Nursing Care for HIV - Nursing Care of Women

Authors: Talitha Crowley, MCur, PGDip Primary Health Care, PGDip Nursing Ed, BCur
Editors In Chief: Ian M. Sanne, MBBCH, FCP(SA); Stacie Stender, MSN, MSc ID, FNP (More Info)

Last Reviewed: July 8, 2016 (What's New)

Credit Information

inPractice® Africa’s Continuing Education Unit (CEU) provider, the South African Medical Association, does not offer CPD points for this individual module, but all participants who complete the module with a 70% pass rate will receive a participation certificate. To learn more on CPD credits and participation certificates, click here.

Introduction: Prevention of Mother-to-Child Transmission of HIV in South Africa

Prevalence of Mother-to-Child Transmission

  • In 2012, the overall HIV prevalence estimate among antenatal women has stabilised at 29.5% (95% CI: 28.8% to 30.2%)[ZA NDOH Survey 2012]
    • The national HIV prevalence estimate has remained the same, at 29.5% (95% CI: 28.7% to 30.2%) since 2011
  • Transmission can occur during any of the following stages 
    • Pregnancy
    • Labour and delivery
    • Breast-feeding
  • Without intervention, approximately 1 in 4 infants born to women living with HIV will acquire HIV in utero or during delivery[Wade 1998]
    • In 2008-2010, 40.5% of maternal deaths were from nonpregnancy-related infections, mostly HIV complicated by tuberculosis, pneumonia, and Pneumocystis jirovecii pneumonia[Saving Mothers 2012]
    • In 2011, HIV was associated with one half of all deaths of children younger than 5 years of age[ZA NDOH HIV Tx 2015]
  • In South Africa, mother-to-child transmission rates at 6 weeks of < 3% have been achieved since a national prevention of mother-to-child transmission programme was implemented[ZA NDOH HIV Tx 2015]
    • Early identification is key
    • Effective antenatal, delivery, and infant care
      • Includes antiretrovirals
      • Treatment initiated during labour to the mother or the neonate decreases transmission rates from 26% to 10% or less[Wade 1998]
    • Testing and appropriate treatment before and during pregnancy
      • Helps further reduce transmission of HIV from mother to child, as viral load is suppressed earlier
      • Helps maintain maternal health
      • Provides opportunity to test and treat additional family members
      • Engages mother and her family in care

Comprehensive Approach to Caring for Women Living With HIV and Preventing Mother-to-Child Transmission

  • The approach to preventing mother-to-child transmission (PMTCT) of HIV has the following objectives
    • Early identification of pregnant women infected with HIV
    • Keep mothers well
    • Reduce maternal viral load
    • Reduce vertical transmission during labour and delivery
    • Reduce postnatal transmission of HIV through safer feeding options and retaining women in care
    • Early diagnosis of infected infants with linkage to care and treatment
    • Timely linkage to treatment and care for infected mothers and their families
  • Table 1 describes how to prevent MTCT from antepartum through 18 months postpartum according to South Africa National Department of Health clinical guidelines for the treatment and prevention of HIV (Management Guidelines)[ZA NDOH HIV Tx 2015]

Table 1. The Spectrum of PMTCT Care[ZA NDOH HIV Tx 2015]