National Guidelines For PPTCT 0 PDF

Updated Guidelines for
Prevention of Parent to Child

Transmission (PPTCT) of HIV using
Multi Drug Anti-retroviral Regimen in India
December, 2013
Government of India
Ministry of Health & Family Welfare
Department of AIDS Control
Basic Services Division
Chandralok Building, Janpath
New Delhi - 110001

December, 2013
Government of India
New Delhi - 110001
Acknowledgement
We acknowledge the valuable contributions made by technical experts from the Department of AIDS Control/ GoI,
WHO, UNICEF, Clinton Health Access Initiative and CDC India.
Writing Group:
1. Dr Geetanjali Kumari, (ex) National Programme Officer/ PPTCT, DAC

2. Dr Avinash Kanchar, (ex) Programme Officer/ HIV-TB, DAC
3. Dr Raghuram Rao, National Programme Officer/ ICTC, DAC
4. Dr B B Rewari, WHO National Consultant & NPO/ ART, DAC
5. Dr M. Naina Rani, National Consultant/ PPTCT, WHO, India
6. Dr Srilatha Sivalenka, Scientific Affairs Specialist, CDC, India
Guidance Group:
1. Dr Suresh Mohammed, (ex) National Programme Officer/ ICTC, DAC

2. Dr Po-Lin Chan, (ex) Medical Officer, WHO/ SEARO
3. Dr Vimlesh Purohit, (ex) National Consultant/ PPTCT, WHO, India
4. Dr Ivonne Cameroni, (ex) Country Director, UNICEF, India
5. Ms Ameeta Chebbi, (ex) Country Director, CHAI, New Delhi
6. Dr Pauline Harvey, Director, CDC DGHA, India
7. Dr K Sudhakar, National Advisor, CDC, India
8. Dr Malalay Ahmadzai, Health Specialist, UNICEF, India
9. Dr Sudha Balakrishnan, Health Specialist, UNICEF, India
10. Dr Sandhya Kabra, (ex) Asstt. DG/ Lab Services, DAC
11. Dr Laxman Bharathi, Programme Officer/ ART, DAC
12. Dr Padmini Srikantiah, Consultant, CDC, India
13. Dr Subhashree Raghavan, Executive Director, SAATHII, India
14. Dr Reshu Agarwal, Programme Officer/ CST, DAC
15. Dr Debashish Dutta, (ex) Maternal & Child Health Specialist, UNICEF, India
16. Dr Amaya Maw Naing, Regional Advisor, HIV/AIDS, WHO/ SEARO
17. Dr Razia Pendse Narayanan, WHO/ SEARO
18. Dr Melita Vaz, (ex) Programme Officer/ Counseling, DAC
We also sincerely acknowledge the technical support extended by Members of the Technical Resource Groups
(TRGs) of PPTCT, ART, Paediatric & Laboratory Services; Project Directors & BSD Officers at all SACS, Regional
Coordinators/ CST, DAC, PPTCT Consultants and all others concerned with PPTCT.
Mentors:
1. Dr Ashok Kumar, Dy. DG/ BSD, DAC
2. Dr R S Gupta, (ex) Dy. DG/ BSD, DAC
3. Dr Mohd Shaukat, (ex) Dy. DG/ CST, DAC
4. Dr R S Rathore, Dy. DG/ CST, DAC
5. Dr S Venkatesh, Dy. DG/ M&E, DAC
6. Dr S Khaparde, Dy. DG/ STI, DAC
7. Dr Neeraj Dhingra, Dy. DG/ TI, DAC
8. Dr Naresh Goel, Dy. DG/ Lab Services, DAC
The assistance provided in preparing this document by Mr Stefen Tonsing (Technical Officer/ PPTCT, DAC),
Mr Rohit Mehta (M & E Officer, DAC), Ms Divya Taneja (Technical Officer/ Training, DAC), Mr Reneej K B (Technical
Officer/ ICTC, DAC), Ms Manali Jain (Office Assistant/ BSD, DAC) and Mr Vikas Gaur (Office Assistant/ BSD, DAC),
is appreciated
The technical support provided by WHO India Office in developing this document, as well as to UNAIDS India and
CDC India for facilitating its printing are acknowledged with thanks.
Contents
Chapter 1 Introduction 11
Chapter 2 PPTCT Policy, Essential Package and Guiding Principles 14
2.1 The Overall Goals of the PPTCT Programme 15
2.2 The Essential Package of Services under the PPTCT Programme 16
2.3 General Principles 18
2.3.1 Sexually Transmitted Infections and Reproductive Tract Infections 20
2.3.2 HIV–TB Collaborative Activities 22
2.4 Guiding Principles for Use of ARV Drugs (ART) in PPTCT 24
Chapter 3 PPTCT Services Under NACP 26
3.1 Existing Facilities 27
3.2. Continuum of Care under PPTCT 28
Chapter 4 Care and Assessment of HIV Infected Pregnant Women 30
4.1 Care during the Antenatal Period 31
4.2 Initial Assessment 32
4.3 Criteria for ART Initiation 34
4.4 Indications for Co-trimozaxole Prophylactic Therapy (CPT) in Pregnancy 34
Chapter 5 HIV Infected Pregnant Women Requiring ART for her own Health 35
5.1 HIV Infected Pregnant Women being Newly Initiated on ART 36
5.2 Principles of Management 36
5.2.1 For HIV-infected Pregnant Women who Require ART for their Own Health 36
5.2.2 Choice of ART Regimen for HIV-infected Pregnant Women 36
5.2.2 Safety of Efavirenz (EFV) in Pregnant Women 38
5.3 ART Regimen for Pregnant Women having Prior Exposure to
38
NNRTI for PPTCT
Figure 2: Components of PPTCT Programme
5.4 Pregnant Women Already Receiving ART 38
5.5 Clinical and Laboratory Monitoring of Pregnant Women Receiving ART 39
5.6 Offer
ARV of HIV Counselling
Prophylaxis for Infantsand Testing
Born Services
to Mothers to allLifelong
Receiving PregnantARTWomen 41
Chapter 6 Interventions for Women Diagnosed with HIV Infection in
40
Labour and Postpartum
6.1 ART for Women Presenting in Active Labour 43
HIV Negative HIV Infected Pregnant Women
6.2
Pregnant ARV Prophylaxis for Infants Born to Women Presenting in Active Labour
Women 44
l Antenatal Care (ensure at-least 4 visits)–Monthly ART/ARV
l 6.3
Safe sex ARV Prophylaxis for Infants Born toat
Women who did not Receive any ART 44
prophylaxis ART Centers.
counselling.
Chapter 7 Special Considerations l Counselling on choices of continuation or medical termination46 of
l Couple
7.1 Pregnant Women with Active TB (MTP)–to undertake within the first 3 months47
pregnancy of
counselling.
7.2 pregnancy only.
l Linkages Pregnant
to familyWomen with HIV-2 Infection 47
7.3
planning Pregnant Screening for TB and other OIs.
services. Women with Hepatitis B or Hepatitis C Virus Co-infection
l
48
l Free condoms. Screening and treatment
Chapter 8 Labour and Delivery in the HIV Infected Pregnant Women
l for STIs. 50
l Behaviour change l WHO clinical staging and CD4 testing.
8.1 Intra Partum Management 51
communication l Counselling on positive living, safe delivery, birth-planning and
8.2
(BCC) forIntra
highPartum
risk Anti Retroviral Treatment (ART) 51
infant feeding options.
women and
8.3 her Circumstances: Caesarean Section
Special 51
partner. l Couple and safe sex counselling and HIV testing of spouse and
8.4 False Labour 51
l Repeat HIV other living children.
8.5 Safer Delivery Techniques 52
testing, l Referral to ART Center.
Chapter 9 Care During the Postnatal Period
considering 53
l Provide ART or ARV prophylactic regimen based on CD4 count
window,
9.1 period if
The Postpartum Period and/or clinical staging. 54
spouse
9.2 is positive
Screening for Postpartum Depression 56
or s/he have high l Nutrition counselling and linkages to Government/other
9.3 Counsel and Follow-up of
risk behaviour. Nutrition programmes.
Mother-baby (m-b) Pairs after Discharge 57
Chapter
l 10feeding
Infant Infantand
Feeding Practice
l Postpartum ARV prophylaxis for mother. 59
nutrition
10.1 Family Planning Services.
Principles of Infant Feeding for HIV Infected Pregnant Women
l 60
counselling. EBF reinforcement/Infant feeding support through home visits.
Chapter 11 Care and Follow-up of HIV Exposed Infants
l
66
11.1 Psycho-social support through follow-up counselling,
During the First Post-delivery Visit at 6 Weeks/ First Immunization Visit
l home 67
11.2 visits and support groups.
Confirmation of HIV Status in HIV Exposed Infants should be done at 18
69
Months, Regardless of Earlier Diagnosis
Chapter 12 Essential Gynaecologic Care for HIV Infected Pregnant Women 70
HIV
12.1Exposed Infant (HEI)
Cervical Cancer Screening 71
l Exclusive
12.2 breastfeeds upto 6 months
Family Planning and Birth-spacing (preferred Option-I WHO/NACO Guidelines 2010-'11) 71
and continued breastfeeds in addition to complement feeds after 6 months upto 1 year for
Chapter 13 Monitoring and Evaluation 74
EID negative babies and upto 2 years for EID positive babies who receive Paediatric ART.
Chapter 14 PPTCT Programme: Roles and Responsibilities of Staff 93
l Postpartum ARV prophylaxis for infant for 6 weeks.
l Early infant diagnosis (EID) at 6 weeks of age; repeat testing at 6 months, 12 months & 6 weeks
after cessation of breastfeeds.
l Co-trimoxazole prophylaxis from 6 weeks of age.
l HIV care and Ped ART for infants and children diagnosed as HIV positive through EID.
l Growth and nutrition monitoring.
8 National Guidelines for Prevention of Parent-to-Child Transmission of HIV
l Immunizations and routine infant care.
l Gradual weaning after 6 months and introduction of complementary feeds from 6 months
onwards along with continuation of BF for atleast 1 year for adequate growth & development of
the child.
emmargorP TCTPP fo stnenopmoC :2 erugiF
Annexures 08
Annex 1 ne:moGuidelines
W tnangerfor
P lRolling-out
la ot secivNACP
reS gnand
itseT dna gConvergence
NRHM nillesnuoC VPlan
IH fin
o rthe
effO
States 100
Annex 2 : Dosing Schedules ART for Pregnant Women 111
Annex 3 : ART for Pregnant Women nemoWPresenting

tnangerP din etcActive
efnI VLabour
IH with no Prior ART evitageN V111 IH
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l n e m o W t n a n g e rP
Annex 4 : Infant NVP Prophylaxis Dosing 111
.sretneC TRA ta sixalyhporp xes efaS l
.gnillesnuoc
Annex
fo noi5
tanimre:t lacWHO
idem Clinical
ro noitauStaging
nitnoc foforseAdults
ciohc nand
o gniAdolescents
llesnuoC l 111
elpuoC l
fo shtnom 3 tsrif eht nihtiw ekatrednu ot–)PTM( ycnangerp
Grading of Selected Clinical and.ylLaboratory .gnillesnuoc
Annex 6 : no ycnangerToxicities
p
(Reference: WHO 2010 Guidelines for ART in Adults and Adolescents) y l i m a f ot segakniL 113 l
.sIO rehto dna BT rof gnineercS l .seciv res gninnalp
Annex 7 : Postpartum Depression.sITS rof tnScreening
emtaert dnTool–the
a gnineerEdinburgh
cS l Scale .smodnoc eerF 116 l
.gnitset 4DC dna gnigats lacinilc OHW l egnahc ruoivaheB l

Annex
dna8gninnal:p-hComparing
trib ,y reviledEffectiveness
efas ,gnivil evofitiFamily
sop no gPlanning
nillesnuoMethods
C l noitacinummoc 119
ksir hgih rof )CCB(
.snoitpo gnideef tnafni
Flowchart on Counselling Mothers and their Families on Infant rFeeding eh dna nemow
Annex
dna9esuops: fo Options
gnitset V0-6IH dnMonths
a gnillesofnuAge
oc xes efas dna elpuoC l 120
.rentrap
.nerdlihc gnivil rehto VIH taepeR l
Annex 10 : Testing Algorithm for HIV-1 Exposed Infants
.retneC TRA ot larrefeR land Children <6 Months ,gnitset 121
tnuoc11
Annex 4DC no: deTesting
sab nem iger citcafor
Algorithm lyhpHIV-1
orp VR A ro TRAInfants
Exposed P lChildren >6 Months disnoc 122
edivorand g n i r e
.gnigats lacinilc ro/dna fi doirep ,wodniw
evitisop si esuops
rehto/12
Annex tnemnre: voICTC-ART
G ot segCentre aknil Referral
dna gnForm illesnuoc noitirtuN l hgih evah eh/s ro 123
.semmargorp noitirtuN .ruoivaheb ksir
Annex 13 : OM for .rLaboratory
ehtom rof sInvestigations
ixalyhporp VRA mutraptsoP l dna gnideef tnafnI 124 l
.seciv reS gninnalP ylimaF l noitirtun

Annex 14 : List of Items that can be Procured under Universal Work Precautions 126
.stisiv emoh hguorht troppus gnideef tnafnI/tnemecrofnier FBE l .gnillesnuoc
Annexe15
moh ,gn:illeCF-consent
snuoc pu-woForm
llof hgfor
uoPatients
rht troppRegistering
us laicos-ohinto
cysPHIV
l Care & Starting ART 127
.spuorg troppus dna stisiv
Annex 16 : Transfer Out Form (Form for Transfer of PLHIV to Other ART Centre) 128
OM Regarding Provision of ART/ARV Prophylactic Drugs at ART Centre to

Annex 17 : 129
HIV Infected Pregnant Women )IEH( tnafnI desopxE VIH
)11'-0102 senilediuG OCAN/OHW I-noitpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
f raey 1: otList
Annexro18 pu sof
htnReference
om 6 retfaDoctors
sdeef tfor
nemAdvice
elpmoconotPPTCTnoitiddServices
a ni sdeeIncluding
ftsaerb deCare
unitnof oc dna 130
HIV Exposed Child
.TRA cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIE
Annex 19 : National Coordination Committee .skeeforw 6PPTCT-NRHM
rof tnafni rof sixIntegration
alyhporp VRActivities
A mutraptsoP 131 l
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE l
OM from DDG (BSD) for Roll-out of PPTCT Multi-Drug .sdeefRegimen
tsaerb fo nin oitIndia
assec retfa 133
Annex 20 :
from 1st January 2014
.ega fo skeew 6 morf sixalyhporp elozaxomirt-oC l
.DIE hguorht evitisop VIH sa desongaid nerdlihc dna stnafni rof TRA deP dna erac VIH l
.gnirotinom noitirtun dna htworG l
.erac tnafni enituor dna snoitazinummI l 9
National Guidelines for Prevention of Parent-to-Child Transmission of HIV
shtnom 6 morf sdeef y ratnemelpmoc fo noitcudortni dna shtnom 6 retfa gninaew laudarG l
fo tnempoleved & htworg etauqeda rof raey 1 tsaelta rof FB fo noitaunitnoc htiw gnola sdrawno
.dlihc eht
.stseT )dipaR( ydobitnA 3 lla gnisu shtnom 81 ta seibab lla fo sutats VIH fo noitamrifnoC l
Abbreviations
ANC Antenatal Care IUCD Intra-uterine contraceptive device

AIDS Acquired Immune Deficiency Syndrome LPV/r Lopinavir/ritonavir
ALT Alanine Aminotransferase 3TC Lamivudine
ART Antiretroviral Therapy MTCT Mother-to-Child Transmission of HIV
ARV Antiretroviral NACO National AIDS Control Organisation
ARSH Adolescent Reproductive & Sexual Health NNRTI Non-Nucleoside Reverse Transcriptase
AZT Zidovudine Inhibitor
BCC Behaviour Change Communication NRTI Nucleoside Reverse Transcriptase
CPT Cotrimoxazole Prophylactic Therapy Inhibitor
CDC Centers for Disease Control and NRHM National Rural Health Mission
Prevention NVP Nevirapine
DBS Dried Blood Spot OIs Opportunistic Infections
DIL Direct-in-Labour PEP Post-Exposure Prophylaxis
DNA Deoxyribonucleic Acid PCP Pneumocystis Jiroveci Pneumonia
d4t Stavudine PCR Polymerase Chain Reaction
EBF Exclusive Breast Feeding PPTCT Prevention-of-Parent-to-Child-
EID Early Infant Diagnosis Transmission of HIV
e-MTCT Elimination of Mother–to-Child RCH Reproductive & Child Health
Transmission RPR Rapid Plasma Reagin
ERF Exclusive Replacement Feeding NVP Single-Dose Nevirapine
EFV Efavirenz SRH Sexual and Reproductive Health
EPI Expanded Programme of Immunization TB Tuberculosis
HBV Hepatitis B Virus TDF Tenofovir Disoproxil Fumarate
HCT HIV Counselling and Testing ULN Upper limit of normal
HCV Hepatitis C Virus UNAIDS United Nations Programme on HIV/AIDS
HEI HIV Exposed Infant UNICEF United Nation International Childrens
HIV Human Immunodeficiency Virus Emergency Fund
ICF Intensified case finding of TB VCT Voluntary Counselling and Testing
ICTC Integrated counselling and Testing Centre WBS Whole Blood Specimen
IMNCI Integrated Management of Childhood WHO World Health Organisation
and Neonatal Illness WBFPT Whole Blood Finger Prick Test
1
Introduction
There are an estimated 2.1 million Figure 2: Components
(2011) of PPTCT
People Living withProgramme
HIV (PLHIV) in India, with National adult
HIV prevalence of 0.27% (2011). Of these, women constitute 39% of all PLHIV while children less than
15 years of age constitute 7% of all infections. As on March 2013, 0.1 million HIV positive children
Offer of HIV Counselling and Testing Services to all Pregnant Women
had been registered under the antiretroviral therapy (ART) programme and 38,579 are receiving free
ART. There has been a significant scale-up of HIV counselling & testing, Prevention of Parent-to-Child
Transmission (PPTCT) and ART services across the country over last five years. Between 2004 and 2013,
the number of pregnant women tested annually under the Prevention of Parent-To-Child -Transmission
(PPTCT) programme increased from 0.8 million to 8.83 million and reach of the services has expanded
Pregnant Women Antenatal Care
to the rural areas to a large extent. Concurrently,
l
there(ensure at-least
has also been 4a visits)–Monthly ART/ARV and
significant decentralisation
Safe sex
scale-up of the ART services, with 7.34prophylaxis at ART Centers.
l
Lakhs PLHIV receiving free ART across the country through 409
counselling.
ART centres and 860 Link-ART centres l Counselling
(LAC). on choices of continuation or medical termination of
l Couple
pregnancy (MTP)–to undertake within the first 3 months of
counselling.
Mother-to-child-transmission of HIV ispregnancy
a major only.
route of HIV infection in children. However, out of
Linkages27tomillion
an estimated
l family pregnancies in a year, only about 52.7% attend health services for skilled
planning services. l Screening for TB and other OIs.
care during child birth in India. Of those who availed health services, 8.83 million ANCs received
Free condoms.
HIVlcounselling and testing (March l2013) Screening
out ofand treatment
which 12,551 forpregnant
STIs. women were detected to be
Behaviour change WHO clinical staging and CD4 testing.
HIV positive. To enhance this coverage, a joint directive from the National AIDS Control Programme
l l
(NACP)communication
and the National Rural Health l Counselling
Mission (NRHM)on positive living,convergence
regarding safe delivery,ofbirth-planning and
the two programme
(BCC) for high risk
components was issued in July 2010, explicitly stating that universal HIV screening should be included
women and her
as an integral component of routine lANC Couple and safe sexobjective
check-up. The wasand
counselling to ensure thatofpregnant
HIV testing women
spouse and
partner.
who are diagnosed with HIV would be linked to HIV services for their own health as well as to ensure
prevention of HIV transmission to newborn babies under the PPTCT programme.
considering
In the absence o f any intervention, l a substantial
Provide ART or ARVproportion of children
prophylactic regimenbornbased toonwomen living
CD4 count
window,
with HIV, period
acquire HIV ifinfection from their mothers either
and/or clinical staging. during pregnancy , labour/delivery or during
spouse isWithout
breastfeeding. positive any inter vention, the risk of transmission o f HIV from infected pregnant
or s/he have high is estimated l Nutrition counselling and linkages to Government/other
women to her children to be around
Nutrition 20-45%. Use of ART and sd NVP/Sy NVP to
programmes.
risk behaviour.
mother-baby pairs has shown to bel quite effectiveARV
in reducing thisfor
transmission a s l o w a s 10 per
l Infant feeding and Postpartum prophylaxis mother.
cent. Use of single dose Nevirapine (sd-NVP) at the onset of labour significantly reduces pre-partum
nutrition l Family Planning Services.
HIV transmission. However, it is less effective than other available ARV prophylaxis and it does not cover
the risk of HIV transmission during the l
antenatal or breastfeeding periods. Further , it also adds to the
Psycho-social support through follow-up counselling,
risk of acquiring drug resistance to nevirapine (NVP) as well as cross resistance to Efavirenz (NNRTIs). WHO
l home
in 2010 had recommended two more efficacious regimen,
visits and support option A & option B, to further reduce the chances of
groups.
HIV transmission from mother-to-child.
Further in 2013, consolidated ART guideline, WHO has recommended moving away from the previous
termsHIV Exposed
“Options A, Infant
B and (HEI)
B+”. Instead, the WHO new guidelines (June 2013) 1 recommend two options:
l Exclusive breastfeeds upto 6 months (preferred Option-I WHO/NACO Guidelines 2010-'11)
1. Providing lifelong ART to all the pregnant and breastfeeding women living with HIV regardless of CD4
count or clinical stage OR
2. Providing
l ART ARV
Postpartum (ARVprophylaxis
drugs) forfor pregnant
infant forand breastfeeding women with HIV during the mother-
6 weeks.
to-child
l
transmission
Early infant diagnosis risk(EID)
period
at 6andweeks then continuing
of age; life-longat ART
repeat testing for those
6 months, women&eligible
12 months 6 weeksfor
treatment for their own health.
1
World Co-trimoxazole
l Health Organization,prophylaxis
Consolidated from 6 weeks
guidelines on theofuse
age.
of Antiretroviral drugs for treating and preventing HIV infection,
Recommendations for a public health approach, June 2013.
the child.
Government of India is committed emm toarwork
gorP Ttowards
CTPP fo stachievement
nenopmoC :2 eof rugthe
iF global target of “elimination of
new HIV infections among children” by 2015. Based on the new guidelines from WHO (June 2013),
Department of neAIDS
moWControl
tnangehas
rP ldecided
la ot sectoivprovide
reS gnitlife-long
seT dnaART gnil(triple
lesnuodrug
C VIregimen)
H fo reffO for all pregnant
and breast feeding women living with HIV, in which all pregnant women living with HIV receive a triple-
drug ART regimen regardless of CD4 count or WHO clinical stage, both for their own health and to
prevent vertical HIV transmission from mother-to-child. This would also help in maximising coverage for
those needing treatment for keeping them nemoalive
W tnaand
ngefor
rP dtheir
etcefown
nI VIhealth,
H avoiding stoppingevitagand eN starting
VIH
drugs with repeat pregnancies, provide early protection
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l against mother-to-child n e m o W
transmission t n a n g
in efuture
rP
pregnancies and avoiding drug resistance. .sretneC TRA ta sixalyhporp xes efaS l
.gnillesnuoc
fo norecommendations
These itanimret lacidem rhave
o noitathe
unipotential
tnoc fo sectoiohreduce
c no gnithe
llesnrisk
uoCof lmother-to-child-transmission to less
elpuoC l
than 5 per cent in breastfeeding populations. These guidelines shall be implemented across .gnillesthe nuoccountry
.ylno ycnangerp
from 1st January 2014. ylimaf ot segakniL l
.sITS rof tnemtaert dna gnineercS l .smodnoc eerF l
dna gninnalp-htrib ,y reviled efas ,gnivil evitisop no gnillesnuoC l noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC l .rentrap
.retneC TRA ot larrefeR l ,gnitset
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l g n i r e disnoc
evitisop si esuops
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuN l hgih evah eh/s ro
.rehtom rof sixalyhporp VRA mutraptsoP l dna gnideef tnafnI l
emoh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP l
)IEH( tnafnI desopxE VIH

