child is much higher than any other time.

As you probably know, the fact that you are HIV-negative doesn't necessarily mean that your partner is HIV-negative. Thus, you are strongly advised to ask your partner get tested.

You are encouraged to bring your partner to this clinic for HIV test or just refer him so that providers can offer and do HIV testing for him. If you need any information or referral slip for your partner, here is some information about where to get HIV testing service and how you can protect yourself from getting HIV.At last, thank you for getting tested and I would like to advise you that next time you come, make sure your partner will have been tested for HIV.