the overall risk of Mother-To-Child Transmission of HIV is approximately 5% to 45%. Transmission of HIV from the mother to her child accounts for over 90% of all HIV infections in children aged below 15 years.
Estimated HIV outcomes for infants born to women living with HIV. 100% of infants born to HIV-infected mothers who breastfeed.55%-80% infants will not be HIV -infected.
5-10% infants infected during pregnancy.10-15% infants infected during labor and delivery and 5-20% infants infected during breastfeeding. 20-45% infants will be infected.
Prevention of Mother-To-Child Transmission services in Zanzibar target women of reproductive age, pregnant and breastfeeding women, their partners, children, families and communities. The Prevention of Mother-to-Child transmission program goals are to eliminate HIV transmission from mother to child or vertical HIV transmission and improve care for infected partners and their children.
Comprehensive Prevention of Mother-to-Child transmission services are provided within 176 Reproductive and Child Health (RCH) clinics across all 11 districts in Zanzibar.
Prevention of Mother-To-Child Transmission services aim to prevent HIV infection in children, giving babies the chance to be healthy and HIV free and provide women and their families access to HIV prevention, testing, care, treatment, and support services.
Since the year 2012, Zanzibar has adopted WHO recommendation (Option B+) of providing prompt and life long ART to HIV-infected pregnant and breastfeeding women, regardless of immunological (CD4 count) or clinical (WHO staging) status.
There is a significant reduction of new HIV infection and AIDS related mortalities observed in the country that is markedly attributed to increased access to HIV services, especially early initiation of ART among HIV positive mothers and early ART treatment initiation among children.
The comprehensive approach for eliminating Mother-To-Child Transmission in Zanzibar is based on four prongs, which include:
- Primary prevention of HIV among women of reproductive age
- Prevention of unintended pregnancies among women living with HIV
- Prevention of HIV transmission from mother to child
- Treatment, care, and support for women living with HIV, their children, and families.
Mother-To-Child Transmission of HIV refers to the transmission of HIV infection from HIV-infected mother to their infants that can occur during pregnancy, childbirth, and breastfeeding.
Primary Prevention of HIV among Women and their Partners
Since there is no cure for HIV infection, primary prevention of infection is the most effective means of controlling the spread of HIV and preventing Mother-To-Child Transmission. The following should be taken into consideration:
- Encouraging sexual actively active women and men do adopt safer sex practices, including being faithful to their regular sexual partners, correct and consistent use of condoms
- Providing early diagnosis and prompt treatment of Sexual Transmitted Infections
- Providing young people with information and services to keep them free of HIV infection and encouraging them to abstain from sex until they can make responsible decisions
- Encouraging sexually active women and men to be faithful to their regular sexual partners
- Prevention measures to include getting their male sexual partners tested
- Using standard precautions for blood transfusions during pregnancy and labor (as applicable)
- Use of HIV pre-exposure prophylaxis (PrEP) for HIV negative women of the reproductive age group who are at substantial ongoing risk of HIV acquisition.
Prevention of Unintended Pregnancies among Women infected with HIV
It is every women’s or couple’s right to have children and information regarding family planning so as to make an informed choice on contraception. Therefore, contraceptive options should be provided at all service delivery points and community. Women with HIV infection and their partners should be provided with information about Prevention of Mother-to-Child Transmission and counselling on:
- Effective family-planning to avoid unintended pregnancies
- Consistent use of male or female condoms to prevent HIV transmission
- Use dual protection, including condoms for the prevention of both HIV infection and pregnancy
Prevention of HIV Transmission During Pregnancy, Delivery, and Breastfeeding
Transmission of HIV from a pregnant mother to her infants is the primary source of HIV infection in infants and young children. In Zanzibar, the Prevention of Mother-to-Child Transmission program offers a range of services and interventions aimed at reducing the risk of Mother-to-Child Transmission. These include HIV education, testing, and counselling for pregnant and breastfeeding women and their partners, ART for HIV-infected women, safer delivery practices, safer infant feeding as well as HIV-exposed infant prophylaxis, care, and HIV testing.
Both HIV-concordant and serodiscordant couples must be provided with counselling on safer reproductive options.
For Concordant (Both partners are HIV-infected) and Discordant Couples (One partner is HIV- infected):
- Expert consultation is recommended so that approaches can be tailored to couples’ needs, which may vary from couple to couple.
- Both partners should be screened and treated for genital tract infections before attempting to conceive.
- Both partners should attain maximum viral suppression before attempting conception.
For Discordant Couples:
- Administration of antiretroviral pre-exposure prophylaxis (PreEP) before conception and/or during pregnancy, with a continuation for the entire period during which the HIV negative pregnant mother is at substantial ongoing risk of acquiring HIV.
- The couple only should attempt conception after the HIV-infected partner has initiated ART has achieved sustained viral suppression.
Use of Antiretroviral (ARV) Medicine During Pregnancy or Breastfeeding
Prevention of Mother-To-Children Transmission sites should deliver combination ARV regimens to all identified HIV-infected pregnant and/or breastfeeding women soon after diagnosis.
The preferred first-line ARV regimen for pregnant and breastfeeding women is a fixed-dose combination of TDF 300 mg + 3TC 300mg + DTG 50mg to be taken once daily.
The alternative first-line regimen is TDF + 3TC (or FTC) + EFV 400 mg.