HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.): SECTION C : INFECTION CONTROL MEASURES: (introduction...)

HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.)

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EXECUTIVE SUMMARY

INTRODUCTION

SECTION A : HIV IN PREGNANCY

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Epidemiology of HIV

Susceptibility of women to HIV infection

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Biological factors

Socio-cultural factors

Effect of pregnancy on the natural history of HIV infection

Effect of HIV infection on pregnancy

Mother-to-child transmission

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Factors affecting mother-to-child transmission of HIV-1

Interventions to prevent mother-to-child transmission of HIV

Appropriate interventions to reduce mother-to-child transmission

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Antiretroviral therapy

Immune therapy

Nutritional interventions

Mode of delivery

Vaginal cleansing

Modification of infant feeding practice

Voluntary HIV counselling and testing in pregnancy

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Testing of antenatal women

Counselling before and after HIV testing in pregnancy

Counselling about pregnancy-related issues

SECTION B : MANAGEMENT OF HIV-POSITIVE PREGNANT WOMEN

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Antenatal care

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Obstetrical management

Examination and investigations

Medical treatment during pregnancy

Antiretroviral therapy

Care during labour and delivery

Postpartum care

Care of neonates

SECTION C : INFECTION CONTROL MEASURES

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Universal precautions

Risks of needlestick injuries

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Management of needlestick injuries and other accidental blood exposure

REFERENCES

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(See Guidance Module on Antiretroviral Treatments, Module 7. Treatments following exposure to HIV)

Exposure to blood and other body fluids is common in obstetric practice^{382,383,384,385,386}and staff should receive information, training and access to equipment in order to protect themselves³⁸⁷. In areas of highest HIV prevalence, tests may not be available and many women will also be in the "window period" before seroconversion, and may not be identified by routine HIV-antibody tests. Lack of access to nosocomial infection prevention measures may unfortunately be common in these countries^388,389,390. A study of occupational exposure in the United Republic of Tanzania showed that health workers were exposed on average to five sharp injuries and nine splashed exposures each year, with a higher risk in surgeons³⁹¹. In Rwanda, no evidence was found for any HIV infection caused by occupational blood contact in 215 traditional birth attendants, exposed to an estimated 2234 potentially infectious blood-skin contacts over five years³⁹².

All patients should be regarded as potentially infectious, not only for HIV, but also for Hepatitis and other pathogens^393,394. Health care workers must ensure that they use universal precautions against accidental infection at all times. These require the provision within health services of protective devices and clothing and access to safe containers for sharp instruments³⁹⁵.