prevmothertochildtransofhivppt32-經(jīng)營管理-展示頁
2024-08-28 14:50本頁面
【正文】 with viral loads 1000 copies/mL 來自 料庫下載 Mode of Delivery ? If on HAART: – Continue HAART intrapartum – Offer elective cesarean delivery if viral load 1000 copies/mL ? If on AZT regimen: – Continue AZT intrapartum – Remend an elective cesarean delivery ? If on no treatment: – Offer ?short course? treatments – Cesarean delivery if membranes unruptured or ruptured for less than 4 hours. 來自 料庫下載 Postpartum management ? Encourage mother infant contact and bonding ? Avoid contact of infant with maternal body fluids ? Counsel about contraception ? Arrange medical followup prior to discharge ? Help mother access available social supports 來自 料庫下載 Testing the Neonate ? Maternal HIV antibodies may be found in the infant?s serum for up to 18 months after delivery ? Neonates are considered HIVinfected if two separate blood specimens test positive for HIV by DNA PCR, p24 antigen tests, or viral culture. 來自 料庫下載 Barriers to Implementing MTCT Prevention Programs ? Inadequacies in basic maternalchild health care infrastructure – Low, irregular and late presentation for prenatal care ? Lack of prenatal counseling and testing programs ? Cost of ART and monitoring ? Attitudes of healthcare workers ? Confidentiality issues ? Discrimination ? Dependence on breast feeding 來自 料庫下載 Alternatives to HAART and the PACTG 076 AZT Regimen ? Considerable research has been done to find a short, inexpensive and effective regimen of antiretrovirals to prevent MTCT ? All of these regimens are inferior to HAART and the prolonged AZT regimen 來自 料庫下載 AZT Trials Without Breastfeeding AZT regimen US Cost Efficacy (transmission rate) Thailand “short” Antepartum: 300 mg BID from 36 weeks Intrapartum: 300mg Q3H $200400 At 6 months: 9 % versus 19% in control group Thailand “4 group” Antepartum: 300 mg BID from either 28 or 36 wks Intrapartum: 300 mg Q3H Postpartum: 2mg/kg QID for 3 days or 6 wks variable At 6 months: 11% shortshort % short long % longshort % long long 來自 料庫下載 AZT Trials With Breastfeeding AZT Regimen US Cost Efficacy (transmission rate) Ivory Coast and Burkina Faso DITRAME ANRS 049 Antepa
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