PMTCT Resources

An Overview of HIV and Breastfeeding can be found here.

HIV and Infant Feeding. A Policy Statement.

Published by UNAIDS

The number of infants born with HIV infection is growing every day. The AIDS pandemic represents a tragic setback in the progress made on child welfare and survival. Given the vital importance of breast milk and breast- feeding for child health, the increasing prevalence of HIV infection around the world, and the evidence of a risk of HIV transmission through breast-feeding, it is now crucial that policies be developed on HIV infection and infant feeding. The following statement provides policy-makers with a number of key elements for the formulation of such policies.

Download this document here (PDF, 20.79 KB, 6pg)

Infant Feeding in the Context of HIV in South Africa. Questions and Answers

Produced by the Yezingane Network and UNICEF December 2010, updated July 2011

Abstract: This booklet presents the new evidence on the importance of breastfeeding in the context of HIV in an easy-to-understand way.

Download this document here (PDF, 267.14 KB, 7pg)

Infant Feeding in the Context of HIV in South Africa. Questions and Answers

Published by the Yezinga Network December 2010

This handbook, produced by the Yezingane Network and the United Nations Children's Fund, UNICEF, is designed to answer frequently asked questions (FAQs) about infant feeding in the context of HIV. Beginning with the World Health Organization (WHO) definition of exclusive breastfeeding (giving the baby no food or drink - not even water - other than breastmilk), the FAQs section provides basic information about breastfeeding and breastfeeding with HIV through answers

Download this document here (PDF, 256.76 KB, 7pg)

UNAIDS PMTCT Infographic

The road to elimination of new HIV infections among children

With the right programs and financing, the UN and its partners have said that, by 2015, virtually no HIV-positive mother will have to pass along HIV to her newborn — an exciting goal that can be achieved in just a few short years.

This infographic describes the UNAIDS plan to eliminate PMTCT by 2015 by several programmes.

Download this infographic here (PDF, 864.02KB, 1pg)

WHO Guidelines on HIV and Infant Feeding 2010

Principles and recommendations for infant feeding in the context of HIV and a summary of evidence.

Published by WHO 2010

ISBN: 9789241599535

Significant programmatic experience and research evidence regarding HIV and infant feeding have accumulated since WHO's recommendations on infant feeding in the context of HIV were last revised in 2006. In particular, evidence has been reported that antiretroviral (ARV) interventions to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of postnatal transmission of HIV through breastfeeding. This evidence has major implications for how women living with HIV might feed their infants, and how health workers should counsel these mothers. Together, breastfeeding and ARV intervention have the potential to significantly improve infants' chances of surviving while remaining HIV uninfected.

Download this document here (PDF, 1.58 MB, 58pg)

HIV and Infant Feeding. Revised Principles and Recommendations. Rapid Advice. 1/12/09

Authors: World Health Organization
Number of pages: 28
Publication date: 2009
Languages: English
ISBN: 9789241598873

On 30 November, the eve of World AIDS Day, the WHO released new recommendations on treatment, prevention and infant feeding in the context of HIV, based on the latest scientific evidence.

The new recommendations call for earlier initiation of antiretroviral therapy (ART) for adults and adolescents, the delivery of more patient-friendly antiretroviral drugs (ARVs), and prolonged use of ARVs to reduce the risk of mother-to-child transmission of HIV. And, for the first time, WHO recommends that HIV-positive mothers or their infants take ARVs while breastfeeding to prevent

Download rapid advice here (30p., 267 KB)

Revised WHO Principles And Recommendations On HIV And Infant Feeding (Rapid Advice: November 2009)

Nutrition News for Africa

Background

Additional research and programmatic evidence has accumulated regarding HIV/AIDS treatment and care since the World Health Organization (WHO) last revised its recommendations on infant feeding in the context of HIV in 2006. In particular, new studies have found that antiretroviral (ARV) treatment provided to either the HIV-infected mother or the HIV-exposed infant can substantially reduce the risk of post-natal transmission of HIV through breastfeeding. Because of the importance of these findings for national HIV treatment and infant feeding guidelines, WHO has just released three rapid advice recommendations concerning these issues. The specific topics covered are: 1) antiretroviral therapy (ART) for HIV infection in adolescents and adults; 2) the use of ART for treating pregnant women and preventing HIV Infection in infants; and 3) the principles and recommendations on infant feeding in the context of HIV. Readers are encouraged to obtain all three rapid advice recommendations at: http://www.who.int/hiv/en/

The current issue of NNA summarizes the new WHO recommendations regarding infant feeding in the context of HIV.

