HIV in Pregnancy - Model Answer (3+3 marks)

Part (a): Public Health Measures to Prevent Mother-to-Child Transmission (3 marks)

1. Universal HIV Screening in Antenatal Care

• Routine HIV counselling and testing is offered to all pregnant women at ICTCs (Integrated Counselling and Testing Centres) with an "opt-out" option.
• Involvement of spouse and family members - a shift from "ANC-centric" to a "Family-Centric" approach.

2. Lifelong ART for All HIV-Positive Pregnant Women

• Provision of lifelong triple-drug ART (TDF + 3TC + EFV) to all HIV-positive pregnant and breastfeeding women, regardless of CD4 count or clinical stage (Option B+).
• This replaced earlier single-dose Nevirapine (SD-NVP) strategy.

3. Safe Delivery Practices

• Promotion of institutional deliveries for all HIV-positive pregnant women to reduce intrapartum transmission risk.

4. ARV Prophylaxis to Newborn

• Provision of ARV prophylaxis to infants from birth up to a minimum of 6 weeks (extended to 6 months).

5. Infant Feeding Counselling

• Counselling and support for exclusive breastfeeding within one hour of delivery as the preferred option, continued for 6 months (rather than mixed feeding, which increases risk).

6. Early Infant Diagnosis (EID)

• Initiation of Co-trimoxazole Prophylactic Therapy (CPT) and HIV-DNA PCR at 6 weeks of age onwards for HIV-exposed infants.
• Integration of follow-up of HIV-exposed infants into routine immunization services.

7. Management of Co-infections

• Provision of care for associated conditions - STIs, RTIs, tuberculosis, and other opportunistic infections.
• Provision of nutrition counselling and psychosocial support for HIV-positive pregnant women.

8. Community Outreach

• Strengthening community follow-up through local networks to support HIV-positive pregnant women and their families.

Part (b): Role of National AIDS Control Programme (NACP) in Management (3 marks)

Key Roles of NACP:

• HIV Sentinel Surveillance at antenatal clinics (ANC) and high-risk group sites every 2 years, to track epidemic trends and allocate resources.
• Categories of districts (A-D) based on HIV prevalence to prioritize interventions.

• More than 15,000 ICTCs across the country offer PPTCT services.
• Facility-level, standalone, and community-based HIV testing at multiple tiers (village to state level).

• Outreach programmes for high-risk groups (FSWs, IDUs, MSM, transgender persons) and bridge populations (truckers, migrants).

• Free, universal, lifelong standardized ART through ART centres, Centres of Excellence (CoE), and ART-Plus centres.
• First-line, second-line, and third-line ART available (third-line includes Raltegravir + Darunavir).
• CD4 testing and viral load monitoring every 6 months free of charge.
• Management of opportunistic infections (OIs) at ART centres.

• Integration of PPTCT services with the existing Reproductive and Child Health (RCH) programme.
• National target: MTCT rate <5% and <50 new paediatric HIV infections per 100,000 live births.

• Joint strategy with RNTCP: offering HIV testing to all diagnosed TB patients and TB screening among PLHIV.
• Isoniazid Prophylaxis Therapy (IPT) for PLHIV to prevent TB.

• National Paediatric HIV/AIDS Initiative (launched 2006) - free ART and paediatric ARV formulations at all ART centres.
• Early Infant Diagnosis (EID) programme - HIV-DNA PCR for confirmation, linkage to ART.

• Adolescence Education Programme in schools (class IX and XI, 16-hour sessions).
• Red Ribbon Clubs in colleges for peer-to-peer HIV prevention messaging.
• Communication targeted at general population, high-risk groups, and anti-stigma initiatives.

• NSP 2017-25 commits to 100% domestic funding for key NACP components: prevention outreach, testing, treatment, PMTCT, viral load suppression, care and support.