PPTCT - some thoughts

[Guest guest]

Dear friends,

Some thoughts on Prevention of Parents To Child Transmission (PPTCT) .

PPTCT

It is evident now that the HIV has the unique property to infect the child of an

HIV positive mother in the following ways:

1. When the baby is in the mother’s womb, transmission of HIV may take place

through placental route during the last trimester of pregnancy. Possibility of

such transmission is 5-10%.

2. During delivery and labour when the possibility goes up to 10 – 20%.

3. During breastfeeding with the possibility of transmission of 10-20%. (If

the mother gets infected after childbirth possibility of transmission during

breastfeeding becomes as high as 29%).

It has been estimated that in 90-95% cases the child acquires HIV from the

mother.

Possible sources of HIV infection in case of positive mothers

The mother’s positive status is responsible for the transmission of HIV into the

child. It has been observed that mothers may have various resources for HIV

acquisition like,

Infected father/partner – In 90% of the cases in India women get the virus in

the monogamous relationship only from the promiscuous husbands or partners or

the husbands/partners being an IDU.

Infected needle – If the woman is an IDU herself

Infected blood – If the woman is transfused with infected blood

Multiple partner relationship – If the woman has multiple partners (like FSW)

Levels of transmission

So, the transmission can take place at two primary levels before it finally hits

the baby.

Extra Household transmission: Transmission occurring outside the household

Transmission from external sources to the father – Maximum possibility in Indian

context

Transmission from external sources to the mother

(External sources may be an infected partner/needle & syringe/blood)

Intra Household transmission: Transmission occurring inside the household

Transmission from father to mother

Transmission from mother to child

During pregnancy

During labour

During breast feeding

Levels of Interventions to prevent mother to child transmission

1. Interventions to prevent Extra Household transmission of HIV

Prevention of infection to the father from external sources

Prevention of infection to the mother from external sources

These initiatives are taken through Targeted Intervention approaches (in case of

HRG), general awareness building and large scale IEC efforts (in case of general

mass).

2. Interventions to prevent Intra Household transmission of HIV

Prevention of infection from the father to the mother if the father is already

infected

Prevention of pregnancy through appropriate contraceptive methods if the mother

is infected

Prevention of infection from the mother to the child if the mother is already

infected and becomes pregnant

Prevention of infection in lactating mothers

Care of the infected child and mother

In cases of PMTCT (Prevention of Mother To Child Transmission), emphasis is

given to prevent Intra household transmission of HIV. So, the term PMTCT is

replaced by PPTCT (Prevention of Parents To Child Transmission) to make it more

appropriate and focussed at the context of the households.

More than 27 millionwomen including 92 000 HIV infected women give birth in

India every year. According to NACO number of HIV positive women is increasing

and with it the number of babies with HIV infection.

NACO is already in the process of rolling out PPTCT programs (phase wise) in

different states with the technical support from UNICEF in the following manner.

First phase (2002): PPTCT centres in 81 hospitals in high prevalence states

Second phase(2002 - 2003): PPTCT centres in 157 District Hospitals and Maternity

Centres in high prevalence states

Third phase (2003 - 2004): PPTCT centres in 79 hospitals in low prevalence

states

Forth phase (2004 - 2006): PPTCT centres in 450+ District Hospitals and

Maternity Centres in low prevalence states

The major thrust of such initiative is developing linkages between ANC centres

and VCTC and providing ARV to the infected mother and new born under

supervision.

But the real challenge lies in developing effective community mobilization for

'INSTITUTIONAL DELIVERY' which can eventually enhance the PPTCT process.

NGOs can play a crucial role in this to provide useful support to NACO's PPTCT

intervention initiative.

All the best

Sugata

Dr Sugata Mukhopadhyay

CARE India, New Delhi

E-mail: <sugataids@...>

[Guest guest]

Dear FORUM,

While people have accepted and argued about the use of the term PPTCT

(Prevention of Parents To Child Transmission) we should decide whether it is

scientifically correct.

While arguments such as Sugata Ganguly's, widen the spectrum (and there by also

diffuses the same) they skirt the essential issue: what do we prevent from the

child's perspective or from the point of view of preventing the child from

getting infected is essentially the Mother to Child transmission.

One of the essential components of the same would be primary prevention in the

mother, but then extending it to the reasons why she gets infected and calling

it PPTCT is still un-scientific becuse we try and prevent her infection from her

partner or otherwise from other source (which certainly has nothing to do with

being a parent).

Dealing with issues of vulnerability of women and marriage emerging as the most

important risk factor for women as far as HIV is concerned are VERY IMPORTANT

yet separate issues and need not be mixed with the child's vulnerability which

is preventable.

One of the problems that has impeded response to the epidemic is faling to call

spade a spade.

PRAYAS, Pune

E-mail: <prayashealth@...>

[Guest guest]

Dear Friends,

Sometimes using over intellectuall topics complicate the matter instead of

finding any solution. Proposed PPTCT looks like that. We know very well that the

child to be born or newly born is infected by his/her mother only, at any stage,

and the father or the partner of the mother has nothing to do there except

educating the mother to prevent her from transmitting the virus to the child by

taking care of many methods before or/and after the birth.

It might be useful to educate the fathers/partners of the mothers to prevent the

transmission onto their children, but why should it be mixed with the

internationally accepted terminology (PMTCT) and make it more comlicated by

inventing a new word PPTCT, when we have already a great challenge of awareness

and education on prevention of the pandemic among the rural populations in the

country ? It will deviate the concentration, make the issue more complicated and

create unnecessary confusion among the volunteers, NGOs/CBOs, community people

etc. alrady working for the cause. I don't think it will support the campaign

for prevention of HIV/AIDS in the country in any way.

regards,

Bhawani

Bhawani Shanker Kusum

Secretary & Executive Director

Gram Bharati Samiti (GBS)

NGO Delegate for Asia Pacific, UNAIDS PCB

Amber Bhawan, Amber 302028

Jaipur India

Tel./Fax : 91-141-2530719

E-mail: gbsbsk@...

www.gbsjp.org

[Guest guest]

Dear Forum,

I do agree with Prayas. Prevention of Parent to Child transmission of HIV is

very unscientific terminology.

The idea in introducing this term was to minimise the stigmatization of woman,

increase the husband's involvement and to make males aware that they are mostly

responsible for the transmission to their spouces. However, none of the above is

the objective of PPTCT programme.

In PNDT (Prenatal Diagnostic Technique. Now it is amended to Pre-conceptional

Selection & Prenatal Diagnostic Technique. The law to forbid these for gender

selection and gender specific abortions has been enforced from 1994 in India),

we are emphasizing the role of husband sauyng that he equally plays the role in

sex formation of child because that is the truth and his active role is very

important there.

Howver, the situation in PPTCT is entirely different. This term has following

disadvantages:

It distracts the focus of attention from the care to the transmission from

mother to child and paediatric prevention to genral care to the family; which

some may welcome; but taht takes away the advantage of focus. There are many

other programmes which take care of the rest of popullation. However, PPTCT is

the only programme which takes care of the child.

The extended PPTCT is also intended to continue the on going care to the mother

as and when needed.

In capacity building and training programmes, this term creats quite a confusion

in the minds of participants as to exact intention and scope of the programme.

There is a risk that males would prevent their spouces from attending PPTCT

clinics to avoid their botherarion.

However, there is an advantage that this makes the society aware of Gender

issues.

Dr. Nishikant Shrotri

E-mail: nishparna@...