rof raey 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
.skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP l
.sdeeftsaerb fo noitassec retfa
.dlihc eht
2
PPTCT-Policy, Essential Package and Guiding Princi ples
2.1 The Goals of the ePPTCT
mmargorP TCTPP fo stnenopmoC :2 erugiF
Programme
In line with WHO standards for a comprehensive strategy, the National PPTCT programme recognises
nemoW tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO
the four elements integral to preventing HIV transmission among women and children. These are:
Prong 1: Primary prevention of HIV, especially among women of child bearing age.
Prong 2: Preventing unintended pregnancies nemoW among tnangerwomen P detcefliving nI VIHwith HIV. evitageN VIH
n e m oW tnangerP
Prong 3:VRPrevent
A/TRA yHIVlhtntransmission
oM–)stisiv 4 tsfrom ael-tpregnant
a erusne( ewomen raC latainfected
netnA lwith HIV to their child.
Prong
fo no4:
itanProvide
imret laccare,
idemsupport
ro noitauand nitnotreatment
c fo seciohto c nwomen
o gnillesnliving uoC withl
HIV, her children lland . g n i esnufamily
oc in
women in child bearing age. e l p u o C l
.gnillesnuoc
.ylno ycnangerp
ylimaf ot segakniL l
.sIO r4ehprongs
to dna BTfor rof gPPTCT
nineercS l .seciv res gninnalp
.gnitset 4DC dna gnigats lacinilc OHW l Prong 4:
e g n ahc ruoivaheB l
noitacinummoc
Prong 1: Prong 2:
dna gninnalp-htrib ,y reviledPrimary efas ,gnivil eunintended
vPrevent
itisop no gnillePrevention
snuoC l
Prong 3: Care,
support
prevention of MTCT and k s i r hgih rof )CCB(
of HIV
pregnancies
treatment
reh dna nemow
evitisop si esuops
rehto/tnemnrevoG ot segaknil dna HIVg+ve nillesnuoc HIV no+ve
itirtuN l hgih evah eh/s ro
HIV +ve Mother
HIV Negative i.e.
general
. s e
Not Pregnantm
Family Planning
m a r g o r p n o i t
& Pregnanti r t u N & Child
.ruoivaheb ksir
.reARSH
htom rof sixICTC a lybut
hpmore
orp VRA mutraptsoP l
population, counselling in
e.g. dna gnideef tnafnI l
importantly at
.ART
secentres
civ reS gninnalP ylimaF l noitirtun
The National PPTCT programme adopts a public
emoh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP l health approach to provide these services to pregnant
women and their children. This approach seeks to ensure equitable access to high-quality PPTCT
services at the grass-root level while taking into account what is feasible on a large-scale within
available health infrastructure, human and financial resources.
Goals of National PPTCT Programme in India are: )IEH( tnafnI desopxE VIH
1. Primary prevention of HIV, especially among women in child-bearing age.
2. Integration
.TRA cirtaidof
eaPPPTCT
evieceinterventions
r ohw seibab ewith
vitisogeneral
p DIE rohealth
f sraeyservices
2 otpu dsuch na seas ibabasic
b evitaAnte-natal
gen DIE Care
(ANC), Natal and Post –Natal Services,.sSexual keew 6Reproductive
rof tnafni rof sHealth
ixalyhpoand rp VFamily
RA mutPlanning,
raptsoP lEID,
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraservices.
Paediatric ART and Adolescent Reproductive and Sexual Health (ARSH), TB and STI/RTI E l
3. Strengthening post-natal care of the HIV-infected mother and her exposed infant.
4. Provide.Dthe
IE hessential
guorht evpackage ofsPPTCT
itisop VIH a desonservices
gaid nerd(seelihc dFigure
na stn1 afnon
i ronext
f TRA page).
deP dna erac VIH l
.dlihc eht
2.2 The Essential Package of Services under the PPTCT Programme
The PPTCT services provide access to all pregnant women for HIV diagnostic, prevention, care and
treatment services. As such, the key goal is to ensure the integrated PPTCT services delivery within
existing Reproductive & Child Health (RCH) programme.
The Essential Package of PPTCT Services includes:

• Pregnant
RoutineWomen
offer of HIV counsellingl (Group/Individual counselling)
Antenatal Care (ensure and
at-least testing to all pregnant
4 visits)–Monthly ART/ARV women
l attending
Safe sex ante-natal care, with ‘opt out’ option.
prophylaxis at ART Centers.
counselling.
• l Ensure Counselling on choices of continuation or medical termination of
Couple involvement of spouse & other family members and move from an “ANC centric” to a
l
“Family centric” approach. pregnancy (MTP)–to undertake within the first 3 months of
counselling.
pregnancy only.
l Linkages to family
• Provide ART to all HIV infected pregnant women
Screening for TB andregardless
other OIs.of WHO staging and CD4 count
planning services. l
results. Preferred regimen is TDF+3TC+Screening EFV.

and treatment for STIs.
l Free condoms. l
Behaviour
• l Promote change delivery lfor WHO
institutional all HIVclinical staging
infected and CD4
pregnant testing.
women (ANMs/ASHAs, Community
communication
workers to accompany to institutions;
l Counselling on positive
reduction living,
of stigma andsafe delivery, birth-planning
discrimination and
amongst health
(BCC) for high risk
care providers through sensitisation infant
andfeeding
capacityoptions.
building).
women and her
Couple and safe sex counselling and HIV testing of spouse and
partner. of care for associatedl conditions
• Provision (STI/RTI, TB & other Opportunistic Infections (OIs).
• Provide
testing, nutrition counselling land psychosocial
Referral support for HIV infected pregnant women
to ART Center.
considering
(Linkages with ANM, ASHAs, lCommunity
Provide ART or ARVworkers,
outreach DLNsregimen
prophylactic to advise themononCD4
based thecount
right
window, period if
foods to take and to go to Anganwadi and/or Centres for nutritional support and to the district level
clinical staging.
spouse is positive
network of Positive People for lpeer counselling and psycho-social support).
or s/he have high Nutrition counselling and linkages to Government/other
• Provide counselling and support for initiation of exclusive breastfeeds within an hour of delivery
Infant Postpartum ARV prophylaxis for mother.
the feeding and
l as l
preferred Option and continue for 6 months. After 6 months, complementary feeding
nutrition
should Family A
be given along with breastfeeds.
l Planning Services.
small number of babies born to HIV infected mothers
counselling. EBF reinforcement/Infant feeding (who
support through
who have serious illness or have died and a few reluctant mothers
l at their ownhome visits.
risk despite
Psycho-social
counselling) may decide not tol breastfeed support
but adopt throughreplacement
exclusive follow-up counselling, home
feeding (ERF).
visits and support groups.
• Provide antiretroviral prophylaxis to infants from birth up to a minimum period of 6 weeks.
• Integrate follow-up of HIV-exposed infants (HEIs) into routine healthcare services including
immunization.
HIV Exposed Infant (HEI)
• Ensure initiation of Co-trimoxazole Prophylactic Therapy (CPT) and Early Infant Diagnosis (EID)
and continued
using HIV DNA PCR breastfeeds
at 6 weeks in addition to complement
of age onwards as per the feeds
EIDafter 6 months upto 1 year for
guidelines.
• l Strengthen
Postpartumfollow-up and outreach
ARV prophylaxis through
for infant ANMs, ASHAs and District level networks and other
for 6 weeks.
l
outreach workers
Early infant diagnosis (EID) atHIV
to support infected
6 weeks of pregnant
age; repeat women
testingand
at 6their family.
months, 12 months & 6 weeks
l Co-trimoxazole prophylaxis Figurefrom1: Essential
6 weeks Package
of age. of PPTCT Services
the child.
emmargorPand
Offer of HIV Counselling TCTPTesting
P fo stneServices
nopmoC :2toerall
ugiPregnant
F Women

Pregnant Women • Ante-natal Care (ensure at least 4 visits)
• Safe sex counselling • Counselling on choices of continuation or medical termination of
pregnancynemoW tnangerP
(MTP)–to detcefnI with
undertake VIH in the first 3 months eviof tagpregnancy
eN VIH
• Couple counselling. n e m o W t n angerP
VRA/TRA ylhtnoM–)stisivonly. 4 tsael-ta erusne( eraC latanetnA l
• Linkages to family • Screening .sretnforeCTB TR(40A taGene-Xpert
sixalyhporptesting sites is being launched xes efshortly)
aS l
planning services. . g n i l l e s n u oc
fo noitanimret lacidem ro noitaand unitnother
oc fo sOIs.
eciohc no gnillesnuoC l
• foFree e l p u o C l
shtncondoms.
om 3 tsrif eht nih• tiw Screening
ekatrednuand ot–)treatment
PTM( ycnfor angSTIs.
erp
.gnillesnuoc
• Behaviour change • WHO clinical staging .ylnoand ycnaCD4 ngerptesting.
communication .sIO rehto d
• Counselling on napositive
BT rof gnliving, ineercsafe S l delivery, birth-planning
.seciv res gninand nalpinfant
(BCC) for high risk feeding
.sITS rofoptions.
tnemtaert dna gnineercS l .smodnoc eerF l
women and her
partner. . •
g n i t Couple
s e t 4 D C and
d n a safe
g n i g asex
t s l acounselling
c i n i l c O H W and
l HIV testing
e g of
n ahspouse
c ruoivaand heBother
l
living children. noitacinummoc
• d na gninHIV
Repeat nalptesting,
-htrib ,y reviled efas ,gnivil evitisop no gnillesnuoC l
• Linkage to ART services. ksir hgih rof )CCB(
considering window .snoitpo gnideef tnafni
dna esuops fo gnitset VIH dna gnillesnuoc regardless
period if spouse is • Provide ART xes efas dnof a eclinical
lpuoC stage and CD4 rcounteh dna nemow
positive or s/he have
l
.rentrap
• Nutrition counselling .nerdlihc gnivil rehtoand linkages to Government/other nutrition
high risk behaviour. programmes. VIH taepeR l
• Infant feeding • Family Planning Services.
tnand
uoc nutrition
4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l g n i r e disnoc
• EBF reinforcement/Infant feeding support through home visits.
fi doirep ,wodniw
counselling. .gnigats lacinilc ro/dna
• Psycho-social support through follow-up counselling, evitisophome si esuvisits ops and
support groups.
HIV Exposed Infant (HEI) .rehtom rof sixalyhporp VRA mutraptsoP l dna gnideef tnafnI l
• Exclusive breastfeeds up to 6 months (preferred Option-I WHO/NACO Guidelines 2010-11) and
.stcontinued
isiv emoh hbreastfeeds
guorht troppinusaddition
gnideef tto nacomplementary
fnI/tnemecrofniefeeds r FBE after .gnillesnuoc
l
6 months up to 1 year for EID
negative
emoh ,gbabies
nillesnuandoc pup
u-wto oll2ofyearshguorforht tEID
ropppositive
us laicosbabies -ohcysPwhol receive Paediatric ART.
• Postpartum ARV prophylaxis for infant .spuofor rg tminimum
roppus dna6sweeks. tisiv
• Early infant diagnosis (EID) at 6 weeks of age; repeat testing at 6 months, 12 months & 6 weeks
• Co-trimoxazole prophylaxis from 6 weeks of age. )IEH( tnafnI desopxE VIH
• HIV )11'-care
0102and senPediatric
ilediuG OART CANfor /OHinfants
W I-noand itpO children
derreferpdiagnosed ( shtnom 6asotHIV pu spositive
deeftsaethrough
rb evisulEID. cxE l
• Growth and nutrition monitoring.
• Immunizations
.TRA cirtaideaand P evroutine
iecer ohinfant w seibcare.ab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIE
• Gradual weaning after 6 months and introduction .skeew 6 rof of tnacomplementary
fni rof sixalyhporpfeeds
VRA m from
utrap6tsmonths oP l
onwards along with continuation of BF for at least 1 year for adequate growth & development of
the child..
• Confirmation of HIV status of all babies at 18 months using all 3 Antibody (Rapid) Tests.
.DIE hguorht evFigureitisop V2: IHComponents
sa desongaidof nePPTCT
rdlihc dnProgramme
a stnafni rof TRA deP dna erac VIH l
.dlihc eht
The first and foremost important Figure 2: all
step for Components
pregnantofwomen
PPTCT Programme
attending health services is to know their
HIV status as part of the routine ante natal screening blood tests. This has been clearly stated a directive
jointly issued by bothofNRHM
Offer and NACO1 (Annexure
HIV Counselling and Testing1). Services to all Pregnant Women
Four typical scenarios where pregnant women may attend the counselling and testing services include:
• Women attending ante natal clinics.
HIV Negative spouse of HIV-positive
• Pregnant HIVmen,
Infected Pregnant
or those with Women
high risk behaviour.
Pregnant
• Pregnant Womenwomen screened alt the Antenatal Care (ensure
Sub centre level by at-least 4 visits)–Monthly
ANM/Nurse (whole blood ART/ARVfinger prick
l Safe
test)sex
& Confirmation at ICTC. prophylaxis at ART Centers.
counselling.
• Women presenting directly-in-labour l Counselling on choices
(un-booked of continuation
cases, require a HIV or medical
screeningtermination of
test before
l Couple
delivery). pregnancy (MTP)–to undertake within the first 3 months of
counselling.
pregnancy only.
Screening for TB and other OIs.
2.3 General
planning services. Principles
l
l Free condoms. l Screening and treatment for STIs.

