CARE FOR HIV POSITIVE WOMEN EMTCT

Ensure the following care is provided during pregnancy, labour, delivery, and postpartum period for all HIV+ women

  • Find out what she has told her partner (degree of disclosure), labour companion, and family support.
    Respect her choice and desired confidentiality

Key Interventions for eMTCT

  • Routine HIV Counseling and Testing during ANC
  • ART in pregnancy, labour and post-partum, and for life – Option B+

MANAGEMENT

Recommended ARV for option B+

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

Alternative regimens for women who may not tolerate the recommeneded option are:

  • If TDF contraindicated: AZT+3TC+EFV
  • If EFV contraindicated: TDF + 3TC + LPV/r

Prophylaxis for opportunistic infections

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

During labour: safe obstetric practices

  • Avoid episiotomy
  • Avoid artifical rupture of membranes
  • Avoid instrumental delivery (vacuum)
    • Avoid frequent vaginal examination
    • Do not milk umbilical cord before cutting
    • Actively manage third stage of labour

Baby

  • Give infants daily Nevirapine (NVP) for for 6 weeks (12 weeks for high risk infants)
  • Give Cotrimoxazole beginning at 6 weeks, continue until final HIV status is confirmed
    negative

    • Offer DNA PCR test at 6 weeks, and again 6 weeks after cessation of breastfeeding
Notes
  • TDF and EFV are now considered safe in pregnancy
  • Those newly diagnosed during labour will receive sdNVP tablet and 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 investigation before giving TDF
  • TDF is contraindicated in advanced chronic renal disease

Benefits of Option B +

  • Reduction of new HIV infection in children, by minimizing the risk of HIV transmission from infected pregnant and lactating women, to less than 5% in breastfeeding populations, and to less than 2% in non-breastfeeding populations
  • Improved health, and reduced maternal mortality and morbidity of HIV-infected mothers through lifelong ART
  • Reduction of the risk of HIV transmission to non-HIV infected sexual partner in discordant relationship
  • Reduction in the number of HIV/AIDS orphans
  • Contribution to the achievement of the 90/90/90 goals by 2020
  • Contributes to achievement of the Sustainable Development Goals by 2030