Prevention of Parent-to-Child Transmission (PPTCT) of HIV

1. Antenatal measures

• Universal HIV testing with informed consent and counselling at the first antenatal visit.
• Repeat HIV test in late pregnancy in women at continuing/high risk or as per local programme policy.
• Test and treat sexually transmitted infections; screen for tuberculosis, hepatitis B/C and anaemia.
• Start lifelong combination antiretroviral therapy (ART) immediately in every pregnant woman diagnosed with HIV, irrespective of CD4 count or viral load.
  • A commonly used first-line regimen is TDF + 3TC (or FTC) + DTG, according to national guidelines.
• Ensure adherence counselling, viral-load monitoring, nutritional support and partner testing.
• Prevent new maternal HIV infection during pregnancy/breastfeeding: safer sex, condoms, partner ART, and PrEP for eligible HIV-negative women at substantial risk.

2. Intrapartum measures

• Continue maternal ART throughout labour.
• Aim for vaginal delivery if maternal viral load is suppressed.
• Elective caesarean section may be considered when viral load is high or unknown near term, according to national protocol.
• Avoid procedures that increase fetal exposure to maternal blood:
  • Artificial rupture of membranes unless necessary
  • Prolonged rupture of membranes
  • Fetal scalp electrode/scalp blood sampling
  • Routine episiotomy, instrumental delivery and traumatic procedures where avoidable
• Follow universal precautions and minimise maternal blood loss.

3. Care of the newborn

• Give antiretroviral prophylaxis to the baby as early as possible after birth, preferably within 6-12 hours.
  • Low-risk infant: usually single-drug prophylaxis.
  • High-risk infant, such as mother untreated or viraemic near delivery: enhanced multi-drug prophylaxis as per guideline.
• Perform early infant diagnosis using HIV nucleic-acid testing according to the national schedule.
• Cotrimoxazole prophylaxis is given to HIV-exposed infants from about 4-6 weeks until HIV infection is excluded, as per protocol.
• Ensure immunisation, growth monitoring and follow-up at the ART/PPTCT clinic.

4. Infant-feeding advice

• Feeding advice must follow the national PPTCT policy.
• Where replacement feeding is affordable, feasible, acceptable, sustainable and safe, exclusive replacement feeding may be advised.
• In settings following WHO breastfeeding guidance:
  • Mother should remain on effective ART with adherence support.
  • Exclusive breastfeeding for the first 6 months.
  • Then complementary feeding with continued breastfeeding up to at least 12 months, and possibly up to 24 months or longer, depending on national guidance.
  • Avoid mixed feeding in the first 6 months, because it raises transmission risk.
• Promptly treat mastitis, breast abscess and cracked nipples.

5. Counselling and programme measures

• Confidential counselling, stigma-free care and partner involvement.
• Family-planning services and avoidance of unintended pregnancy.
• Link mother and infant to lifelong HIV care.
• Maintain records, follow-up and testing of the infant until HIV status is definitively known.