•
l
Informed consent
Behaviour change as per guidelines
l WHO toclinical
be taken for alland
staging ANCs.
CD4 testing.
communication
• Counselling to inform all pregnant l women about
Counselling the anteliving,
on positive natal routine screening
safe delivery, tests haemoglobin
birth-planning and
(BCC)
(Hb %),for Urine
high risk
albumin/sugar, VDRL/RPR, blood grouping & typing and the benefits of testing for
women
HIV. and her
• Nurse/Counsellors to provide information on the ante natal screening comprehensive package
including HIV testing through both individual counselling and group counselling information
testing,
sessions. l Referral to ART Center.
considering l Provide ART or ARV prophylactic regimen based on CD4 count
• window,
Pregnantperiod
Women if who opt-out and/or of HIV testing should be offered repeat counselling to explore
clinical staging.
the reasons
spouse is positivefor opting out, address any misunderstandings and encourage her to reconsider her
ordecision.
s/he have These
highwomen should l beNutrition counselling
offered routine and at
HIV testing linkages to Government/other
each subsequent clinic visit.
Nutrition programmes.
• risk behaviour.
Post-test counselling for all pregnant women is very important so as to educate those with
l Infant feeding
negative testsandto remain un-infected;
l PostpartumwhileARV prophylaxis
for those for mother.HIV positive tests-further
with confirmed
nutrition
counselling, support and referrals l Family
to carePlanning Services.
& treatment services.
counselling. EBFreferred
reinforcement/Infant feeding support
• Pregnant women who havel been by ANMs after whole bloodthrough
screeninghometests
visits.
must
undergo pre-test counselling landPsycho-socialfollow the usual support
HIV through follow-upsimilar
testing protocol counselling,
to the home
regular ante
natal cases at the stand-alone ICTCs for confirmatory
visits and support groups. tests.
• Disclosure of HIV status is to be done only at stand-alone ICTCs after appropriate confirmatory
testing as per laboratory guidelines (post-test counselling) and only by trained health staff (MO,
Nurse or Counsellor).
•
l
All pregnant
Exclusive women upto
breastfeeds referred to other(preferred
6 months HIV services including
Option-I ART Centre,
WHO/NACO should
Guidelines be tracked to
2010-'11)
ensure that they actually reach the services, and have been registered at the respective centres.
• EIDPartner/Spouse
negative babies and andfamily
upto(other children)
2 years for EID testing for babies
positive HIV to who
be done as per
receive ICTC guidelines.
Paediatric ART.
•
l Partner (Husband)
Postpartum involvement
ARV prophylaxis duringforthe
for infant pregnancy and thereafter. PPTCT interventions and FP
6 weeks.
l Early infant diagnosis (EID) at 6 weeks of age; repeat for
methods to be encouraged e.g., couple counselling mutual
testing at 6psycho-social
months, 12 monthssupport, &6 mother
weeksto
ART and baby to ARV,
after cessation of breastfeeds. Family planning counselling etc.
1 Co-trimoxazole
Guidelines
l for rolling outprophylaxis
NACP and from NRHM 6 weeks of age.plan in the state. No X-19020/17/2009-NACP(IEC), 10
Convergence
August 2010
the child.
5.2 Flow of HIV Infected Pregnant Women Detected during Ante-natal Care and PPTCT Services
Figure-3 summarizes the flow of pregnant women presenting in antenatal care and PPTCT services.
Figure 3: Services to Pregnant Women during Antenatal Period
Pregnant women visiting Sub center
ANC Registration by Sub center ANM/MPHW (F)
A
nemoW tnangerP detcefnI VIH evitageN VIH
Sub center: Routine ANC & PNC
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l Sub center: Screen pregnant women n e m oW tnangerP
Services for HIV, Syphilis and TB
.gnillesnuoc
fo noitanimret lacidem ro noitaunitnoc fo seciohc no gnillesnuoC l
elpuoC l
Screening Test for HIV: Screening test for Syphilis: for Tuberculosis: .gnillesnuoc
.ylnfor ycnangerp Screening
o Syphilis
-Provide Does Finger prick Whole blood test Screening for Tuberculosis:
ylimafRefer ot Pregnant
segakniL l
Group/Individual screening. .sAsk
IOpregnant
rehto dwomen
na BT forr-more
of gnthan
ineercS women to designated microscopic center at
counselling session one syndrome or condition, check for
l
. s e c i v r e
PHC if there is persistent cough of any s gninnalp
-Offer HIV test
. s I T S
Vaginal/Cervicalr o f t n e m
Discharge,t a e r t
Genital d n
ora gnineercS duration,l .smodnoItcmay
usually with expectoration. eerF l
ano-rectal ulcer/blisters, Lower Abdominal Pain be accompanied by one or more of the
.gorntenderness,
itset 4DCAno-rectal
dna gnDischarge,
igats laInguinal
cinilc OHW following l symptoms such as weight loss, heB l
e g n a h c r u o i v a
dna gninnalp-htrib ,y revileanal
Bubo, Genital or anal warts, Individuals with
d eorfagenitalwarts,
s ,gnivil eGenital
vitisoscabies,
p no Genital
gnillesnuoC fever,particularly
l
noitacofinbreath,
chest pain, tiredness, shortness ummoc
with rise of temperature in
Pediculosis, Genital lesions k s i r h g i h r o f )CCB(
.snoover
itpogenitalia
gnideef tnafni the evening, in some cases there willbe
blood in the sputum, loss reofhappetite
dna nand emow
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC night l sweats
.rentrap
-Refer to PHC with Designated
Agree for test Opt out/Refuse .retneC TRA ot larrefeR l Microscopic center (DMC) ,ifganitset
If Syphilis reactive refer to PHC/STI
tnuoc 4D
Collection of
C nsample
test
o desab nemiger citcalyhporp VClinic RA for ro symptomatic
TRA edivtreatmentand
orP l
woman hasany of the gnabove
iredisnoc
blood symptoms
and does .gnigaRPR ts latesting
cinilfor
c rconfirmation
o/dna fi doirep ,wodniw
Finger Prick evitisop si esuops
rehto/tneWholeblood
mnrevoG ot Repeat segaCounseling
knil dna gnillesnuoc noitirtuN l hgih evah eh/s ro
test for HIV .semmargorp noitirtuRPR N Positive .ruoivaheb ksir
.rehtom rofHIV
Offer sixtest
alyatheach
porp VRA mutraptsoP l d
Start n a
Anti gTuberculosis
nideef tnafnI l
subsequent visit
.seciv reS gninadvise nalContinue
ylimtreatment,
Pcondom ause
F andl partner noitirtun
treatment after confirmation
HIVNegative of TB at DMC
.stisiv emoh hguorhHIV t troppus gnideef tnafnI/tnemecrofnietreatment r FBE l .gnillesnuoc
Reactive
.spuorg trICTC us dn5a ml
oppcollects stblood
isiv for
HIV rapid test and RPR test RPR Positive
Post-test Counseling Refer to ICTC for (if RPR is not done earlier)
information, support confirmation of HIV
Start treatment
IfHIV Negative If)IHIV
EH(
tnafnimmediately,
I desopxadvise E VIH
provide post -test Positive
)11'-0102 senilediuG OCAN/OHW I-noitpO derreferp( shtnom 6 otpu sdeeftsaerbcondom
counseling i suse and
partner treatxE l
e v u l c
.TRA cirt-Refer
aideaHIV
P einfected
viecerPregnant
ohw semother
ibab to
evART
itiscenter
op DIfor
E rCD4
of stest,
raeyTB2screening
otpu dand na clinical
seibastaging
b evita**gen DIE
Ensure allreferred pregnant women actually.sreach
keewthe6ART
rof center
tnafnand
i roare
f sixstarted
alyhponorARTwithout
p VRA mudelaytraportsoP l
waiting for CD4 and other laboratory reports**
Figure 3: Services to Pregnant.eWomen ga fo skeduring
ew 6 mAntenatal
orf sixalyhpPeriod
orp elozaxomirt-oC l
National Strategic Plan Multi-Drug ARV for Prevention of Parent to Child Transmission of HIV 27
.dlihc eht
Figure and
2.3.1 Sexually Transmitted Infections 2: Components of PPTCT
Reproductive Programme
Tract Infections
Sexually transmitted infections and reproductive tract infections (STIs/RTIs) are important public health
problems in India. OfferStudies
of HIV suggest
Counselling and Testing
that around Services
6 per cent of thetoadult
all Pregnant
populationWomen
in India is infected
with one or more STIs/RTIs. Individuals with STIs/RTIs have a significantly higher chance of acquiring
and transmitting HIV. Moreover, STIs/RTIs are also known to cause infertility and reproductive morbidity.
Controlling STIs/RTIs helps decrease HIV infection rates and provides a window of opportunity for
counselling about HIV prevention and reproductive health.
Pregnant Women l Antenatal Care (ensure at-least 4 visits)–Monthly ART/ARV
Safe sex
Thel implementation framework of National Rural at
prophylaxis Health Mission (NRHM) provides the directions for
ART Centers.
counselling.
synergizing the strategies for prevention, control andon management for STI/ RTIorservices
l Counselling choices of continuation medicalunder Phase II
termination of of
Couple
Reproductive and Child Health Programme (RCH II) and Phase III of National
within AIDS Control Programme
l
pregnancy (MTP)–to undertake the first 3 months of
counselling.
(NACP III). While the RCH programmepregnancy advocatesonly.
a strong reference “to include STI/RTI and HIV/AIDS
preventions, screening and management Screening for TBand
in maternal child OIs.
and other health services”, the NACP includes
services
l Freeforcondoms.
management of STIs andl ART as a major
Screening programme
and treatment forstrategy
STIs. for prevention of HIV.
Behaviour
Syndromic
l change
Case Management (SCM)l is WHO clinical staging
the cornerstone and CD4
of STI/RTI testing.
management, being a comprehensive
communication Counselling on positive living, safe delivery, birth-planning and
approach for STI/RTI control endorsed by the World Health Organization (WHO). This
l approach classifies
(BCC) for high risk
STI/RTIwomen
into syndromes, infant feeding options.
and her which are easily identifiable group of symptoms and signs and provides treatment
for thepartner.
most common organisms causing l Couple and safe sexTreatment
the syndrome. counselling andbeen
has HIV standardized
testing of spouse and in
as given
Table
l 1. SCM achieves
Repeat HIV high cure rates because it provides
other living children.immediate treatment on the first visit at little
or no laboratory
testing, cost. However, it goes l hand-in-hand
Referral to ARTwith other important components like counselling,
Center.
partnerconsidering
treatment, condom promotion l
and referral for HIV testing.
Provide ART or ARV prophylactic regimen based on CD4 count
window, period if and/or clinical staging. of STI/ RTIs
Table 1: Syndromic Management
spouse is positive
or s/heSyndrome
have high l Nutrition counselling and linkages to Government/other
Treatment Colour-coded Kits for STI Treatment
Urethral Discharge (UD), Tab. Azithromycin 1 G (1) and Grey
Infant
Cervicitis
l (CD) feeding
Ano-rectaland
discharge l
Tab. Postpartum
Cefixime 400 mg ARV(1)prophylaxis for mother.
(ARD)Painful Scrotal Swelling (PSS)
Presumptive Treatment (PT)
counselling. l EBF reinforcement/Infant feeding support through home visits.
Vaginitis (VD) Tab. Secnidazole 2 g (1) and Green
Tab. Psycho-social
l Fluconazole 150 support
mg (1) through follow-up counselling, home
Genital Ulcer Disease- Non Herpetic visits andpenicillin
Inj. Benzathine support2.4 groups.
MU (1) and White
(GUD-NH) Tab. Azithromycin 1 G (1) and Disposable
syringe 10 ml with 21 gauge needle (1)
and
Sterile water 10 ml (1)
Genital Ulcer Disease- Non Herpetic Tab. Doxycycline 100 mg (30) and Blue
Exclusive
(GUD-NH)–for
l breastfeeds
patients allergic to upto 6Tab.
months (preferred
Azithromycin Option-I WHO/NACO
1 G (1) Guidelines 2010-'11)
penicillin.
Genital Ulcer Disease- Herpetic Tab. Acyclovir 400 mg (21)
(GUD-H)
EID negative babies and upto 2 years for EID positive babies whoRed receive Paediatric ART.
l Postpartum ARV prophylaxisTab.
Lower Abdominal Pain (LAP/PID)
for infant for 6 weeks.
Cefixime 400 mg (1) and Yellow
l Early infant diagnosis (EID) at 6 weeks
Tab. of age;400
Metronidazole repeat testing
mg (28) and at 6 months, 12 months & 6 weeks
Cap. Doxycycline 100 mg (28)
Inguinal Bubo (IB) Tab. Doxycycline 100 mg (42) and Black
l Co-trimoxazole prophylaxis from Tab. 6 weeks of age.
Azithromycin 1G
the child.
STI/ RTI Service Package emmargorP TCTPP fo stnenopmoC :2 erugiF
The syndromic approach is the foundation of STI/RTI services at all facilities. Laboratory tests can be
used wherever neavailable.
moW tnaThengerminimum
P lla ot spackage
ecivreS of
gnSTI/RTI
itseT dnservices
a gnille(Table
snuoC2)Vto
IHbe
foprovided
reffO at different
facilities are tabulated below:
Table 2: Level of Care Service Provider Modalities Package of Services
Level of Care nemoW tnanModalities

Service Provider gerP detcefnI VIH evitageN
Package of Services VIH
Village VRA/TRA ylhtnoMASHA/Link
–)stisiv 4 tworker/
sael-ta eruThrough
sne( eratheir
C latanetnA l
• Information
n e m o W t n a n g erP
Health worker .sretneC TRA ta sixalyhporp
outreach • Condom provision and xespromotion
efaS l
(M/F) meetings and • Screening for STI/RTI.gnillesnuoc
observance of village • Referral for treatmentelpuoC l
health and .gnillesnuoc
.ylno ycnangerp
nutrition days ylimaf ot segakniL l
Sub-centre ANM/Health .sworker
IO rehto dThrough
na BT roANC
f gnineercS In addition to .above,
l
seciv res gninnalp
.sITS rof tnemclinics,
taert dgroup
na gnineercS • Provide counselling
l .smodnoc eerF l
meetings and • Referral toegICTC
nahc ruoivaheB l
.gnitset 4DC dna gnigats lacinilc OHW l
household
dna gninnalp-htrib ,y reviled efas ,gnivil evicontacts
tisop no gnillesnuoC l
noitacinummoc
ksir hgih rof )CCB(
PHC/Mobile Medical Medical Officer/ .sRoutine
noitpo gOPDs,
nideef tnafni In addition to above,
reh dna nemow
dna esuops fo gnitseStaff
Unit/Dispensary/CHC/ t VIHNurse/
dna gnillesnuocANC xes eClinics/
fas dna elpuoC • STI/RTI treatment through
l
.rentrap
Urban Health post/ LHV/Laboratory Camps syndromic approach and partner
Rural Hospital/Sub Technician management
divisional .retneC TRA ot larrefeR • Simple diagnostic tests
l ,gn(including
itset
Hospital
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l Syphilis screening) g n i r e d i s noc
.gnigats lacinilc ro/dna • ARSH servicesfi doirep ,wodniw
• Referral toevICTC
itisop si esuops
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuN l
• Reporting htogidistrict
h evah RCH eh/sOfficer
ro
.semmargorp noitirtuN .ruomanagement
ivaheb ksir of
District hospital, Medical Officer STI/RTI clinic • Syndromic case
Medical College .rehtnurse
Staff om rof sixalyhpGynaecology/
orp VRA mutraptsoP l STI/ RTI d na gnideof
(provision ef directly
tnafnI l
hospitals, select Rural Counsellor, .secivObstetrics
reS gninnaclinics
lP ylimaF l observed treatment nfor oitsingle
irtun
Hospital/Sub divisional Laboratory ANC Clinics dose regimen) .gnillesnuoc
.stisiv emoh hguorht troppus gnideef tnafnI/tnemecrofnier FBE l
Hospital). Technician General OPD • Minimal laboratory testing
emoh CLINIC”
“SURAKSHA ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP l• Counselling
.spuorg troppus dna stisiv • Condom Promotion
• Partner treatment
• Syphilis screening
• Referral to ICTC
• Linkage
)IEHwith
( tnaother
fnI deservices
sopxE VIH
)11'Women
Pregnant -0102 seand
niled iuG RTI
STI/ OCAServices
N/OHW I-noitpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
All pregnant
.TRA cwomen
irtaideaPshould
eviecebe
r ohscreened
w seibabfor
evitsyphilis.
isop DIE Syphilis
rof sraeyis2 oneotpuofdnthe a seeasily
ibab evtreatable
itagen DISexually
E
Transmitted Infection (STI/RTI) caused by Treponema .skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP sexual
pallidum, which can be transmitted to l
partners
skeew 6as& well
shtnoas
m 2from
1 ,shtinfected
nom 6 tapregnant
gnitset taewoman
per ;egato fo sher
keew new6 taborn)DIE(child. sisongUntreated
aid tnafni ylsyphilisraE l is
. s d e
responsible for multisystem complications and other sickness among infected patients and may e f t s a e r b f o n o i t a s s e c r e tfa cause
miscarriages, low birth weight and premature delivery .ega info the
skeepregnant
w 6 morf woman.sixalyhpoMany rp elozpatients
axomirt-of oCsyphilis
l
.dlihc eht
Figure 2:any
are asymptomatic and do not manifest Components
symptomsof PPTCT
of the Programme
disease. The National STI/RTI prevention
and control programme mandates a screening test to detect hidden syphilis among all pregnant women
attending Antenatal Clinics.
Offer of The Rapid Plasma
HIV Counselling Reagin test
and Testing (RPR to
Services Test)
all or Venereal Women
Pregnant Diseases Laboratory
Test (VDRL Test) are the most commonly used screening tests to detect syphilis. The programme
recommends treatment of all RPR reactive patients.
HIV Negative
Process of Screening ANC Women HIV Infected Pregnant Women
ANM Safe
l at thesex
village/subcentre level will prophylaxis
do screening at test
ART for HIV and Syphilis using whole blood finger
Centers.
counselling.
prick test. l Counselling on choices of continuation or medical termination of
l Couple
counselling.
If the Syphilis test is reactive then the pregnant woman would be referred to designated STI/RTI clinics
pregnancy only.
or PHC
l Linkages
with RPRtotesting
familyavailability for Syphilis confirmation.
If the Freetest
l HIV condoms.
is reactive then the pregnant l Screening
woman and treatment
will be referredfor STIs.
to stand alone ICTC for confirmation
of HIV
l Behaviour
by rapid tests.changeThe patient then WHO clinical
l undergoes staging
pre-test and CD4 at
counselling testing.
the ICTC by the ICTC counsellor.
The ICTC collects 5 ml blood for HIV rapid tests and RPR test.
l
(BCC) for high risk
women
After HIV and and
RPRher testing, the patient returns to the ICTC counsellor for post test counselling. During
post-test counselling the ICTC counsellor provides the HIV and syphilis test report and counsels the
patienttesting,
to go to the STI/RTI clinic for further follow-up and advice from the STI/RTI counsellor and
l Referral to ART Center.
Medical officer for treatment if required.
window, period if and/or clinical staging.
spouse is
2.3.2 HIV-TB positive
Collaborative Activities
Tuberculosis (TB) is responsible for about 25% of all deaths among HIV infected individuals. The risk of
Infant feeding and 10 times higher l Postpartum ARV prophylaxis for mother.
active
l
TB is approximately in HIV-infected pregnant women compared to HIV uninfected
women. Active TB in HIV-infected pregnant women can contribute to increased risk of maternal mortality,
and is also associated with prematurity, low birth weight, and perinatal tuberculosis among infants. A
l Psycho-social support through follow-up counselling, home
recent study in India found that maternal TB increases the risk of HIV transmission from mother -to child
by 2.5 times. The key TB prevention interventions recommended by World Health Organization at HIV
care settings include airborne infection control at HIV care settings and Isoniazid Preventive Therapy
(IPT). NACP is currently implementing airborne infection control measures like fast tracking of cough
symptomatic patients, promotion of cough hygiene etc. at ART centres. Further, the National Technical
Working Group (NTWG) on TB-HIV collaboration, at NACO endorsed IPT as a strategy and recommended
its implementation at all ART centres in the country. This activity is planned for roll-out in 2014-15.
Along Postpartum
l with ARV prophylaxis
TB prevention, for infant and
early detection for 6 treatment
weeks. of HIV-TB are also important for reducing
Early
mortality.
l Theinfant
NACP diagnosis
and Revised(EID)National
at 6 weeks TBof age; repeat
Control testing(RNTCP)
Programme at 6 months, 12 months
implement & 6activities
various weeks
after
jointly to cessation
ensure early of breastfeeds.
detection and treatment. These include:
the child.
Activities for Early Detection of eHIV
mmaAssociated
rgorP TCTPPTB
fo stnenopmoC :2 erugiF
• HIV testing of presumptive TB cases

• HIV testing of diagnosed TB patients
• Intensified TB case finding (ICF) at ICTC