Summary of Recommendations

A total of 8 key principles and 7 key recommendations were developed for the new set of WHO guidelines. These principles and recommendations are directed towards policy makers, academics, and health workers; and they are intended to assist national technical groups and international partners in formulating infant feeding recommendations in the context of HIV. The principles reflect a set of values regarding the provision of care; and the most important key principle is that infant feeding practices by mothers known to be HIV-infected should support the greatest likelihood of HIV-free survival of their children and not harm the health of mothers. This principle is meant to balance the risk of infants acquiring HIV through breast milk with the higher risk of dying from other causes, such as diarrhea and lower respiratory tract infections, due to the elevated risk of these non-HIV related diseases among infants who are not breastfed. 

The 7 key recommendations are summarized, as follows:

1.    HIV-infected mothers should be provided with lifelong ART's or antiretroviral prophylaxis interventions to reduce HIV transmission through breast milk. (The specific recommendations on the use of anti-retroviral drugs for treating pregnant women and preventing transmission of HIV infection to infants can be found at: http://www.who.int/hiv/topics/mtct/. Briefly, to prevent HIV transmission to infants via breastfeeding, either: 1) the mother should receive AZT during pregnancy, and the infant should receive daily Nevirapine from birth until the cessation of breastfeeding; or 2) the mother should receive a 3-drug regimen during pregnancy, and this maternal regimen should be continued until the cessation of breastfeeding.)  

2.    HIV-infected mothers with uninfected infants (or infants with unknown HIV status) should exclusively breastfeed for the first 6-months, after which appropriate complementary foods should be introduced. Breastfeeding should be continued through 12 months of life, and should be stopped only after nutritionally adequate and safe dietary alternatives can be provided.

3.    Abruptly stopping breastfeeding is not advisable. HIV-infected mothers who decide to stop breastfeeding should gradually stop over the course of approximately one month. If the mother or child has been taking prophylaxis medications, this treatment should continue for at least one week after stopping breastfeeding.   

4.    Infants of HIV-infected mothers who stop breastfeeding should be provided with safe and adequate replacement feeds to enable normal growth.

5.    HIV-infected mothers with uninfected infants (or infants with unknown HIV status) should only provide commercial infant formula milk as a breast milk replacement if the milk replacement is: affordable, feasible, acceptable, sustainable, and safe (AFASS).

6.    HIV-infected mothers should consider expressing and heat-treating breast milk as an interim strategy in special circumstances, to assist with stopping breastfeeding, or if ART is temporarily unavailable.

7.    HIV-infected infants and young children should be exclusively breastfed for the first 6-months of life, and continue breastfeeding up to 2-years or beyond.

Program Implications

New evidence indicating that provision of ART to either HIV-infected mothers or HIV-exposed infants can markedly reduce or eliminate HIV transmission through breast milk has major implications for infant and young child feeding recommendations. The specifically recommended ART regimens are described on the WHO web site indicated above. If these recommendations are effectively implemented, they should yield improvements in the quality of life and survival of women living with HIV and important reductions in HIV transmission and deaths due to HIV/AIDS and other causes in young children. 

Editorial Comments*

Since the late 1980's it has been known that exclusive breastfeeding of non-HIV exposed infants decreases the incidence of diarrhea and pneumonia and reduces infant mortality; and ongoing breast feeding beyond six months continues to reduce these risks, even into the second year of life. However, infant feeding studies in the context of HIV have indicated that mother-to-child-transmission of HIV (MTCT) can occur via breast milk. As a result, earlier recommendations in settings with high HIV prevalence emphasized the use of replacement feeds when AFASS, to avoid the risk of MTCT of HIV. However, newer data have since shown that children who receive replacement feeds are at greater risk of other (non-HIV) infections and death. Therefore, when developing infant feeding recommendations in the context of HIV, both the risk of HIV transmission and the risk of death from other causes must be considered.

