This step-by-step approach has helped women to gradually make difficult personal changes to their birth plans. The input of the MDT is crucial to support these women, as they are often the most isolated and unsupported. Where, despite all efforts, the MDT is unable to influence a mother’s views antenatally, a pre-birth planning meeting with social services should be held.

The mother should be informed that it is the paediatrician’s role to advocate on behalf of the child’s well-being and therefore to prevent, where possible, HIV infection. If the mother continues to refuse any intervention package, then legal permission should be sought at birth to treat the infant for 4 weeks with combination PEP and prevent breastfeeding. Preparation of the legal case may be lengthy and time consuming; useful documentation EX 527 cell line can be obtained from colleagues who have already undertaken this. HIV diagnosis during pregnancy may be a profoundly shocking and life-changing experience for the newly diagnosed

HIV-positive woman. There may be a complex mix of emotional, psychosocial, relationship, economic and even legal issues that Fluorouracil arise directly out of the HIV diagnosis. The newly diagnosed woman also has a relatively brief time in which she needs to be able to develop trust in her medical carers and attain sufficient medical knowledge of her situation to be able to make informed decisions that will affect the long-term health of herself, her fetus and her male partner. PMTCT can only be achieved if the pregnant woman embraces medical interventions appropriately. To maximize the effectiveness of interventions for pregnant women in reducing MTCT the psychosocial context of their HIV infection must not be overlooked. old Clinical experience indicates that the management of

issues, including dealing with the diagnosis and uncertainty during pregnancy and robust confidentiality processes have an impact on adherence to ART and acceptance of recommended interventions and all clinicians must be mindful of this. 9.1. Antenatal HIV care should be delivered by MDT, the precise composition of which will vary. Grading: 1D The minimum team would comprise an HIV specialist, obstetrician, specialist midwife and paediatrician, with the recommendation of peer- and voluntary-sector support. All efforts should be made to involve the woman’s GP and health visitor. It may be necessary to involve some of the following: patient advocates, social workers, legal advocacy, clinical psychologists, psychiatrists, counsellors, health advisors, Citizens Advice Bureau workers, interpreters, community midwives, clinical nurse specialists and health visitors [313]. In settings with relatively few HIV-positive pregnant women, it is still important to develop robust pathways of care with identified members of an MDT. Regular links, formal or informal, can also be established with a larger unit to provide advice and support as necessary.