• ICF at ART centres
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l n e m oW tnangerP
Activities to Ensure Early Treatment of .srHIV
etneC TRA ta sixalyhporp xes efaS l
.gnillesnuoc
• Linkage of HIV-TB cases to ART elpuoC l
.gnillesnuoc
.ylno ycnangerp
• Initiation of HIV-TB cases on ART ylimaf ot segakniL l
HIV testing of presumptive TB cases: .sITS rDetection
of tnemtaeofrt HIV
dna gbyninoffering
eercS HIVl tests to diagnosed
.smodnTB oc epatients
erF l is
being implemented by NACP .gnand
itseRNTCP
t 4DC dnjointly
a gnigasince
ts lacinilc OHW l egnahc ruoivaheB l
2007-08. NACP and RNTCP decided to offer HIV test upstream during evaluation ksir hgiof h rpatients
of )CCB( for TB
when they present with TB symptoms. This activity is expected to expedite detection reh dnaofneHIV mowby 2-4
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC l .r e n trap
weeks, leading to early linkage to treatment and hence reduction in mortality.
Intensified TB case finding at ART centres: .ICF at ART centres
retneC TRA ot larrefeR l is implemented since 2010 ,gand
nitsitetis now
implemented
tnuoc 4DC at noall
deART
sab ncentres,
emiger cLink
itcalART
yhpocentres
rp VRA andro TRLink
A edART
ivorPplus g n i r e d isnoc
l centres. Gene-Xpert testing is being
fi doirep ,wodniw
proposed by the TB programme in 40 sites.gsoon nigatfor
s laearly
cinilcscreening
ro/dna and testing for
evitTB.
isop si esuops
Process of Screening ANC Women .semmargorp noitirtuN .ruoivaheb ksir
Women registered for ANC care would be .sescreened
civ reS gnifor
nnaTB
lP yalong
limaF with
l
HIV and Syphilis bynoANMs itirtun at sub
centre
.stilevel.
siv emoh hguorht troppus gnideef tnafnI/tnemecrofnier FBE l .gnillesnuoc
emoh ,for
ANM checks gniTB
llesnsymptoms
uoc pu-wo(Refer
llof hguPregnant
orht troppwomen
us laicoto s-odesignated
hcysP l microscopic centre (DMC) at PHC
if there is a persistent cough of any duration. It may be accompanied by one or more of the following
symptoms such as weight loss, chest pain, tiredness, shortness of breath, fever, particularly rise of
temperature in the evening, in some cases there can be blood in the sputum, loss of appetite and night
sweats).
rofHIV
Refer all raeypositive
1 otpu pregnant
shtnom 6women
retfa sdtoeeRNTCP
f tnemelforpmTB oc odiagnosis
t noitiddaand ni streatment
deeftsaerbatdethe uniearliest.
tnoc dna
.dlihc eht
Stand Alone ICTC Stand Alone ICTC Sub-centre level Whole Blood Finger
Offer of HIV Counselling and Testing Services to all Pregnant
Prick TestWomen
(WBFPT centre)
• Three Rapid test for Screening of Ante-natal cases Screening of Ante-natal

Confirmation of HIV for HIV and syphilis/STI/TB cases for HIV using WBFPT,
Screening women for Syphilis
• Syphilis confirmation using
HIV RPRNegative
test and HIV Infected Pregnant Women using WBFPT/STI and Screen
women for TB by history taking
• TB screening
l Safe sex • Referral linkage with
prophylaxis at ICTC
ART forCenters.
Stand-alone
counselling. confirmation
• Couple
Provides confirmation of l Counselling onofchoices
HIV status.
of continuation
• or medical
Referral termination
linkage with of
l
HIV status for Women pregnancy (MTP)–to
• Refer to STI clinic/PHC/ undertake within the first
Stand-alone 3
ICTC months
for of
counselling.
screened positive with confirmation of HIV status
pregnancy only.
ICTC with RPR testing
l Linkages
Whole Blood to Finger
familyPrick facility for confirmation of
Screening • Refer to STI clinic/PHC/
Test (WBFPT)
planning services. l Syphilis for TB and other OIs.
ICTC with RPR testing
l• Free condoms.
Provides confirmation of l Screening
• Refer to and
DMCtreatment
for TB for STIs. facility for confirmation of
Syphilis status for women Syphilis
l Behaviour change
screened reactive with l confirmation
WHO clinical staging and CD4 testing.
communication
WBFPT l
• Referbirth-planning
Counselling on positive living, safe delivery, to DMC for TB and
(BCC) for high risk confirmation
women and her
Referral Linkage with ART Tracking
Couple referral
and safeof infected
sex counselling and HIV testing of spouse and
partner.
centre
l
pregnant women to ART centre
other living children. Tracking referral of infected
l Repeat HIV pregnant women to ART centre
testing, for institutional
Coordination l Referral to ART Center. Through MO-PHC
delivery, EID, provision of ART
considering
for “direct-in-labor” cases etc. l Provide ART or ARV prophylactic regimen based on CD4 count
spouse
Liaison with is positive
outreach workers, Liaison with outreach workers, Follow-up visits to infected
ANMor etc.
s/heforhave highof HIV
follow-up
l Nutrition counselling and linkages
ANM etc. for follow-up of HIV
to Government/other
women for EID, visits to ART
infected Women
risk behaviour. Nutrition
infected programmes.
women centre, regular treatment
l Infant feeding and l Postpartum ARV prophylaxis for mother.
counselling.Figure 4: PPTCT Services
l
for Pregnant Women at Different Levels
EBF reinforcement/Infant feeding support through home visits.
2.4 Guiding Principles for Use of ART in PPTCT
The guiding principles for the use of ART to prevent HIV transmission from mother-to-child are:
• HIV infected pregnant women, in need of ART for their own health should receive life-long ART.
•
l Postpartum
Exclusive ART initiation
breastfeeds upto 6tomonths
mother (preferred
and ARV Prophylaxis to child are
Option-I WHO/NACO aimed at2010-'11)
Guidelines improving HIV-
free child survival by reducing HIV transmission through breastfeeding.
• EID
HIV negative babies and
exposed infants upto
should be2followed-up
years for EID andpositive
managed babies who
as per thereceive Paediatric
National ART.
Guidelines on “Care
l Postpartum
of HIV exposed ARVinfants
prophylaxis for infant for 6 weeks.
and children”.
In India, the PPTCT programme has been in place for many years, and recommended ARV prophylaxis
was sd of Tab Nevirapine (200mg) to mother during labour and single dose of Sy Nevirapine to the
infant at birth.
the child.
emmthe
However, with evolving evidence, argorNational
P TCTPP fotechnical
stnenopmoC :2 erugiF have been revised and, it is
guidelines
recommended that:
neinfected
1. All HIV moW tnpregnant
angerP llwomen
a ot secshould
ivreS be
gniinitiated
tseT dnaongnlife-long
illesnuoART
C VI(on
H ftriple
o reffART)
O regardless
of WHO clinical stage or CD4 cell count.
2. HIV infected pregnant women should preferably be initiated on ART at ART centre and should
not be delayed for want of CD4 cell count report.
The summary of the technical guidelines Multi Drug Anti-retroviral Regimen for PPTCT n e m oWistnprovided
angerP in
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l
Figure 5. xes efaS l
.sretneC TRA ta sixalyhporp
Care . g n i llesnduring
uoc the
fo nfor
oitathe
nimHIV-infected
ret lacidem ropregnant
noitaunitwomen
noc fo sebegins
ciohc nono gntheillesfirst
nuoCcontact
l with health services
ante e l p u oC l
fo natal
shtnom period.
3 tsriEstablishing
f eht nihtiw aekrelationship
atrednu ot–)or PTaMrapport
( ycnangwith erp the HIV infected pregnant woman is
.gnillesnuoc
fundamental in providing a continuum of care involving .ylno ycnaprevention,
ngerp care, support, and treatment for
the mother and child. This requires.sthe IO reinvolvement
hto dna BT rof of gthe
ninclinical
eercS land para-medical team at the health
.seciv res gninnalp
facility – the Obstetricians, Paediatricians, Physicians,
.sITS rof tnemtaert dna gnineercS l Medical Officers, Nurses, ANMs, ASHAs, Lab
.smodnoc eerF l
Technicians, Counsellors and Outreach Workers. District Level Positive Networks, Local Community
Based Organizations and Self-Help Groups (SHGs) should help support the HIVninfected oitacinummother moc and
dna gninnalp-htrib ,y reviled efas ,gnivil evitisop no gnillesnuoC l
her family. ksir hgih rof )CCB(
reh dna nemow
dna esuops fo gnitset VIH dna gnEstablish
illesnuoHIVc xestatus
s efasofdPregnant
na elpuWomen oC l .rentrap
Antenatal
tnKnown
uoc 4HIVDC infected
no descase
ab nand
emialready
ger citreceiving
calyhpoARTrp VRA Newly
ro TRdetected
A edivoHIV rP infection
l
g n i
HIV test Negative r e disnoc
evitisop si esuops
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuN l hgi(as
h eper
vah eh/s ro
From ICTC Collect the blood Repeat HIV test
Continue ART sample.sfor
emCD4
marandgorsend
p noitititortuN guidelines for window .ruoivah&eb ksir
period
(as per guidelines)
.rehtom rof sARTixalycentrerand
hpoART refer women to
p Vcentre
R A mutraptsoP l H/o risk factor)
dna gnideef tnafnI l
Labour & Delivery

ART Centre: Initiate ART to HIV positive pregnant mother
emoh ,gnillesnuoc pu-wregardless
ollof hguof
orWHO
ht troclinical
ppus lstage
aicosand
-ohCD
cys4Pcount
l
results
Preferred
.spuorregimen:
g troppuTDF+3TC+EFV
s dna stisiv
ART centre will collect sample for baseline and other
investigations
Mother: Continue ART during Labour, )IEH( tnafnI desopxE VIH

)11'-0102 senilediuG OCAN/OHWDelivery I-noitpand
O dthereafter
erreferplifelong
( shtnom 6 otpu sdeeftsaerb evisulcxE l
Mother: Continue ART life long
Postpartum
Infant: Daily NVP from birth until minimum 6 weeks of age,
.skeofechoice
then stop (irrespective w 6 rooff tinfant
nafnifeeding)
rof sixalyhporp VRA mutraptsoP l
skeew 6 & shtnom 21 ,shtnom 6 ta gn
Exclusive itset taeporerExclusive
Breastfeeds ;ega fo Replacement
skeew 6 taFeed )DIE( sisongaid tnafni ylraE l
Figure 5: The Summary of the Technical .ega fo Guidelines
skeew 6 moand rf sixOptions
alyhporpfor elozthe
axomirt-oC l
.DIE hguorht evitisopMore
VIH sEfficacious
a desongaidPPTCT nerdlihcRegimen
dna stnafni rof TRA deP dna erac VIH l
.dlihc eht
3
PPTCT Services under NACP
3.1 Existing FacilitiesemmargorP TCTPP fo stnenopmoC :2 erugiF
Under the National AIDS Control Programme, various HIV related services are provided through public
and private health care providers depending on the programme need and the availability of health
infrastructure, human resource and their expertise.
The PPTCT services are provided through the Integrated Counselling and Testing Centres (ICTCs)
which are of the following types: nemoW tnangerP detcefnI VIH evitageN VIH
1. Stand-Alone ICTCs: These are HIV counselling and testing facilities supported byxeNACP s efaS inl the
. s r e t n e C T R A t a s
form of staff (Counsellor & Lab Tech) and necessary logistic support. Thesei x a l y h p o r p
.gncentres
illesnuoperformc
fo noiconfirmatory
tanimret lacidtests
em ro fornoitaHIV.
unitnTypically
oc fo seciothese hc no centres
gnillesnuare oC located in Medical Colleges, elpuoCDistrict
l
l
fo shHospitals,
tnom 3 tsrTaluk
if ehtHospitals
nihtiw ekand atreCommunity
dnu ot–)PTM ( ycnaCentres.
Health ngerp
.gnillesnuoc
.ylno ycnangerp
2. Facility-Integrated ICTCs (F-ICTCs): y l i m a f ot Nurses
segakniand L lLab
.sIO rehto dThese na BTare rof gfacilities
nineercSwhere l
the staff – (Staff
.seciv res gninnalp
Technicians) from existing health facilities are trained in counselling and testing, and service
delivery is ensured with provision of HIV test kits from the NACP. though it would be best to be
purchased from NRHM budget. The centres perform only screening tests for HIV using Whole
dnaBlood
gninnaFinger
lp-htriPrick
b ,y revtest
iledkits
efasand
,gniany
vil eclient
vitisopfound no gnipositive
llesnuoCon lscreening is referred noitacinummoc
to a stand-alone
ksir hgih rof )CCB(
. s n o i t p o g n i d e e f
ICTC for confirmation. Typically, these centres are located at PHCs. The rprivate/NGOt n a f n i
eh dna nemofacilities w
also function under this model.
3. Screening Centres: These are health .facilities nerdlihc gwhere nivil rethe hto Auxillary Nurse Midwives VIH ta(ANMs;epeR lnow
called Jr. Health Assistant (F)) at existing .retneChealth t larrefeRarel trained in counselling anditscreening
TRA ofacilities , g n set
tnuocfor 4DHIV
C nby
o dwhole
esab nblood
emigefinger
r citcaprick
lyhpotest. rp VRThese A ro Tcentres
RA edivperform orP l only screening test for HIVothrough
g n i r e d i s n c
.gnigand ats lany aciniclient
lc ro/dfound
na fi doirep ,wodniw
whole blood finger prick test (WBFPT) reactive through this screening test
evitisop si esuops
rehtois/tnreferred
emnrevoto G Stand-Alone
ot segaknilICTCs dna for gnconfirmation.
illesnuoc noiTypically, tirtuN l these centres are located at PHCs
hgih evah eh/s ro
and Sub Centres. .semmargorp noitirtuN .ruoivaheb ksir
.rehtom rof sixalyhporp VRA mutraptsoP l d n a gnidiseedetailed
f tnafnI below
The 5 tier structure of public health system and HIV related services at different levels l

in the Table 3:
Table 3: HIV Services at Different Level of Health Facilities
Level of Health Infrastructure .spuorg trHIV

Available oppFacilities
us dna stisiv Available HIV Services
Medical College Stand -Alone ICTC, ART Centre ICTC, PPTCT, HIV-TB, ART
Centre of Excellence (CoE) in HIV care including
Paediatric Centre of Excellence (pCoE) Paed. ART, OI, STI, EID
District Hospital Stand- Alone ICTC, ART Centre ICTC,)IEPPTCT,
H( tnaHIV-TB,
fnI desART,
opxEOI,VISTI,
H
)11'-0102 senilediuG OCALink N/OHARTW ICentre,
-noitpOBlood
derreBank
ferp( shtnom 6 EID otpuservices,
sdeeftsLinkages
aerb evisto ulcDLNs/
xE l
rof raey 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni DIC sdeeforftspsycho-social
aerb deunitnosupport
c dna and
services
.TRA cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2 otpICTC
Sub-district/Community Health Stand- Alone ICTC, Facility-ICTC ART/
u dn/a HIVseibScreening,
ab evitagePPTCT,
n DIE HIV-
Centre Link -ART Centre.sBlood
keewstorage
6 rof tnacentre
fni rof siTB,
xalyART,
hporOI,p VSTI,
RA m utraEID
DIC, ptsServices
oP l
skeew Health
Primary 6 & shtCentres/
nom 21 ,shtnomStand-Alone
6 ta gnitsetICTCs
taeper ;ega fo skeew 6 ta )HIV DIEScreening,
( sisongaidPPTCT,
tnafni HIV-TB,
ylraE STI
l
24x7 PHCs Facility integrated ICTCs .sdeeftsaerb fo noitassec retfa
Sub-Centres Screening Centre (Whole.ega foBlood
skeew Finger
6 morf HIVsixaScreening
lyhporp elTest
ozaxomirt-oC l
Prick Test)
.dlihc eht
3.2. Continuum of careFigure 2: Components of PPTCT Programme
under PPTCT
With the revision of PPTCT guidelines that recommend use of the more efficacious Multi Drug ART regimen,
it is important to consider Prong-3 of National PPTCT programme as a continuum of interventions
rather than a one-time activity (Fig 6). This requires close coordination between various implementing
components for PPTCT-ART linkage, Early Infant Diagnosis (EID), Paediatric ART services etc.
TheHIV Negativeof care involves the HIV

continuum Infected
following Pregnant Women
steps:
1. Safe
Increasing
sex uptake of PPTCT services by pregnant women.
l
counselling.
2. Counselling and Testing of pregnant
l Counselling
womenon aschoices of continuation
an integral part of ANCor Comprehensive
medical termination of
Services
l Couple
package. pregnancy (MTP)–to undertake within the first 3 months of
counselling.
pregnancy only.
3. Linkages
l
Detectiontooffamily
HIV infected pregnant women.
4. Free
l Linking HIV infected pregnant
condoms. Screening
l women and treatment
to Care, Support andfor STIs.
Treatment services.
5. Initiating ART for all HIV infected pregnant women regardless of CD4 count, starting it as soon as
communication Counselling
diagnosed
(BCC) for high continued for llife.
andrisk However, on positive
make sure living, safesamples
to obtain delivery,for
birth-planning
CD4 cell countandand
baseline tests infant feeding options.
women and herat the time of initiating ART or soon after initiating ART.
6. Counselling on birth-planning and institutional deliveries of identified HIV infected pregnant
women.
considering
7. Screening emergency labour lroom deliveries
Provide ART (un-booked cases) forregimen
or ARV prophylactic HIV. If HIV
based positive,
on CD4providing
count
window,
ART andperiod if sample for CD4
obtaining cell count as soon
and/or clinical staging. as possible.
spouse is positive
8. orLinking of HIV
s/he have infected pregnant
high l Nutrition counselling
women identified andemergency
through linkages labour-room
to Government/other
care services
to Care, Support and Treatment services.
9. nutrition
Provision of Syrup Nevirapinel for the new
Family born infant
Planning from birth till 6 weeks of age (minimum).
Services.
At the end of 6 weeks, CPT should be initiated and baby to be linked to the EID programme.
CPT continued to baby from 6 weeks up to 18 months or until the confirmatory test of the baby
is done using all three Rapid Antibody Tests. If baby is confirmed positive, then CPT will be
continued. visits and support groups.
10. If the infant is detected positive in EID programme (DBS+WBS tests are positive), then ensure
initiation of Pediatric ART for the baby through ART centre as per ART guidelines as soon as
possible.
11. Follow-up
and continued of HIV infected mother
breastfeeds and to
in addition baby until breastfeeding
complement feeds afterperiod is over.
6 months upto 1 year for
12. At six weeks of age of baby, do DBS test and confirm with WBS test. If the age of baby is more
l Postpartum
than 6 months, ARV prophylaxis
then do antibody for infant for 6test
(rapid) weeks.
first, if found positive then only DBS sample should
l Early infant diagnosis (EID) at 6
be sent. If DBS comes positive then do a WBSweeks of age; repeat
testtesting
If WBSatis6 positive,
months, 12 months
start & 6 weeks
Paediatric ART as
after
sooncessation
as possible.of breastfeeds.
13. Confirmation of diagnosis of child using 3 anti-body tests (Rapid) at ICTCs at 18 months of age.
the child.
nemoW
Ante-natal PPTCT tnangerP lla ot sIntra
ecivnatal
reS PPTCT
gnitseT dna gnillesnuoC VIPost
H fonatal
refPPTCT
fO
services: services: services:
Initiate–ART Continue–ART Continue– ART life long

Counselling and testing in all phases; encourage institutional deliveries .gnillesnuoc
elpuoC l
.gnillesnuoc
.ylno ycnangerp
Link with ART services and CD4
.sITS Link
rof twith
nemART rservices
t dna gnand
taetesting ineeCD4
rcS l Link with ART services, CD4 testing,
.smodART
EID & paediatric nocInitiation
eerF l
testing
dna gninnaFigure
lp-htrib6:,yPRONG
reviled e3:fasContinuum
,gnivil evitisof
opCare
no gnfor
illeHIV
snuoInfected
C l Pregnant Womennoitacinummoc
ksir hgih rof )CCB(
reh dna nemow
evitisop si esuops