 For these reasons, the new WHO infant feeding recommendations aim to maximize HIV-free survival time. Because the latest studies show that the risk MTCT of HIV via breast milk can be reduced or eliminated if the mother and/or child are given ART, it is now possible to recommend usual breast feeding practices in most cases, as with children of HIV-negative mothers.

* These comments have been added by the editorial team and are not part of the cited publication.

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

For pregnant women and their families

Published by the Yezingane Network June 2010

Brief 10

This briefing document contains up-to-date information on preventing HIV infection in babies. This information can help pregnant women and their families as well as people providing services to pregnant women, and organisations advocating for improved services. Please share this information with others – it can save lives.

View Preventing Mother-To-Child Transmission of HIV (PMTCT) attached below (PDF, 656,51KB, 4pg)

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Preventing_Mother-To-Child_Transmission_of_HIV_(PMTCT).pdf656.51 KB

Guiding Principles for Feeding Non-Breastfed Children 6-24 Months of Age.

World Health Organisation. The present document presents guidelines for feeding non-breastfed children after the first six months of life. Download (616 KB).

Risk Factors For Mother-To-Child HIV Transmission (MTCT)

 From SA Dept of Health document "Prevention of Mother-to-Child HIV Transmission and Management of HIV Positive Pregnant Women" launched October 2000.

4.1 Maternal Factors

a.       Immune status:
The risk for MTCT is increased with the severity of immune deficiency. Women with low CD4 counts (<200 cells/ml or less) are more likely to transmit HIV to their infants.
b.      Vitamin A deficiency:
Studies on MTCT have suggested an association between Vitamin A deficiency in the mother and risk of MTCT. Vitamin A deficiency in HIV- infected mothers is associated with a higher risk of HIV transmission from mother to child. Ongoing trials in Malawi, South Africa, Tanzania and Zimbabwe are currently studying whether adding vitamin supplements to pregnant women’s diet will affect the risk of MCTC.

4.2 Behavioural factors

Cigarette smoking, drug use, and unprotected sexual intercourse during pregnancy has been associated with an increased risk of MTCT.

4.3 Obstetrical Factors

a.       Placental infection:
Infection of the chorion or the amnion may increase the chance of MTCT. Genital infections and especially sexually transmitted diseases (STD’s) may result in chorioamnionitis. Prolonged rupture of membranes during labour is another common cause of infection.
There is a relatively high risk of transmission during delivery due to presence of the virus in blood and mucus in the birth canal. Therefore, various methods of vaginal washing (lavage) before and during delivery are being investigated in several developing countries. In a trial performed in Malawi, lavage-using chlorhexidine showed no overall difference in rates of MTCT, but did show a significant reduction in cases where membranes were ruptured for more than four hours. It also resulted in significant reduction of infant mortality and morbidity.
b.      Mode of delivery:
The mode of delivery may also influence the risk of MTCT. Elective Caesarean section births has been shown to reduce the risk of MTCT.

4.4 Infant Factors

a.       Breastfeeding:
HIV is transmissible through breastmilk. Subsequently breastfeeding is associated with at least one-third all MTCT.
b.      Foetal trauma:
Traumatic births and births where the foetal skin is traumatised from obstetrical procedures increase the risk of MTCT.
c.       Prematurity:
Pre term births tend to place the infant at higher risk for MTCT as compared to full term births.

4.5 Viral Factors

a.       HIV Viral load:
A high level of circulating HIV virus (viral load) is an important contributor to MTCT. The higher the viral load the more likelihood that MTCT will occur. There is a higher risk of MTCT in women with advanced HIV disease (AIDS) or documented high viral loads (e.g. >50,000 HIV viral particles or more/ml).

Read the document online