MANAGEMENT OF HIV POSITIVE PREGNANT MOTHER

Key Interventions for eMTCT

  • Routine HIV Counseling and Testing during ANC (at 1st contact. If negative, repeat HIV test in the third trimester/ labour.
  • Enrolment in HIV care if mother is positive and not yet on treatment
  • If mother already on ART, perform viral load and continue current regimen
  • ART in pregnancy, labour and post-partum, and for life – Option B+

Management

Recommended ARV for option B+

  • One daily Fixed Dose Combination (FDC) pill containing TDF + 3TC + EFV started early in pregnancy irrespective of the CD4 cell count and
    continue during labour and delivery, and for life

Alternative regimen for women who may not tolerate the recommended option are:

  • If TDF contraindicated: ABC+3TC+EFV
  • If EFV contraindicated: TDF + 3TC + ATV/r

Prophylaxis for opportunistic infections

  • Cotrimoxazole 960 mg 1 tab daily during pregnancy and postpartum
    • Mothers on cotrimoxazole DO NOT NEED IPTp with SP for malaria

Notes

  • TDF and EFV are safe to use in pregnancy
  • Those newly diagnosed during labour will begin HAART for life after delivery

Caution

  • In case of low body weight, high creatinine, diabetes, hypertension, chronic renal disease, and concomitant nephrotoxic medications: perform renal function investigations before starting TDF
  • TDF is contraindicated in advanced chronic renal disease