.dlihc eht
4
Care and Assessment of HIV Infected Pregnant Women
4.1 Care during the Antenatal Period
HIV infected pregnant women may present to ICTCs and ART centres at various stages of pregnancy
(Refer to Table 4).
• Pregnant Women who are detected to be HIV infected during ante natal care should be initiated
on ART (TDF+3TC+EFV) regardless of clinical stage or CD4 count. However, it is important to
obtain sample of blood for CD4 nem oW tnand
count angfor erPbaseline
detcefnItests VIH before initiating ART. evitaThe geNinitiation
VIH
V n e m o W t n a n g erP
ofRART
A/TRshould
A ylhtnonotM–be)stidelayed
siv 4 tsaefor l-tawant
erusnofe(CD4 eraCtest latan etnA l
results.
• Pregnant women who are detected to be HIV infected by screening test (by .gnitest
one llesnkit)uoc during
fo shactive
tnom 3 labour
tsrif should
eht nihbe tiwinitiated
ekatrednon u ARTot–)Pbut TM(should ycnanbe gerreferred
p for confirmation of HIV ostatus
e l p u C l at
the earliest and linked to ART centre, if confirmed .gnillesnuoc
.ylno ycnapositive.
ngerp
• The table below (Table 4) provides .sIO rehsummary
to dna BTof romaternal
f gnineercART S l(life long) and.seinfant
civ resARVgninprophylaxis
nalp
for different clinical scenarios.. s I T S r o f t n e m t a e r t d n a g n i n e e r c S l .smodnoc eerF l
Table 4: Summary of Maternal ART (Life Long) and Infant ARV Prophylaxis for
dna gninnalp-htrib ,y reviled efas ,gn ivil evitisClinical
Different op no gnScenarios
illesnuoC l noitacinummoc
ksir hgih rof )CCB(
Scenarios Different Clinical Scenarios Maternal ART Infant ARV reDuration
h dna nofemow
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpprophylaxis uoC l .rentrap
Infant ARV prophylaxis
Scenario 1 Mother diagnosed with HIV Initiate .nmaternal
erdlihc gART nivil rNVP ehto 6 weeks VIH taepeR l
during pregnancy .retneC TRA ot larrefeR l ,gnitset
Scenario
tnuoc 24DCMother
no dediagnosed
sab nemwith citcalyhpInitiate
iger HIV orp VR maternal
A ro TRART A ediNVP vorP l g n i
Extending NVP prophylaxisr e disntooc12
during labour or immediately
.gnigats lacinilc ro/dna
weeks fi doirep ,wodniw
postpartum and plans to evitisop si esuops
rehto/tnembreastfeed
nrevoG ot segaknil dna gnillesnuoc noitirtuN l hgih evah eh/s ro
Scenario 3 Mother diagnosed with HIV .semother
Refer mmargfor orHIV
p noitirNVP tuN 6 weeks .ruoivaheb ksir
ehtom rof sixacare
during labour or.rimmediately lyhpand orpevaluation
VRA mutraptsoP l
postpartum and plans for treatment d n a gnideef tnafnI l
Exclusive Replacement . s e c i v r e S g n i n n a l P y l i m a F l noitirtun
.stisiv emfeeding(ERF)
oh hguorht troppus gnideef tnafnI/tnemecrofnier FBE l .gnillesnuoc
Scenario
em4 ohInfant
,gnilleidentified
snuoc pas wollof hguorInitiate
u-HIV ht tropmaternal
pus laicART
os-ohcNVP
ysP l
Perform infant DNA/PCR test if child
exposed after birth (through is 6 weeks old or older Immediately
infant (at 6 weeks or after) or .spuorg troppus dna stisiv initiate 6 weeks or longer of NVP–
maternal HIV antibody testing)) strongly consider extending this to 12
and is breastfeeding weeks
Scenario 5 Infant identified as HIV Refer mother to ART No NVP Do HIV DNA/PCR test in accordance
exposed after birth (through Centre after CD4 tests (No drugs) )IEnational
with H( tnarecommendations
fnI desopxE VIon H
)11'-01infant
02 sorenmaternal
ilediuG HIVOCAN/OHWand
I-nobaseline
itpO detest
rreand
ferp( shtnom 6 otearly
pu sinfant
deeftdiagnosis;
saerb evino
sulinfant
cxE ARVl
antibody testing) and is not treatment prophylaxis; initiate treatment if the
rof raebreastfeeding
y 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni sdinfant
eeftsisaeinfected
rb deunitnoc dna
.TRA Mother
Scenario 6
cirtaidreceiving
eaP evieART
cer but
ohw seibDetermine
ab evitisoan p DIE rof sNVP raey 2 otpuUntil dna6sweeks
eibab after
evitamaternal
gen DIEART
interrupts ART regimen .sART
alternative keew 6 rof tnafni rof sixaislyrestarted
hporp VorRA mu1trweek
until aptsafter
oP l
while breastfeeding (such as regimen or solution; breastfeeding has ended
toxicity, stock-outs or refusal to counsel regarding
continue) continuing ART .sdeeftsaerb fo noitassec retfa
without interruption
.dlihc eht
HIV infected pregnant women require Figure 2: Components
joint management of PPTCT Programme
from both the HIV care team (for her HIV
condition) and the Obstetric team (for successful outcomes of pregnancy). HIV infected pregnant
women requireOfferall components of good antenatal
of HIV Counselling and Testingcare, Services
including toiron-folate supplementation,
all Pregnant Women anaemia
management, baseline CD4 count, screening of TB, prevention and management of OIs, STI treatment,
special Obstetric practices especially during labour and delivery, ART initiation and its continuation,
counselling for infant feeding options, post natal care, follow-up, family planning and contraception.
Postpartum care and follow-up for the
HIV Negative well-
HIV being Pregnant
Infected of motherWomenand infant, as well as adherence to ART and
other care, to prevent
Pregnant Women HIV transmission
l Antenatal Care (ensureisat-least
during breastfeeding important.
4 visits)–Monthly ART/ARV
Safe sex prophylaxis
ensuresatthatARTpregnancy
Centers. and delivery:
l
Good antenatal care
counselling.
l Counselling on choices of continuation or medical termination of
l Couple • Is a safe experience for the mother.undertake within the first 3 months of
pregnancy (MTP)–to
l
Box
counselling.1
Linkages to family
pregnancy only.
• Builds the foundation for the delivery of a healthy baby (minimal risk of HIV
planning services. transmission l Screening for TB and other OIs.
to the baby)
4.2 Initial assessment
(BCC) for high risk
l

women and her
All HIV infected pregnant women should haveand
Couple routine
safe sexante natal care
counselling andforHIV
thetesting
well-being of her
of spouse andbaby
partner. l
including: other living children.
l Repeat HIV
• testing,
At least 4 ANC check-ups during
l Referral to ART
pregnancy Center. and 1st check-up within 12 weeks, 2nd
(registration
considering
between 14-26 weeks, 3rd between
l Provide 28-32
ART weeks
or ARVand 4th between
prophylactic 36-40
regimen weeks)
based as per
on CD4 RCH/
count
window, period if
NACP guidelines. and/or clinical staging.
spouse is positive
• orHistory, physical
s/he have high and abdominal
l Nutrition
examination.counselling and linkages to Government/other
• Antenatal routine blood screening: Postpartum ARV prophylaxis for mother.
l Infant feeding and l
nutrition
o Hb, blood group & Rh typing,
l Family
urinePlanning
routine atServices.
1st visit; including tests for syphilis, Hepatitis
counselling.
‘B’ and HIV. l EBF reinforcement/Infant feeding support through home visits.
o Urine routine to be donel atPsycho-social
all visits, andsupport
Hb% tothrough follow-upatcounselling,
be re-checked home
the 3rd visit at 28-32
weeks gestation. visits and support groups.
• 2 Doses of Tetanus Toxoid (TT) to prevent maternal and newborn tetanus:
First dose:
HIVoExposed Infantat(HEI)
ANC registration.
l Exclusive
o Second breastfeeds
dose: 4-6upto weeks 6 after
months the(preferred
first dose, Option-I
preferably WHO/NACO
at least oneGuidelines 2010-'11)
month before the expected
date of delivery
and continued (EDD).in addition to complement feeds after 6 months upto 1 year for
breastfeeds
EID negative
• Antenatal babies and upto 2 years for EID positive babies who receive Paediatric ART.
drug supplementation:
l
o IFA
Early tablet
infant (100mg
diagnosis ironat
(EID) +60.5 mg folic
weeks of age;acid) dailytesting
repeat for 100
at days, after 12
6 months, 1stmonths
trimester
& to prevent
6 weeks
anaemia.
l Co-trimoxazole
o Double theprophylaxis
dose if anaemia from 6persists.
weeks of age.
the child.
emmargosigns,
Counselling on nutrition, rest, warning rP TCTPART
P fo slinkages-CD4
tnenopmoC :2 etesting
rugiF if HIV positive and ART, birth
planning, institutional delivery, exclusive breastfeeding within an hour of delivery, safe sex, HIV-specific
advice and contraception.
From the HIV care aspect for pregnant women, the initial assessment follows standard adult ART
guidelines including:
• WHO clinical staging. nemoW tnangerP detcefnI VIH evitageN VIH

• Clinical screening for TB and STI symptoms: Screen for TB at each visit: Intensified Case Finding
xes efaS l
(ICF) as per TB-HIV guidelines.sfor retn eC TRA taTB
screening sixin
alyall
hpoHIV-infected
rp individuals..gnillesnuoc
fo sho tnom Clinical
3 tsriscreening–ask
f eht nihtiw ekfor atrcough
ednu o(oft–)any
PTMduration),
( ycnangecoughrp with blood in sputum,elunexplained puoC l
fever or weight loss, fatigue, night sweats, .gnilleglands/nodes
snuoc
.ylnoloss
ycnaofngappetite,
erp pleuritic chest pain;
in neck, armpits/axilla or y l i m a f o t s e g akniL l
.sIgroin.
O rehto dna BT rof gnineercS l .seciv res gninnalp
o The normal weight gain .sITSinrofatnnormal
emtaertpregnancy
dna gnineeisrcSaround l 11 kg. Most .smofoditnoccurs
oc eerF inl the
second and third.gntrimester
itset 4DC(approximately
dna gnigats laci5nilkg c Oin
HW each l trimester), ewhile gnahcthe ruofirst
ivahetrimester
B l
dna gninisnausually
lp-htrib1-2,y rekg.
viledThe
efaweight
s ,gnivilgain
evitispatterns
op no gnishould
llesnuobe C co-related
l clinicallynoitaandcinum mocfactors
other
like twin pregnancy, hyperemesis gravidarum during the first ksir h
trimester gih Arofailure
etc. f )CCB(to gain
weight should arouse the suspicion for further evaluation. Weight loss reh dduring
na nempregnancyow
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC l .r e n t r ap
requires detailed assessment, because it can be a sign of underlying Opportunistic Infections
(OIs) in HIV infected individuals. .nerdlihc gnivil rehto VIH taepeR l
• Screen and treat any STIs: any concurrent STIs may increase the risk of HIV transmission g n i r e disnoc from
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l
mother-to-child, and may adversely.gnaffect igats lthe
acinpregnancy.
ilc ro/dna Treat STIs according fi doirep to ,wothedniw national
guidelines. Baseline laboratory investigations as per national adult guidelines. evitisop si esuops
• CD4 cell count (baseline): .semmargorp noitirtuN .ruoivaheb ksir
.rehtom rof sixalyhporp VRA mutraptsoP l
o Women who do not return for results should be actively traced back gand d n a nidebrought
ef tnafnI tol the
continuum of care through the help of grass-root level health functionaries – ANMs/ASHAs/
.stisiv em oh hguorhthealth
troppuworkers.
s gnideef tnafnI/tnemecrofnier FBE l .gnillesnuoc
Community
• Initiate adherence counselling (antiretroviral treatment for mother and ARV prophylaxis for infant)
and it is re-emphasized that the initiation of ART for the pregnant women should not be withheld
for want of the above laboratory investigations and clinical staging. Initiate Co-trimozaxole
Prophylactic Therapy (CPT) if CD4 ≤ 250 cells/mm3.
• Nutritional counselling for the mother: good food, rest and exercise.
• roAdherence
f raey 1 otp tou iron-folate
shtnom 6 and retfavitamin/mineral
sdeef tnemelpmsupplements.
oc ot noitidda ni sdeeftsaerb deunitnoc dna
• Counsel for regular ante natal check-up and institutional delivery.
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taepean
• Counsel for exclusive breastfeeding within r ;ehour
ga fo ofskedelivery.
ew 6 ta )DIE( sisongaid tnafni ylraE l
• No MIXED FEEDING (No breast feeding and other milk feeds .sdduring
eeftsaertheb fofirst
noita6ssmonths)
ec retfa under
any circumstances. .ega fo skeew 6 morf sixalyhporp elozaxomirt-oC l
.dlihc eht
4.3 Criteria for ART Initiation
Initiation of ART in pregnant women needs to be done at the earliest and after adequate treatment
preparedness for adherence to maintain her own health and also to prevent HIV virus transmission to
the unborn baby.
In HIV infected pregnant women the dictum should be “do not delay ART initiation”. The eligibility
HIV for
criteria Negative HIV Infected
initiating ART in HIV positive pregnant Pregnant
women Women
are as below:
l Safe sex ART eligibility inprophylaxis
pregnant women:
at ART Centers.
counselling.
Counselling
• Initiate lifelong
l ART in all onpregnant
choices ofwomen
continuation or medical HIV
with confirmed termination of
infection
l Couple
pregnancy (MTP)–to undertake within the first
regardless of WHO clinical stage or CD4 cell count. TDF + 3TC + EFV 3 months of
counselling.
pregnancy only.
l Box to2 family is recommended
Linkages as first-line ART in pregnant and breastfeeding women,
Screening
planning services. (including pregnant women
l for TBinand
theother
first OIs.
trimester of pregnancy and women
l Free condoms. Screening
of childbearing age)
l and treatment for STIs.
communication • ART shall lbe Counselling
initiated only at ART centre
on positive living, safe delivery, birth-planning and
(BCC) for high risk
women and her
4.4 Indications
partner. for Co-trimozaxole
l
Prophylactic Therapy (CPT) in
Repeat HIV other living children.
Pregnancy
l

considering
The indications for co-trimozaxole initiation
l ProvideinART
pregnant
or ARVwomen are same
prophylactic as those
regimen based for othercount
on CD4 adults
window, period if
(CD4≤250 cells/cmm). Co-trimoxazoleand/or prophylaxis
clinicalisstaging.
helpful in reducing morbidity and mortality as it
spouse is positive
prevents Opportunistic Infections (OIs) l such as Pneumocystis
Nutrition counselling jiroveci pneumonia
and linkages to(PCP), toxoplasmosis,
Government/other
or s/he have high
diarrhoea as well as other bacterial infections.
risk behaviour.
Infant feeding and l Postpartum ARV prophylaxis for mother.
l
Starting Co-trimoxazole in pregnancy
counselling. • Co-trimoxazole
l EBFshould be started if CD4
reinforcement/Infant count
feeding is ≤ through
support 250 cells/mm3 and
home visits.
continued lthrough pregnancy, delivery and breastfeeding as
Psycho-social support through follow-up counselling, home per national
Box 3 guidelines (Dose:
visitsDouble strength
and support tablet – 1 tab daily).
groups.
• Ensure that pregnant women take their folate supplements regularly.

the child.
5
ART for HIV Infected Pregnant Women
All HIV infected pregnant women Figure 2: Components
(irrespective of CD4ofcount/Clinical
PPTCT Programme
stage) should receive lifelong ART.
This treatment serves two key purposes:

1. Improves health and prolongs survival of the mother.
2. Reduces the risk of HIV transmission from mother-to-child during pregnancy, labour, delivery, and
throughout the breastfeeding period.
5.1l Safe
HIVsexInfected Pregnant prophylaxis Womenatbeing Newly Initiated on ART
ART Centers.
counselling.
HIV-infected Counselling on choices of continuation or medical termination of
Couplepregnant women who are initiated on ART should be referred for routine baseline clinical
l
l
and laboratory evaluation as per national pregnancy
guidelines(MTP)–to
for adultsundertake within the
and adolescents. The first 3 months
absence or delay of of
counselling.
pregnancy only.
laboratory
l investigations
Linkages to familyshould not prevent the initiation of ART.
Box 4
communication All HIV infected
l
pregnant women
Counselling should
on positive be safe
living, seendelivery,
on a priority in the ART
birth-planning and
(BCC) for high risk
Centre. infant feeding options.
women and her
5.2 Principles
considering of management l Provide ART or ARV prophylactic regimen based on CD4 count
5.2.1 spouse is positive Pregnant Women should Start ART
All HIV-infected l Nutrition counselling and linkages to Government/other
or s/he have high
• risk behaviour.
Start Nutrition
ART as soon as possible and continue programmes.
ART throughout pregnancy, delivery, breast feeding
l Infant
periodfeeding and
and thereafter lifelong.
l Postpartum ARV prophylaxis for mother.
• counselling.
Even if the pregnant women lpresents very late in pregnancy
EBF reinforcement/Infant (including
feeding supportthose
throughwho present
home visits.after
36 weeks of gestation), ART should be initiated promptly.
5.2.2 Choice of ART Regimen for HIV-infected Pregnant Women
There are several regimens recommended for use as first-line ART regimen for adults in India.
However, in case of
HIV Exposed HIV infected
Infant (HEI) pregnant women requiring ART, the recommended first-line regimen is
Tenofovir
l
(TDF) (300
Exclusive mgs) +
breastfeeds Lamuvidine
upto 6 months(3TC) (300 Option-I
(preferred mg) + Efavirenz
WHO/NACO (EFV) (600 mg).
Guidelines 2010-'11)
EID negative babies and upto 2 years
The recommended for EIDregimen
first-line positive babies
for HIVwho receivePregnant
infected PaediatricWomen
ART. is
Postpartum ARV prophylaxis for infant for 6+ weeks.
l
Box 5 Tenofovir (TDF) (300 mg) Lamuvidine (3TC) (300 mg) + Efavirenz (EFV)
l Early infant diagnosis (EID) at 6 weeks of age;
(600 mg) (if there is no prior exposure repeat testing at 6 (NVP/EFV)
to NNRTIs months, 12at months & 6 weeks
any gestational
after cessation of agebreastfeeds.
the child.
First line ART for pregnant and breastfeeding women and ARV drugs for their infants
• A once-daily fixed-dose combination of TDF + 3TC + EFV is recommended as first-line ART in
pregnant and breastfeeding women, including pregnant women in the first trimester of pregnancy
and women of childbearing age.
• Infants of mothers who are receiving nemoWART tnanandgerPare efnI VIH breastfeeding or edoing
detcexclusively vitageexclusive
N VIH
VRA/TRA yfeeding
replacement lhtnoM–should)stisiv 4 tsael-tatleast
receive a erusnsixe( eweeks
raC laof
taninfant
etnA prophylaxis
l n e m o W t n
with daily Syp Nevirapine. a ngerP
Infant prophylaxis should begin at .srbirth
etneCorTR A ta sHIV
when ixalyexposure
hporp is known. xes efaS l
.gnillesnuoc
elpuoC l
The recommended first-line regimen for pregnant .gnillesnas uoca fixed
.ylnand
o ycnbreastfeeding
angerp women, is available
dose combination (FDC), is safe for .sIboth
O rehtpregnant
o dna BT and rof gnbreastfeeding
ineercS l women and .sectheir
iv res ginfants,
ninnalpis well
.sITS rof tnem
tolerated, has low monitoring requirements, istacompatible
ert dna gninwitheercSother l drugs used in.sclinical
modnoccare, eerF and
l is
.gnitset 4DC dna gfor

harmonised with the new recommendations nignon-pregnant
ats lacinilc OHwomen W l as well asegfor namen.
hc ruoThe ivahalgorithm
eB l
dna for
for ART gninpregnant
nalp-htriwomen
b ,y revileand
d efatheir
s ,gninfants
ivil evitiis
sodescribed
p no gnillesinnuFigure
oC l 7 below noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
PREGNANT AND BREASTFEEDING
MTCT RISK PERIOD
HIV – EXPOSED INFANTS

WOMEN WITH HIV .nerdlihc gnivil rehto VIH taepeR l
evitisop si esuops
rehto/tnemnrevoG ot segaknil dna gnillesnuoc nExclusive oitirtuN Breastfeeding
l
hgih evah eh/s ro
.semmargorp nfor oitfirst
irtuN 6 months. Daily .Exclusive
ruoivaheReplacement
b ksir
.rehtom rof sixalyhporp VRA mutraNVP ptsoP for minimum feeding for first 6 months
l
6 weeks (or maximum d n a g n i d e e f t nafnI l
Initiate lifelong ART: .seciv reS gninnalP yliifmmaternal
aF l ART 6 weeks
noitiof rtuNVP
n
started late) .gnillesnuoc
.stisiv emoh hguTDF
orh+ t t3TC
ropp+usEFVgnideef tnafnI/tnemecrofnier FBE l
emoh ,(Assess
gnillesnCD4
uocbaseline
pu-wolbut
lof hdogunot
orht troppus laicos-ohcysP l
CESSATION OF MTCT RISK
withhold ART while waiting for results)

