• Give psychosocial support
  • Encourage mothers to enroll in Family Support Groups (FSG) for peer support
  • Advise on the importance of good nutrition
    • Talk to family members to encourage the woman to eat enough and help her avoid hard physical work
    • Micronutrient supplementation during pregnancy and breastfeeding; iron + folic acid and multivitamins
  • Advise her that she is more liable to infections, and to seek medical help as soon as possible
  • Review the birth plan
    • Advise her to continue attending ANC
    • Advise her to deliver in a health facility where appropriate care can be provided for her and the baby
    • Advise her to go to the health facility as soon as labour starts or membranes rupture

During postpartum period

  • Advise on the infectiousness of lochia and blood- stained sanitary pads, and how to dispose them off safely according to local facilities
  • If not breastfeeding exclusively, advise her to use a family planning method immediately to prevent unwanted
  • Linkage of mother-baby pair and her family, for on-going care beyond peurperium
  • Breast care: If not breastfeeding, advise that:
    • The breasts may be uncomfortable for a while
    • She should avoid expressing the breast to remove milk (the more you remove the more it forms)
    • She should support her breasts with a firm, well-fitting bra or cloth, and give her paracetamol for painful
    • Advise her to seek care if breasts become painful, swollen, red; if she feels ill; or has fever

Counselling on infant feeding choice

  • Begin infant feeding counselling before birth when the pregnant mother has been identified to be HIV positive.
  • The decision on how she will feed the baby should be made before delivery. The mother should then be
    supported to implement the feeding option she has chosen
  • All mothers are encouraged to breastfeed their babies exclusively for 6 months and then introduce
    complimentary feeding until 1 year
  • The mother has to continue her ARVs all through breastfeeding
  • The child should continue cotrimoxazole prophylaxis, until status confirmed negative with a PCR at 6 weeks
    after stopping breastfeeding
  • If a mother chooses to feed the newborn on replacement feeding from the beginning, the choice of replacement
    feeds should fulfil the AFASS Criteria (Affordable, Feasible, Available, Sustainable and Safe).