.spuorg troppus dnEarly
a stiinfant
siv diagnosis (EID) at 6 weeks, 6 months; 12
(ART Initiation to be done only at ART centre) months (or after 6 weeks of stopping
breast-feeds completely)

Final infant diagnosis at 18 months (3 rapid tests)
LINKAGE TO ART TREATMENT .skAND
eewCARE
6 rofFORtnafn i rof sWOMAN
BOTH ixalyhpoAND rp VINFANT
RA mutraptsoP l
Figure 7: Algorithms for the 2013 Recommendations for Pregnant .sdeand
eftsaBreastfeeding
erb fo noitassecWomen retfa
Lifelong ART for all Pregnant and Breastfeeding Women with HIV
.dlihc eht
Figurewomen
The alternate regimen if the pregnant 2: Components of PPTCT
are unable Programme
to tolerate preferred first-line regimen are as
below:
Offer of HIV CounsellingPreferred
First-Line ART for
and Testing Services to all Pregnant
First-line Regimen
Women
Alternate First-line Regimens
HIV positive pregnant women TDF + 3TC+ EFV AZT+ 3TC+EFV
AZT+3TC+NVP
TDF+ 3TC+NVP
5.2.3 Safety of
Pregnant Women Efavirenz (EFV) in Pregnant
l
Women
Antenatal Care (ensure at-least 4 visits)–Monthly ART/ARV
Safe sex
is a critical issue for pregnant andprophylaxis at ART Centers.
l
Safety counselling. breastfeeding women and infants as well as women who might
become
l pregnant. Although data on EFV and TDF use in pregnantcontinuation
Couple
l Counselling on choices of women remain or medical
limited, termination of
more data have
become counselling.
available since 2010 and provide increased
pregnancy only.assurance for recommending TDF+3TC+EFV as
the first-line ART regimen for pregnant and breastfeeding women
planning services. l Screening for TB and other(Ford.
OIs. N et. al, 2011, Ekouevi DK et.al
2011,
l
Use condoms.
Free of Efavirenz during pregnancy:
l a public
Screening andhealth perspective,
treatment for STIs. Technical update on treatment
optimisation,
l BehaviourGeneva, World Health lOrganization,
change WHO clinical2012).
stagingBased
and CD4on testing.
evidence available, EFV has been
communication
recommended for use in pregnant women
l in all trimesters
Counselling of pregnancy
on positive living, safeincluding first trimester. and
delivery, birth-planning
(BCC) for high risk
women and her
5.3 partner.
ART Regimen for Pregnant l Couple Women
and safe sexhaving
counsellingPrior
and HIVExposure to
testing of spouse and
Repeat
l NNRTIs HIV for PPTCT other living children.
considering
HIV infected pregnant women who have l
had previous
Provide ART orexposure to Sd NVPregimen
ARV prophylactic (or EFV) based
for PPTCT prophylaxis
on CD4 count
window, period if
in prior pregnancies, an NNRTI-based ART and/or clinicalsuch
regimen staging.
as TDF+3TC+EFV may not be fully effective
spouse is positive
due to orpersistence
s/he haveofhigh
archived mutation
l Nutrition
to NNRTIs.counselling
Thus, theseandwomen linkages to Government/other
will require a protease-inhibitor
based risk
ARTbehaviour.
regimen viz: Nutrition programmes.
TDF +nutrition
3TC + LPV/r (Lopinavir/ritonavir)
l Family Planning Services.
The dose will be TDF+3TC (1tabletdaily)+ l
LPV (200mg)/r (50mg) (2 tablets BD)
5.4 Pregnant Women Already Receiving ART
Pregnant women who are already receiving ART for their own health, should continue to receive the
sameHIV Exposedthroughout
regimen Infant (HEI) pregnancy, labour, breast-feeding period and thereafter life-long. If a woman
Exclusive breastfeeds
is on an EFV based regimen,
l upto 6 months
there is no need(preferred Option-I with
to substitute WHO/NACO Guidelines
nevirapine 2010-'11)
(this was done as per
earlier guidelines). She must continue on whatever regimen she is stabilized on and is responding to
adequately.
the child.
5.5 Clinical and Laboratory Monitoring of Pregnant Women
Receiving ART
Clinical and laboratory monitoring of HIV infected pregnant women on ART should be done as per
national ART guidelines for adults and adolescents.
Key points to be noted in pregnant women nemoW in tmonitoring

nangerP deART tcefnin I Vpregnant
IH women are: evitageN VIH
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l nemoW tnangerP
• Look for clinically significant anaemia among HIV-infected pregnant women, since anaemia
during pregnancy is common (usually developing around 28-34 weeks of gestation). .gnillesnuoc
elpuoC l
fo• shWHO
tnom clinical
3 tsrif estaging
ht nihtwilliw ehelp
katreindnmonitoring
u ot–)PTM(the ycnpatient
angerpclinically, potential disease progression
.gnillesnuoc
or treatment failure. .ylno ycnangerp
• Weight loss is one of the .indicators
sITS rof tneused
mtaeto rt determine
dna gnineedeteriorating
rcS l clinical stage,
.smodbut noc thiseerFcan l
be
difficult to assess during .gnitspregnancy.
et 4DC dna Whengnigatsdefining
lacinilc O the
HW clinical
l stage of eagn pregnant
ahc ruoivwoman, aheB lit is
dnanecessary
gninnalp-htotritake
b ,y reinto
viledconsideration
efas ,gnivil evher
itisoexpected
p no gnillweight
esnuoCgain noitacinummoc
l in relation to the gestational age of
the pregnancy and her potential weight k s i r hgih rof )CCB(

.snoiloss
tpo gfrom
nideeHIV
f tna(see
fni section 5.1).
reh dna nemow
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC l .rennausea
trap and
• ART-related side-effects may overlap with that of common pregnancy conditions eg.
.nerdlihc gnivil rehto VIH taConsultepeR l the
vomiting. Minor symptoms should be controlled symptomatically with medicines.
.retneC TRA ot larrefeR l , g n itset
Obstetrician for drugs that are safe for use in pregnancy. g n i r e d i s noc
.gnigatsabsolute
lacinilc roCD4
/dnacell count decreasesfi doirep ,wodniw
• Due to pregnancy-related haemo-dilution, during pregnancy.
evitisop si esuops
rehtoAfter
/tnemdelivery,
nrevoG body ot sefluidgaknchanges
il dna normalise
gnillesnuoto c the
noinon-pregnant
tirtuN l state, and
hgihCD4 evahlevels eh/s may ro rise
.semmargorp noitirtuN .ruoiwoman
vaheb kreceiving
sir
by 50-100 cells/ul. Therefore, a decrease in absolute CD4 count in a pregnant
.rehtom rof sixalyhporp VRA mutraptsoP l d n a g n i d e e f t n a f nI l
ART in comparison to CD4 values prior to pregnancy may not necessarily indicate immunologic
decline and should be interpreted with caution (ref to SACEP in case of any doubt).
The recommended
emoh ,gnillesclinical
nuoc pu-and
wollolaboratory
f hguorht trfollow-up
oppus laicschedule
os-ohcysPforl pregnant women is similar to that
recommended for non-pregnant adults, and .spuisordetailed
g troppusindn Table
a stis5.
iv Additional assessments of hemoglobin
or Liver Function Tests (LFT), Renal Function Tests (RFT) should be performed when warranted by
clinical signs & symptoms.
HIV care and follow-up of pregnant women should be scheduled to coincide with their antenatal visits,
as far as possible. Document all investigation results in the RCH/MCH card (Antenatal & Child) also, so
that the .TObstetric
RA cirtaiteam
deaP is
eviaware
ecer ohofwtest
seibresults.
ab evitiInform
sop DIEpatient
rof srato
ey ensure
2 otpu that
dna other
seibabhealth
evitagcare
en Dproviders
IE
in the team eg. Obstetricians & their support staff are updated on the progress of their
.skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP l HIV care.
ske6ew
After 6 & shof
months tnopregnancy,
m 21 ,shtnin
omcase
6 taagpregnant
nitset taewoman
per ;egaisfounable
skeew to 6 tgoa )D
toIEthe
( siART
songacentre,
id tnafn i ylART
the raE drugs
l

can be given to an authorised member of her family. The drug dispensing to an authorised member can
continue for 2 more months after delivery. ( Refer Annexure-17)
.dlihc eht
Figure
Table 5: Recommended Clinical and2: Laboratory
Components Follow-up
of PPTCT Programme
of Pregnant Women Receiving ART
Assessment Baseline 2 Weeks 4 Weeks 8 Weeks 12 Weeks Every 6 Comment

Offer of HIV Counselling and Testing Services to all Pregnant
Months Women
Clinical evaluation √ √ √ √ √ √ Every month
Adherence counselling √ √ √ √ √ √ Every month
Weight √ √ √ √ √ √ Every month
*Haemoglobin
HIV Negative √ √ Infected
HIV √ Pregnant √ Women √ √ Re-check at 28-32
weeks
√ √ X X X √ As and when required
l Safe sex
ALT (LFT) prophylaxis at ART Centers. clinically
counselling.
Urinalysis* √ l Counselling on choices of continuation √** or medical termination
**Specifically for of
l Couple
pregnancy (MTP)–to undertake within the TDF-based regimen. of
first 3 months
counselling. Urinalysis dipsticks is
pregnancy only. routinely done in
planning services. l Screening for TB and other OIs. follow-up
CD l4 count
Free condoms. √ Thereafter
l every 6 months as per guidelines
Screening and treatment for STIs.
Blood
l
Urea / Sr. Creatinine
Behaviour change √ l WHO clinical staging and CD4 testing.√
Blood Grouping and
communication Typing √
l Counselling on positive living, safe delivery, birth-planning and
HBV, HCV(BCC) for high risk √ Screening should
screening infant feeding options. be performed in
women and her
Couple and safe sex counselling and HIV States
testing where ANCs
of spouse and
partner. l
are being tested
l Repeat HIV other living children. routinely or based on
testing, l Referral to ART Center. the risk profile (e.g.
considering IDUs, through blood
transfusion)
RPR/ VDRL*
spouse is positive √
Blood Sugar*
or s/he have high √ l Nutrition counselling and linkages to Repeat Government/other
every 6 months
Lipid profile
risk behaviour. √ Nutrition programmes. if started on LPV/r
based regimen
* Normally part of standard ante-natal routine screening.
counselling.
A baseline Blood urea and serum creatinine should be undertaken before starting Tenofovir based regimen, wherever available
l EBF reinforcement/Infant feeding support through home visits.
(ART should not be withheld in pregnant women for want of these baseline investigations that could be carried out over time,
as soon as possible). l Psycho-social support through follow-up counselling, home
visitsand
Lipid profile and Blood Sugar at baseline, 6 months andonesupport
year, if groups.
started on LPV/r based regimen.
Table 6: Dosage Schedule and Common Side-Effects with ART Drugs
Name of ARV Dose Major side-effects

1 Tenofovir Disoproxil Fumarate (TDF) 300mg Once Daily Nephrotoxicity, Hypophosphaetemia
2 Lamivudine (3TC) 300mg Once Daily Very few side effects: Hypersensitivity,
and continued breastfeeds in addition to complement feeds after 6 months
rarely upto 1 year for
Pancreatitis
3 EID negative
Efavirenz (EFV) babies and upto 2 600 years mgfor EIDDaily
Once positive babies who receive Paediatric
Neuro-psychiatric symptomsART.
like
l Postpartum ARV prophylaxis for infant for 6 weeks. hallucinations, suicidal ideations,
nightmares, vivid dreams etc
4 Lopinavir/Ritonavir (LPV/r) 400/100 mg Twice Daily Gastro-intestinal disturbances, glucose
after cessation of breastfeeds. (Dose of FDC tablet of LPV(200mg)/r intolerance, Lipo-dystrophy and
l Co-trimoxazole prophylaxis from 6 weeks– 2oftabs
(50mg) age.BD) hyperlipidemia
the child.
5.6 ARV Prophylaxis for Infants Born to Mothers Receiving Life-long ART
Infant ARV prophylaxis is required for all infants born to HIV infected women receiving ART to further
reduce pre-partum and postpartum HIV transmission, in addition to the protection received from
the mother’s ART regimen. Infant ARV prophylaxis provides added protection from early postpartum
transmission, particularly in situations where women started ART late in pregnancy, have less than
optimal adherence to ART and have not nemachieved
oW tnangfull
erPHIV
detcviral
efnIsuppression.
VIH evitageN VIH
VRA /TRAprophylaxis
ylhtnoM–)swhere
tisiv 4 tmothers
sael-ta earerusnreceiving
e( eraC laART tanetis: nA Daily nemoW tnangerP
The infant ARV l
NVP for 6 weeks (i.e. till the first
.sretneCof TRwhether
A ta sixalthe yhpoinfant rp xes efaS l
immunization visit for the infant), regardless is exclusively breastfed or receives
.gnillesnuoc
fo noitareplacement
exclusive nimret lacidem ro noitaunitnoc fo seciohc no gnillesnuoC l
feeding. elpuoC l
Dose and duration of infant daily NVP prophylaxis.yis .gnillesnuoc
lnogiven
ycnabelow
ngerp in Table 7.
Table 7: Dose.sand IO reDuration
hto dna Bof T rInfant
of gninDailyeercS NVP l Prophylaxis
.seciv res gninnalp
.sITS rof tnemtaert dna gnineercS l .smonodWHOnoc eeGuidelines)
rF l
(based
Birth Weight NVP daily dose (in mg) NVP daily dose (in ml)* Duration
Birth to 6 weeks: ksir hgih rof )CCB(
Infants with birth weight < 2000 gm 2 mg/kg once daily. 0.2 ml./kg. once daily rehtod6nweeks
Up a nemow
dna esuops fo gnitset VIH dna gInnconsultation
illesnuoc xewith s efaas dna elpuoC l irrespective.rofenwhether
trap
paediatrician trained in HIV exclusively breast fed or
care. exclusively replacement
Birth weight 2000 – 2500 gm
.retneC TRA ot larrefeR l
10 mg. once daily 1 ml. once a day fed. (may be,gextended
nitset
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l to 12 weeks, ifismother
g n i r e d noc
.gnigats lacinilc ro/dna fi doirep ,wodnART
has not received iw for
adequate duration
evitisop si esuops
Birth
rehweight
to/tnemore
mnrethan
voG2500
ot gm segaknil15 dmg.na once
gnidaily
llesnuoc noi1.5 tirtuml. N once
l a day i.e atleast 24 weeks
hgih evah eh/s ro
. s e m
*Considering the content of 10 mg Nevirapine in 1ml suspensionm a r g o r p n o i t i r t u N .ruoivaheb ksir

.dlihc eht
6
Interventions for Women Diagnosed with HIV
Infection in Labour and Postpartum
emmof
There is a significant percentage argpregnant
orP TCTPPwomen
fo stnenowith
pmoC unknown
:2 erugiF HIV status presenting directly-
in-labour for delivery (un-booked cases). Any pregnant woman who presents in active labour with
unknown HIV nestatus
moW tshould
nangerPbellaoffered
ot secthe
ivreSroutine
gnitseTscreening
dna gnilof
lesHIV,
nuoCwith
VIHopt-out
fo reffOoption as per
National Guidelines. Screening using Whole Blood Finger Prick Test in the delivery/labour ward should
be undertaken.

6.1 VPregnant
RA/TRA ylhtnWomen
oM–)stisiv 4intsaLabour
el-ta erusnWho
e( eraCare
latanFound
etnA Positive innemoW tnangerP l
HIV-screening Test should .sretneCbe:

TRA ta sixalyhporp xes efaS l
.gnillesnuoc
fo1.
noiInitiated
tanimret on
laciART
dem (TDF+3TC+EFV)
ro noitaunitnoc fo simmediately. eciohc no gnillesnuoC l
elpuoC l
.gnillesnuoc
2. The next day the Counsellor should visit the .ylnopost-natal
ycnangerpward offer pre-test Counselling, counsel
and advise for exclusive breast .sIOfeeding
rehto dnfor a Bfirst
T ro6months,
f gnineercSif she l
has already
.sestarted
civ res gbreast
ninnalfeeds; p if
. s I T S r o f t n e m t a e r t d n a
not she must be counselled on option for breast vs replacement feeding but mustg n i n e e r c S l .smodadhere
noc eerto F either
l
. g n i t s e t 4 D C d n a g n i g a t s l a c i n i l c O H W
exclusive breast feeding or exclusive replacement feeding the first six months. Thereafter, thelLab l e g n a h c r u o i v a h e B
dnatech
gninwill
nalpconfirm
-htrib ,y rthe
evilHIV
ed efstatus
as ,gniby vil e3virapid
tisop anti-body
no gnillesntests. uoC Bloodl
noitacinummoc
sampleksfor
ir hCD4
gih rtesting
of )CCBshall ( be
. s n o i t p o g
drawn of all HIV confirmed cases by Lab tech and S/he will personally carryn i d e e f t n a f n i
rehthe dnasample
nemowto CD4
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC l
lab and bring the report along with a month’s supply of ART taking her spouse orrebuddy . ntrap along
.nerdlihc gnivil rehto
with her/him under extreme circumstances when the post-partum mother isVIunable H taepeto R reach
l
.retneC TRA ot larrefeR l , g n i t s e t

the ART Centre within the next 2 days for Pre-ART Registration and Adherence gniredCounselling.
isnoc
However, she should be motivated and followed- up for ensuring she reports fi doirep ,woART
to the dniwCentre
within 30 days. The ICTC Counsellor and Lab Technician after confirming evitisherop sstatus
i esuopthe s next
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuN l h g i h e v a h e h / s r o
day will ensure no interruption in the .sem continuation
margorp noiART tirtuNonce the first dose .was given to the HIV
ruoivaheb ksir
positive pregnant women
.rehtom in rofthesixalabour-room
lyhporp VRAand mutrthe aptnext
soP day l in the post-natal
dna gnidward.eef tnafnI l
The broad principle is “as far as possible direct-in-labour women must be seen by ART Medical Officer”
at the earliest opportunity but this should not lead to delaying in ART initiation. All efforts should be
made that at least she is seen by the facility Medical Officer.
)IEH( tnlabour
Women who are screened and found HIV Infected during afnI deorsojust
pxE after
VIH
)11Box
'-01026seniledelivery
diuG OCshould
AN/OHWbeI-n oitpOadeTop
given rrefePriority
rp( shtnfor
om Clinical
6 otpu sdManagement
eeftsaerb evisand
ulcxECD4 l
rof raey 1 otpu Assessment

shtnom 6 rein sdeART
tfathe ef tneCentre.
melpmoc ot noitidda ni sdeeftsaerb deunitnoc dna


National Guidelines for Prevention of Parent-to-Child Transmission of HIV 43
.erac tnafni enituor dna snoitazinummI l
.dlihc eht
Protocol for Women Presenting Directly-in-Labour (Unbooked Cases)

Pregnant women coming directly-in-labour
Intrapartum
Pregnant Women
Found HIV positive using Whole Blood
l Finger Prick
Antenatal testing
Care in labour
(ensure room/4delivery
at-least ward
visits)–Monthly ART/ARV
l Safe sex prophylaxis at ART Centers.
counselling.
l Couple Collect blood sample for CD4 and send the sample next day to ART centre
pregnancy
Initiate maternal (MTP)–to undertake within the first 3 months of
ART (TDF+3TC+EFV)
counselling.
pregnancy only.
Next morning:
Postpartum
l FreeCounselling
condoms. l
and confirmation of HIV status and blood sample collection for CD4 testing
communication l CounsellingMother: Continue living,
on positive ART after delivery
safe delivery, birth-planning and
(BCC) for high risk
women and her
Repeat
lInfant: DailyHIV
Sy. Nevirapine from other living children. Mother: Link with ART centre to
birth until 6 weeks (minimum)
testing, l Referral to ART Center. ART as soon as possible.
continue
spouse Figure 8: Protocol for Women Presenting Directly-in-Labour (Unbooked Cases)
is positive
6.2l riskARV behaviour.
Prophylaxis
Infant feeding and
for l
Infants
PostpartumBorn to Women
ARV prophylaxis Presenting in
for mother.
Active Labour
All infants born to women who present directly-in-labour and receiving intra partum ART and regularly
thereafter, should be started on daily NVP prophylaxis at birth and continued for a minimum of 6 weeks.
These needs to be extended to 12 weeks as mother has not received adequate duration of ART to
suppress viral replication. However, EID should be carried out at 6 weeks as per guidelines.
6.3l Exclusive
ARV Prophylaxis
breastfeeds upto for Infants
6 months Born
(preferred to Women
Option-I WHO/NACO who did not
Receive
and continuedAny ART in(Home
breastfeeds addition to Delivery)
complement feeds after 6 months upto 1 year for
In case
l of infants who
Postpartum ARVare born to HIV
prophylaxis for infected
infant formothers
6 weeks.who did not receive any antenatal or pre-partum
ART,l orEarly infant
in cases diagnosis
where maternal(EID)HIV at 6infection
weeks ofisage; repeatafter
detected testing
the at 6 months,
birth 12 months
of the infant (home&delivery):
6 weeks
•
l
Infants should prophylaxis
Co-trimoxazole be started on fromdaily Sy NVP
6 weeks prophylaxis at their first contact with health services.
of age.
the child.
emmacan
• Daily infant NVP prophylaxis rgorbe
P TC TPP fo seven
started tnenoifpm oC :2 than
more erugiF72 hours have passed since birth.
• Daily infant NVP prophylaxis should continue for atleast 12 weeks, by which time the mother
nebe
should molinked
W tnatongappropriate
erP lla ot sART
ecivservices.
reS gnitseT dna gnillesnuoC VIH fo reffO
The duration of daily infant NVP prophylaxis will depend on whether the mother is to be initiated on
life-long ART and infant feeding practices (see Chapter 12).
5 Do’s for infants at 6 weeks xes efaS l
. g n i llesnuoc
fo noitanimret lacideItmisroimportant
noitaunitnto ocdo
fo sthe
eciofollowing
hc no gnifor llesinfants
nuoC lat 6 weeks:
elpuoC l
• Do re-inforcement for Exclusive Breastfeeding for the first 6 .months gnillesnuoc
.ylno ycnangerp
(Continuation of breastfeeds with introduction of complementary y l i m a f o t segfeeds akniL l
.sIO rehto dna BT rof gnineercS l
Box 7 thereafter) . s e c i v r e s g n i n nalp
• Do.gEIDnitsetesting
t 4DC dna gnigats lacinilc OHW l egnahc ruoivaheB l
• Do Immunization ksir hgih rof )CCB(
reh dna nemow
dna esuops fo gnit•
set VDoIHCPT
dna ginitiation
nillesnuoand c xescontinue
efas dnauntil
elpuobaby
C l is 18 months old .rentrap
or longer if baby is .confirmed positive
nerdlihc gnivil rehto VIH taepeR l
• Do stop NVP Prophylaxis .retneC TR A obaby
for t larreatfe6
R weeks
l (maternal ART is not ,gniof tset
tnuoc 4DC no desab neadequate
miger citcduration)
alyhporp VRA ro TRA edivorP l g n i r e d i s noc
evitisop si esuops

.dlihc eht
7
Special Considerations
7.1 Pregnant Womenemwith
margorP TCTPP fo stnenopmoC :2 erugiF
Active TB
The risk of active TB is approximately 10 times higher in HIV-infected pregnant women compared
to HIV uninfected women. Active TB in HIV-infected pregnant women can contribute to increased
risk of maternal mortality, and is also
2
associated with prematurity, low birth weight, and perinatal
tuberculosis. A recent study in India found that maternal TB increases the risk of HIV transmission
from mother-to-child by 2.5 times. nemoW tnangerP detcefnI VIH evitageN VIH
• V RA/TRA ylh
Intensified tnoMFinding
Case –)stisiv 4(ICF) tsaeas
l-taper
erusnational
ne( eraC lTB-HIV atanetnprotocols
A l must be ninstituted
emoW tnafor ngeall
rP HIV
infected pregnant women. .sretneC TRA ta sixalyhporp xes efaS l
.gnillesnuoc
• All HIV-infected pregnant women presenting with a cough, fever, night sweats andelpweight uoC lloss
should be evaluated for TB and started on TB treatment when indicated. .gnillesnuoc
.ylno ycnangerp
• HIV-infected pregnant women .sIOwith
rehtactive
o dna Btuberculosis
T rof gnineercshould S l start ART, .irrespective
seciv res gninof naCD4lp cell
count. .sITS rof tnemtaert dna gnineercS l .smodnoc eerF l
. g n i t s e t 4 D C d n a g n i g a t s l a c i n i l c O H W l egnahc ruoivaheB l
• The tuberculosis treatment should be started first, and followed by ART as soon as feasible
dna(usually
gninnalpafter
-htrib 2,y rweeks)
eviled efas ,gnivil evitisop no gnillesnuoC l noitacinummoc
ksir hgih rof )CCB(
• Drug interactions between Rifampicin and some of the antiretroviral drugs, reh dnaincluding nemow NVP,
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC l .rentNNRTI
rap
complicate simultaneous treatment of the two diseases. EFV is the preferred for
pregnant women which can be used in those with concurrent TB treatment also.
tn•
uocFor
4Dthose
C no dHIV-TB
esab neco-infected
miger citcalywomen hporp VR notA roable TRAtoedtolerateivorP lEFV, a NVP-based or adiboosted
g n i r e snoc PI
regimen can be considered after .expert gnigats clinical
lacinilc rconsultation.
o/dna f i d o i r e p ,
With the use of a boosted PIw o d n i w
regimen, Rifampicin should be substituted with Rifabutin. evitisop si esuops
7.2 Pregnant Women .rehtom rwith of sixalyHIV-2
hporp VRInfectionA mutraptsoP l dna gnideef tnafnI l
Although the great majority of HIV infections in India are due to HIV-1, there are small .gnillesfoci nuoof c HIV-2
infection as well, primarily in western India. HIV-2 will also progress to AIDS, although progression is
generally much slower. HIV-2 has the same modes of transmission as HIV-1 but has been shown to be
much less transmissible from mother-to-child (transmission risk 0-4%).
DETECTION OF HIV-2 INFECTION SHOULD BE DONE ACCORDING TO NACO’S TESTING GUIDELINES for HIV-2
NNRTI drugs, such as NVP and EFV, are not effective against HIV-2 infection. )IEHTherefore,
( tnafnI defor sowomen
pxE VIHwho
) 1 1 ' - 0 1 0 2 s e n i l e
are infected with HIV-2 alone should: d i u G O C A N / O H W I - n o i t p O d e r r e f e r p ( s h t n o m 6 o t p u s d e e f t s a e r b e v i s ulcxE l
• Follow
.TRA cistandard
rtaideaP eadult viecerguidelines
ohw seibafor b eHIV-2
vitisoptreatment
DIE rof srwhich aey 2 oconsists
tpu dnaofse2NRTIs
ibab evit+ agLPV/r.
en DIE
• Prophylaxis NVP with AZT (instead of Syp .skeNVP)
ew 6 rotof tbe nafngiven
i rof sto
ixababies
lyhporpinVRmothers A mutrapwith tsoPHIV
l -2
skeew(Dosage
6 & shtndetails
om 21are ,shgiven
tnom 6 inta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE l
Table-8)
2
Maternal Tuberculosis: A Risk Factor for Mother-to-Child-Transmission of Human Immunodeficiency virus. Gupta A, Bhosale
R, Kinikar A, et al for the Six .ega fo skeew 6 morf sixalyhporp elozaxomirt-oC l
Week Extended-Dose .DIE Nevirapine
hguorht ev(SWEN) itisop VIndia
IH saStudy
desoTeam.ngaidJID ne2011:203
rdlihc dna(1stFebruary)
nafni rof TRA deP dna erac VIH l
.dlihc eht
Table 8: DoseFigure 2: Components
of AZT for Infants of
of PPTCT
MotherProgramme
with HIV-2 Infection
Birth Weight AZT Daily Dosage in mg. AZT Daily Dosage in ml. Duration
Infant with birth Offer of
weight of HIV Counselling and Testing Services to all Pregnant Women
< 2000 gms 5mg/dose twice daily 0.5 ml twice daily 6 weeks
<2500 gms 10mg/dose twice daily 1 ml twice daily 6 weeks
2500 gms and > 15 mgs/dose twice daily 1.5 ml twice daily 6 weeks
HIVWHO
Source: Negative
Guidelines HIV Infected Pregnant Women
counselling.
l Couple If a pregnant woman is detected to haveundertake
BOTH HIV-1 and the
HIV-2 infections, sheof
Box 8 should receive standard
counselling.
pregnancy
first
(MTP)–to within first
ART Regimen (TDF+3TC+EFV) recommended
3 months
pregnancy only.
for women with HIV-1 infection

(BCC) for high risk
7.3 womenPregnantand her Women with Hepatitis B or Hepatitis C Virus
partner. Couple and safe sex counselling and HIV testing of spouse and
Co-infection
l

The HIVtesting,
epidemic in India is driven lbyReferral
injectingtodrug use in some regions of the Country. Hepatitis B
ART Center.
considering
and Hepatitis C may be a concern inl these areas.
spouse is positive
For Women Co-infected with HIV andl HBV Nutrition counselling and linkages to Government/other
or s/he have high
• risk behaviour.is required for HBV infectionprogrammes.
If treatment
Nutrition 3
, ART should be started irrespective of the CD4 cell
Infant feeding and l Postpartum ARV prophylaxis for mother.
l
count or the WHO clinical stage:
• counselling.
The regimen preferred is TDFl+EBF 3TCreinforcement/Infant
+ EFV. feeding support through home visits.
Psycho-social
• An elevation in liver enzymesl following support through
the initiation follow-up
of ART may occurcounselling,
in HIV-HBVhomeco-infected
women because of an immune-mediated flare in HBV disease secondary to immune reconstitution
(IRIS) with therapy, particularly in women with low CD4 cell counts.
• HBV infection may also increase the risk of hepatotoxicity with certain antiretroviral drugs,
specifically NVP and protease inhibitors.
• andPregnant women
continued with HIV-HBV
breastfeeds co-infection
in addition should be
to complement counselled
feeds about signs
after 6 months upto 1andyearsymptoms
for
of liver
EID toxicity
negative .
babies and upto 2 years for EID positive babies who receive Paediatric ART.
• For women who do not require HBV treatment, ART general recommendations for HIV-infected
l Early infantwomen
pregnant diagnosis (EID)beat followed.
should 6 weeks of age; repeat testing at 6 months, 12 months & 6 weeks
Co-trimoxazole
3(Anti-HBV
l therapy shouldprophylaxis
be considered from 6 weeks
for all women of co age.
infected with HIV and Hepatitis B virus with evidence of severe
liver disease)
the child.
For Women Co-infected with HIVeand
mmaHCV
rgorP TCTPP fo stnenopmoC :2 erugiF
• No specific changes in treatment are recommended in the adult ART treatment guidelines.
• Pregnant women co-infected with HIV and HCV should receive ART according to the general
recommendations for HIV-infected pregnant women.
• Those women on ART require careful clinical and laboratory monitoring.

VRA/Twith
Co-infection RA ylHIVhtnoand
M–)sHBVtisiv 4ortsHCV
ael-taisercommon
usne( eraCamong
latanetnInjecting
A l n e m
Drug Users (IDUs).oW tnHence,angerP all
women living with HIV who are recognized .sretnetoC Tbe
RAIDUs
ta sixashould
lyhporproutinely be offered testing xesforefHepatitis
aS l
.gnillesnuoc
B and
fo noHepatitis
itanimret lCacinfections
idem ro noanditaunmonitored.
itnoc fo seciohc no gnillesnuoC l
elpuoC l
.gnillesnuoc
.ylno ycnangerp
Box 9 Provision of treatment for Hepatitis B & C for HIV co-infected pregnant women
(with Hepatitis B or C) will be the responsibility of the general noithealth
acinumsystemsmoc
ksir hgih rof )CCB(
reh dna nemow
evitisop si esuops

.dlihc eht
8
Labour and Delivery in the
HIV Infected Pregnant Women
8.1 Intra-partum Management
The women’s sero-status should be recorded in the RCH/MCH Card (Antenatal card) and maternity
register. Health care workers should check the woman’s HIV status and details of the ART drugs
during pregnancy. If her HIV status is unknown and she is in the first stage of labour, offer HIV counselling
and testing using Whole Blood Finger Prick Testing. If found positive, she should be administered the first dose of
ART and advised for confirmation of tests nthrough emoWICTC tnanCounsellor
gerP detceand fnI Lab
VIHtechnician the following eviday.
tageShe N Vshould
IH
be counselled on Exclusive Breast Feeds (EPF)
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l to the baby for the first six months and the baby
n e m should
o W t n be
a n given
g e rP Sy
Niverapine for a minimum of 6 weeks and .another 6 weeks
sretneC TRA ta sixalyhporp continuation if need be. xes efaS l
.gnillesnuoc
elpuoC l
8.2
f o shtIntra-partum
nom 3 tsrif eht nihAnti tiw ekRetroviral
atrednu ot–)PTTherapy M( ycnangerp
.gnillesnuoc
.ylno ycnangerp
Women on life-long ART should continue .sIO rehtotodn receive
a BT roART f gninas eerper
cS the usual schedule including during
l
.seciv res gninnalp
labour and delivery. .sITS rof tnemtaert dna gnineercS l .smodnoc eerF l
8.3 dna Special
gninnalp-htrCircumstances:
ib ,y reviled efas ,gnivil evCaesarean itisop no gnillesnSection uoC l noitacinummoc
ksir hgih rof )CCB(
Caesarean section is not recommended for prevention of mother-to-child-transmission reh dnand a neonly mowif there
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC l .r e n trap
is an Obstetric indication for the same.
Use of ARV drugs during Caesarean Sections .retneC TRA ot larrefeR l ,gnitset
• For planned (elective) Caesarean sections, .gnigatsART lacinshould
ilc ro/dnbe fi dooperation.
a given prior to the irep ,wodniw
evitisop si esuops
re• htoWomen
/tnemnreon voG ot seART
life-long gaknshould
il dnacontinue gnillesntheir uoc standard
noitirtuNART l
regimen. hgih evah eh/s ro
• In case of an emergency .rehtomCaesarean
rof sixalyhpsection orp VRA inm pregnant
utraptsoP womenl who arednot
na gonnidART,
eef tnensure
afnI lthat
the women receive ART prior to .the seciprocedure
v reS gninnaand lP ycontinues
limaF l thereafter. noitirtun
.stisiv emoh hwomen guorht trowho ppusundergo
gnideef tn afnI/tnemesection crofnier Fshould BE l receive the standard .gnillesnuoc
All HIV-infected Caesarean prophylactic
e m o h , g n i l l e s n u o c p u - w o l l o f h g u o r h t t r o p p u s l a i c o s
antibiotics. Complications of Caesarean section are higher in women with HIV, with the most frequently- o h c y sP l
reported complication being post-partum.sfever. puorg troppus dna stisiv
)IEshould
H( tnafbe nI performed
desopxE VIfor
H
Box 10 Caesarean
)11'-0102 senileObstetric
sections in HIV positive pregnant women
diuG OCAindications
N/OHW I-nonly.
oitpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
8.4
skeewFalse
6 & shtnLabour
om 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE l
In the case of false labour or mistaken ruptured membranes,
.ega fo skeew 6 morf sixalytaking
for women hporp eARTlozaxshould
omirt-ocontinue
C l
with normal dosing schedule of the combination regimen.
.dlihc eht
8.5 Safer Delivery Techniques
Mother-to-child -transmission risk is increased by the prolonged rupture of membranes, repeated P/V
examinations, assisted instrumental delivery (vacuum or forceps), invasive foetal monitoring procedures
(scalp/foetal blood monitoring), episiotomy and prematurity. Thus, when delivering HIV-infected women,
observe:
• Standard/Universal
HIV Negative Work Precautions
HIV Infected(UWP)Pregnant Women
Pregnant
• Do NOT Women Antenatal
rupture membraneslartificially Caremembranes
(keep (ensure at-least 4 visits)–Monthly
intact ART/ARV
for as long as possible).
o The membranes should be left intact as long as possible and artificial rupture of membrane
counselling.
l
reserved for cases of foetal Counselling
distress on choices
or delay of continuation
in progress of labour. or medical termination of
l Couple
counselling.
• Minimize vaginal examination and pregnancy only. techniques.
use aseptic
• planning services.
Avoid invasive Screening
procedures likel foetal bloodfor TB and other
sampling, foetalOIs.
scalp electrodes.
• Behaviour
Avoid instrumental
change delivery as much as possible.
l l WHO clinical staging and CD4 testing.
communication
o Unless required in cases lof foetal distress
Counselling onor significant
positive maternal
living, fatigue
safe delivery, to shorten labour
birth-planning and or
(BCC)theforduration
high riskof ruptured membranes.
women and her
o If indicated, low-cavity outlet
partner. l Couple
forcepsandissafe sex counselling
preferable and HIV
to ventouse, as testing of spouse
it is generally and
associated
l Repeatwith
HIVlower rates of foetal trauma than children.
other living ventouse.
testing, Referral to ART Center.
• Avoid routine episiotomy as far l
as possible.
• window, period
Suctioning the ifnewborn with a and/or
nasogastric
clinicaltube should be avoided unless there is meconium
staging.
spouse is of
staining positive
the liquor.
Safer surgical techniques
risk behaviour. are useful Nutrition
in programmes.
conducting any operative procedures such as the Caesarean
section,
l
repairing
Infant wounds/lacerations
feeding and l etc.
Postpartum ARV prophylaxis for mother.
nutrition
Use of ‘dry’ Family Planning
haemostatic techniques lto minimize bleeding;Services.
i.e. good observation and following of surgical
counselling.
fascial planes during dissection, judicious
l EBFusereinforcement/Infant
of electro-cautery feeding
during support
Caesarean through home
section visits.
etc.
During Caesarean section, wherever possible, the membranes are left intact until the head is delivered
through the surgical incision. The cord visits
should andbesupport
clamped groups.
as early as possible after delivery;
• Use of round-tip blunt needles for Caesarean section
•
HIVDo not useInfant
Exposed fingers(HEI)
to hold the needle;
•
l Exclusive
Use forceps breastfeeds
to receiveuptoand6hold months (preferred Option-I WHO/NACO Guidelines 2010-'11)
the needle
• Observe good practice when transferring sharps to surgical assistant eg. holding container for
sharps.
Early infant
For ldisposal diagnosis
of tissues, (EID) at
placenta and6 weeks
other ofmedical/infectious
age; repeat testingwaste
at 6 months, 12from
material months
the&delivery
6 weeksof
after cessation
HIV-infected deliveriesofStandard
breastfeeds. waste disposal management guidelines should be followed.
the child.
9
Care during the Postnatal Period
9.1 The Post-partumFigure
Period2: Components of PPTCT Programme
• WithinOffer of HIV
an Hour Counselling and Testing Services to all Pregnant Women
of Delivery
o Infants born to HIV-infected mothers should receive NVP prophylaxis immediately after
birth.
HIV oNegative HIV Infected
Infants after delivery should be putPregnant
on the Women
mother’s abdomen for skin contact to be
Pregnant Women which helpsl inAntenatal
established bonding andCaremaintenance
(ensure at-least of 4baby’s body temperature
visits)–Monthly ART/ARVas well
l Safe assexhelps initiation of breast prophylaxis
milk within at 1 hour of birth.
ART Centers.
counselling.
Counselling
o Infants should be given lexclusive on choices
breastfeeds for of
thecontinuation or medical
first six months termination
preferably. of
Exclusive
l Couple
pregnancy (MTP)–to undertake within the
replacement feeding may be done only if the mother has died or has a terminal illness first 3 months of
counselling.
or decides pregnancy
not to breastfeed despite only.
adequate counselling. (See chapter 11 for updated
guidelines
planning Screening
on infant feeding).
services. l for TB and other OIs.
• If the mother has not made a decision about feeding yet, she should be counselled to give exclusive
breastfeeds for the first 6 months which is the preferred option, followed by complementary feeds
communication Counselling on positive living, safe
after 6formonths.
(BCC) high risk
l
No abrupt weaning to be done after 6 months. Thedelivery,
follow upbirth-planning
guidance forand
babies
on exclusive infant feeding options.
breast feeding and exclusive replacement feeding is given in (Table 9).
women and her
• Counsel and support parent to give infant NVP prophylaxis using the syringe/dropper provided.
• testing,
Emphasize on washing the equipment
l Referralwith clean
to ART boiled water after every use.
Center.
considering Provide ART
Duringwindow,
the post-delivery l
period if period, it is and/or
important toorcontinue
ARV prophylactic
follow-upregimen based on
and support theCD4 count
postpartum
clinical staging.
motherspouse
, considering the fact that this is a stressful period and she has to assume multiple roles and
is positive
responisbilities
or s/he haveas mother,
high wife and HIV l Nutrition counselling
infected person. Whereverand possible,
linkagesinclude
to Government/other
family counselling
(of husband, Nutrition programmes.
in-laws, direct family members) to support care of the HIV infected mother and HIV
risk behaviour.
exposed
l Infant feeding
infant. and
Postpartum Postpartum
depression
l
& psychosis ARV prophylaxis
is common for mother.
in HIV infected women.
• counselling.
Involvement of men (husband/close male family members) is important so that the family
support to the HIV-infected mother and infant is optimal. Husband’s support to the mother-
baby pair (m-b pair) should be encouraged so as to:
o To remind the HIV positive mother to take ART regularly
o Support administration of daily infant NVP prophylaxis medications for 6 weeks to the baby.
o Be involved in care and follow-up of the infant including clinic visits and immunization
follow-up; EID and CPT initiation and continuation up to 18 months at least.
o Be
EID involved
negative in care
babies andofupto
mother for ART
2 years for centre visits babies who receive Paediatric ART.
EID positive
l Postpartum
o SupportARV prophylaxis
exclusive for infant for
breastfeeding for6aweeks.
minimum period of 6 months and continuation of
l Earlybreastfeeds
infant diagnosis (EID) at 6 weeks of
for 1 year in EID negative babies, age; repeat andtesting
up toat26years
months, 12positive
in EID months babies
& 6 weeks
with
after initiation
cessationofofPaediatric
breastfeeds. ART. Weaning foods should be introduced from 6 months onwards in
l Co-trimoxazole prophylaxis
all babies whether fromfed
breast 6 weeks of age. feeds fed.
or replacement
the child.
emmargocontraceptive
o Insertion of Cu-T (temporary rP TCTPP fo stnemethod)
nopmoC :2for
eruHIV
giF infected mother at 6 weeks if a
post-partum IUD (PP-IUD) has already not been inserted within 48 hours in addition to
the use
nem oWof tcondoms
nangerP lwill
la oprevent
t secivreunwanted
S gnitseT pregnancies
dna gnillesn(dual
uoC Vprotection)
IH fo reffO
o Encourage male sterilization in father (No Scalpel Vasectomy (NSV) between 18 months
to 2 years when baby’s survival has been ensured).
Table 9: Pointsnto
embe
oWFollowed
tnangerPfor
deBabies
tcefnI Von
IH EBF OR ERF evitageN VIH
VRA/TReceiving
Babies RA ylhtnExclusive
oM–)stisBreastfeeds
iv 4 tsael-t(EBF)
a erusne( eraCBabies tnA l Exclusive ReplacementoW
lataneReceiving n e m tnangerP
Feeds (ERF) for
for the First 6 Months .sretneC TRA ta sixalyhporp the First 6 Months xes efaS l
Mother Mother . g n i llesnuoc
elpuoC l
fo shtnART
Life-long om initiated
3 tsrif asehsoon
t nihas tiwpossible
ekatreincluding
dnu ot–entire
)PTM(Life-long
ycnangART erp initiated as soon as possible even though the
breast feeding period .gnillesnuoc
.ylnobaby
ycnaisngetting
gerp exclusive replacement feeding
Infants
y
Infants
l i m a f ot segakniL l
i) At Birth: Start Sy. NVP Prophylaxis immediately
.sITS rof tneand aert dnaI) At
mtgive gniBirth:
neercStart
S lSy. NVP Prophylaxis.sfrom birth until 6
modnoc eerF l
until 6 weeks (or more indicated) weeks
ii) At 6 weeks: .gnitset 4DC dna gnigats laii) cinAtilc6 Oweeks:
HW l egnahc ruoivaheB l
a.dStart
na gnCPT
innand
alp-continue
htrib ,y runtil
evilebaby
d efaiss18
,gnmonths
ivil eviof op no gna.
tisage illeStart
snuCPT
oC and l
continue until babynoitaisci18 numonths
mmoc of age
b. Immunization: Start 1st dose of DPT/OPV/Hep-B vaccine (and may be thereafter, if babies
ksir hstatus gih roisf )positive
CCB( in the
(2nd dose) .snoitpo gnideeconfirmatory
f tnafni test) reh dna nemow
c. dEarly
na eInfant
suopsDiagnosis(EID):
fo gnitset VIHDodnDBS a gnatill6esweeks
nuocforxes efas dnb.a Immunization:
elpuoC l Start 1st dose of DPT/OPV/Hep-B .rentrap
all babies; if positive do WBS. If WBS positive, start vaccine (2nd dose)
Paediatric ART irrespective of CD4% for babies less .nethan
rdlihc gnc.ivEarly
il rehInfant
to Diagnosis(EID): Do DBS VIH at tae6pweekseR l for
2 years. all
.retneC TRA ot larrefeR l babies; if positive do WBS. If WBS , g n i t s
positive,et start
d. NO MIXED FEEDING is to be done during the first 6 Paediatric ART irrespective of CD4% g n i r efor
d i sbabies
n o c less
tnumonths
oc 4Di.e.(not
C no detosagive
b nalong
emigwith
er ciBreastfeeds
tcalyhporpany VRother
A ro TRA ethan divo2rPyears.
l
milk (tinned formula food or cow’s milk or dairy .gnigmilk)

ats lacind.
ilcNO na FEEDING is to fibedodone
ro/dMIXED irep ,wodniw
during the first 6
liquid, juices or even water months i.e.(not to give e v i t i s
Breastfeeds+any op si esuoother ps milk
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuN l h g i h e v a h e h / s ro liquid,
(tinned formula food or cow’s milk or dairy milk)
.semmargorp nojuices itirtuor
N even water. No breast.rfeed uoivto ahbe ebgivenksir within
.rehtom rof sixalyhporp VRA mutrfirst aptsix
soPmonths
l dna gnideef tnafnI l
Post-partum Follow-up and Care Extends Beyond the Six-weeks Postpartum Period and Includes:
• eAssessment
moh ,gnillesnof uomaternal
c pu-wollohealing
f hguorhtafter troppudelivery
s laicos-oand hcysevaluation
P l for post partum infectious
complications. .spuorg troppus dna stisiv
• Continued counselling and information on fertility choices and effective post partum
Contraceptive methods as well as condom promotion and ensuring Cu-T IUD adoption and
continued motivation for NSV for males at 18 months Specifically )IE,Hin ( tnHIV
afnIinfected
desopxEpregnant VIH
)1women,
1'-0102 there
seniledshould
iuG OCA N/linking
be OHW I-ofnoithe
tpO baby
derreftoerpthe( shtEarly
nom 6Infant otpu sDiagnosis
deeftsaerb(EID) evisuprogramme
lcxE l
f raeART
roand y 1 oprogramme
tpu shtnom for
6 rmother/child
etfa sdeef tneasmeindicated.
lpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
skeew 6 & shtnom 2Condom
Box 11 1 ,shtnomshould 6 ta gnbe
itsetconsistently
taeper ;ega fo skeew
used by6 allta )D
. s d
IE( sinfected
HIV
e e f t s a
isongaid tmales
e r b f o n o i t
nafni yldespite
a s s e c r
raE l
e tfa
following any other Family Planning Method (Dual Protection)
.dlihc eht
9.2 Screening for Post-Partum Depression
Postnatal blues occur
Offer ofinHIV
almost 80 per cent
Counselling andof women, most commonly
Testing Services in the first post
to all Pregnant Womennatal week, and
improves afterwards. The “post natal or baby blues” refers to a range of feelings between the third and
tenth day after delivery:
HIV Negative
• The feelings include being HIV Infected
tearful, Pregnant
irritable, moodWomen
changes, fatigue, anxiety and feelings of
Pregnant Women
sadness or loneliness. l Antenatal Care (ensure at-least 4 visits)–Monthly ART/ARV
• counselling.
These feelings are thought tol
be caused by
Counselling a number
on choices of factors, including
of continuation or medicalsudden changes
termination of
l Couple
in hormone levels after childbirth, unexpected discomfort from breast engorgement and birth 3 months of
counselling.
pregnancy only.
l pain, adjustment
Linkages to family to parenthood and sleep deprivation.
• Free
l These feelings should disappear
condoms. l a f t e r and
Screening a few days and
treatment no specific treatment is required,
for STIs.
l Behaviour
apart fromchange
recognition, empathy
l WHO
and clinical
supportstaging and CD4
from family andtesting.
friends.
However (BCC)
, in aforgroup
high risk
of post partum women, these feelings may persist and become post partum
women and her
depression. Two prospective studiesl onCouple pregnant women,
and safe in the states
sex counselling andofHIV
Goa and rural
testing South
of spouse andIndia,
partner.
detected
l
depressive
Repeat HIV disorder in 23 perother centliving
and children.
16 per cent respectively, with depression persisting
testing,
six months after child birth in 11-14 l per centto
Referral ofART
women 6
Center.. In HIV infected women, this may be higher.
window,
Post partum period if may begin at delivery,
depression or a month
and/or clinical staging. later; in some women, it may begin during
spouse is positive
the first post-natal menstrual period or l weaning:
Nutrition counselling and linkages to Government/other
or s/he have high
• risk
Thebehaviour.
symptoms include crying, irritability, sleep problems (insomnia or sleeping all day), eating
problems
nutrition (no appetite or eating
l
all Planning
Family day), persistent
Services.feelings of sadness, lack of desire or
counselling.
inability to care for self or baby
l , EBF
exaggerated concerns about
reinforcement/Infant thesupport
feeding baby, and memory
through homeloss.
visits.
• Some women may feel extremely anxious or fearful, sometimes experiencing panic attacks
including palpitations, chest pain, dizziness, cold flushes and shaking.
Post partum depression should be detected early so that counselling support and other interventions
mayHIV Exposed Infant
be provided. (HEI) depression can interfere with mother-infant bonding, cause problems
Postpartum
with spouse and family or other children; and may affect health of the mother. More importantly,
postpartum depression
EID negative babiesmayand reduce
uptothe adherence
2 years for EIDtopositive
ART especially the receive
babies who infant NVP prophylaxis
Paediatric ART. for the
first l6 weeks of life.ARV prophylaxis for infant for 6 weeks.
Postpartum
Screening for postpartum depression should be done before the mother goes home after delivery and
during follow-up visits. See Annex 7 for the screening tool.
the child.
9.3 Counsel and Follow-up Mother-baby (m-b) Pairs after
Discharge
Counselling on Issues Related to the Mother:
• Counsel mothers taking ART for her own health for good adherence to life-long ART.
• The ART drugs will reduce thenerisk moW of tHIV

nantransmission
gerP detcefnIthrough
VIH breastmilk during evitbreastfeeding
ageN VIH
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l n e m o W tnangerP
• Counsel mother who came directly-in-labour about the importance o f A R T.
. g n i llesnuoc
fo• noiCounsel
tanimret mother
lacidemto have
ro n oitauadequate
nitnoc fo serest,
ciohcnutrition
no gnillesand
nuoCto ltake iron-folate during the lactation
elpuoC l
fo shperiod,
tnom 3 ensure
tsrif ehenough
t nihtiwproteins
ekatredand
nu ofluids
t–)PTM in(the
ycndiet.
angerp
.gnillesnuoc
• Family support: involve husband and family .yln o ycnangetorphelp out with baby care so that she can
members ylimaf ot segakniL l
rest and recuperate, and to .sIremind
O rehto her
dna of
BTherrofART
gninand
eercinfant
S l ARV prophylaxis.
.seciv res gninnalp
• Counsel mother for her post-natal checkup at 6 weeks to coincide with the infant’s first
immunization visit.
• Discuss and ensure contraception.snCooitp popgenri-T k s i r hgih rof )CCB(
de(eCu-T)
f tnafniinsertion and condom use as dual
protection at subsequent visits. 4 r e h dna nemow
• Arrange for the mother on ART to be followed .nerdlihcwithgnivthe
il rehART
to Centre. VIH taepeR l
• ANMs/ASHAs/Counsellors/ORWs will follow-up the mother and baby within a week ofsndischarge
tnuocfor 4Dmother’s
C no desprogress,
ab nemigsupport
er citcalinfant
yhporpfeeding
VRA ropractice, orP ladherence to infant NVPdiprophylaxis
TRA edivensure g n i r e oc
.gnand
igatsinfant
lacinifollow-up.
lc ro/dna fi doirep ,wodniw
at home, general counselling advice evitisop si esuops
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuN l hgih evah0–6 eh/smonths.
ro
Refer to Annex 9: Counselling the HIV infected .semm mother/family
argorp noitirtuforN infant feeding options:
.ruoivaheb ksir
Counselling for Issues of Infant to the Parents/ Caregivers:
•
.stisCounsel
iv emoh hand
guorreinforce
ht troppusdecision
gnideef ton
nafinfant
nI/tnemfeeding r FBE lwhether exclusive.gbreastfeeding
ecrofniepractice nillesnuoc for
efirst
moh6,gmonths
nillesnuo(preferably)
c pu-wollof horguexclusive us laicos-ohcyfeeding
orht troppreplacement sP l (for first six months if not willing
to breast-feed and resistant to doing so).
• All infants (irrespective of maternal ART in mother) must receive a minimum of 6 weeks of
infant NVP prophylaxis daily until the first visit for immunization at 6 weeks of age.
o If exclusive replacement feeding is being done, then infant NVP)IE H( tnafnI dmay
prophylaxis esopbexE stopped
VIH
)11'-0at
1062 weeks
seniledof
iuage.
G OCAN/OHW I-noitpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
• Infants
.TRA cirwho
taideare
aP ediagnosed
viecer ohwDNA/seibaPCR
b evnegative.
itisop DIE rof sraey 2 otpu dna seibab evitagen DIE
o Should continue breastfeeding and .be skere-evaluated
ew 6 rof tnafnas i roper
f sixEID
alyhprotocol.
porp VRA mutraptsoP l
o Stop NVP prophylaxis at 6 weeks for babies given exclusive .sdereplacement
eftsaerb fo nofeeding.
itassec retfa
4 .ega fo skeew 6 morf sixalyhporp elozaxomirt-oC l
Postpartum psychiatric care in India: the need for integration and innovation. Prabha S Chandra. World Psychiatry. 2004
June; 3(2): 99–100.
.dlihc eht
• Infants who are diagnosed Figure
DBS2:positive,
Components
areoftoPPTCT Programme
be referred to the ART Centre for Whole Blood
Specimen (WBS) collection. If WBS is also positive, then the infant will be initiated on Paediatric
ART, irrespective of CD4
Offer of HIV %.
Counselling and Testing Services to all Pregnant Women
• Final confirmation of the HIV status in the baby should be done at 18 months in ICTC by doing all
3 Rapid Tests even if the first rapid antibody test comes negative.

Pregnant Women 5 Do’s for infants
l
at 6 weeks
For infants at 6 weeks, it is important to do the following:
counselling.
l Couple
Do re-inforcementpregnancy (MTP)–to undertake within the first 3 months of
for Exclusive
counselling. Do EID testing
Breastfeeds for pregnancy
the first 6 only.
months
Box 12
planning for (Continuation
services. l Screening
of breastfeeds DoOIs.
for TB and other Immunization
Free condoms. with introduction l Screening and treatment for STIs.
of complementary
l
Do CPT initiation and continue until
l Behaviour changefeeds thereafter)
l WHO clinical staging andbaby CD4 is testing.
18 months/continue if baby
l
is tested positive
(BCC) for high risk
women and her Do stopand NVP Prophylaxis for b aand
by
partner. l Couple and safe sex counselling HIV testing of spouse
after 6 weeks (may need extension
to 12 weeks if mother has been
considering initiated late on ART)
spouse is positive

the child.
10
Infant Feeding Practice
Figure 2: Components
Refer to National Guidelines for Nutrition of PPTCT
of HIV affected andProgramme
infected infants and children, 2011.
More than 50 per cent of children under 5 years of age in India have malnutrition. NFHS-3
(2005-06) data Offer
showof that
HIVoverall,
Counselling
57 perand
centTesting
of women Services to all Pregnant
of childbearing Women
age in India (urban and rural)
have anaemia with 30 per cent of infants being born underweight. Growth retardation in young children
starts during pregnancy and is irreversible by age of two years if not corrected. But especially in rural
areas, where women often go back to the fields a few days after giving birth, babies’ diets are often
supplemented with cow’s milk and water, which exposes them to infection.
l Safe sex
The infant feeding guidelines for HIV-exposed and atinfected
prophylaxis infants age 0 to 6 months has been up
ART Centers.
counselling.
dated in 2011. After 6 months of age, l complementary
Counselling foodsofshould
on choices be introduced
continuation or medical just like for other
termination of
l Couple
infants of this age. pregnancy (MTP)–to undertake within the first 3 months of
counselling.
pregnancy only.
Recommendations for infant feeding in HIV exposed and infected infants < 6
l Free condoms. months of agel Screening and treatment for STIs.
communicationThe 2011 National l
Guidelinesonon
Counselling Feeding
positive for HIV-exposed
living, safe delivery,and infected infants
birth-planning and
(BCC) for high risk
< 6 months old recommends:
women and her
Box 13 • Exclusive breastfeeding
partner. l Couple andfor safe
at sex counselling
least 6 monthsand HIV testing of spouse and
• Only in situations where breastfeeding cannot be done (maternal death,
considering severe maternal illness) or individual mother’s choice (at her own risk), then
window, period if exclusive replacement feeding may be considered
and/or clinical staging.
spouse is positive
or s/he l Nutrition counselling and linkages to Government/other
have high is the preferred
Exclusive breastfeeding feedingprogrammes.
Nutrition option for HIV-exposed infants <6 months of age.
risk behaviour.
However, it is recognized that for some women, breastfeeding
Postpartum ARV prophylaxis mayfornot be possible – for example in
mother.
situations of maternal death and severe
nutrition l
maternal
Family illnessServices.
Planning in which case Exclusive Replacement Feeding
shouldcounselling.
be done only when AFASS criteria is fulfilled:
Psycho-social
A – Affordable F – Feasible A – Acceptable
l support
S – Sustainable S through
– Safe follow-up counselling, home
10.1 Principles of Infant Feeding for HIV Infected Pregnant Women
The 10 principles of infant feeding options for HIV infected pregnant women and their infants are:
1.
l Exclusive breastfeeds
All HIV infected pregnantupto women
6 months (preferred
should Option-Iinterventions
have PPTCT WHO/NACOprovided
early in pregnancy
and continued
as far breastfeeds in addition to complement feeds after 6 months upto 1 year for
as possible.
2. Exclusive breastfeeding is the recommended infant feeding choice in the first 6 months, irrespective
of the fact that mother is on ART early or infant is provided with ARV prophylaxis for 6 weeks.
3. after
MIXED FEEDING
cessation SHOULD NOT BE DONE AT ANY COST WITHIN THE FIRST 6 MONTHS
of breastfeeds.
l (Feeding breast-feeds
Co-trimoxazole prophylaxisand from
replacement
6 weeks feedsof age.simultaneously in the first 6 months).
the child.
nemoW AFASS
tnangecriteria
rP lla for
ot Exclusive
secivreSReplacement
gnitseT dnaFeeding
gnillesnuoC VIH fo reffO
Mothers known to be HIV-infected, if insist on opting for exclusive replacement

feeding which is contrary to the WHO/NACO’s guidelines of giving exclusive
breastfeeds for nfirst emo6Wmonths, tnangerPare detcdoing
efnI Vso IH at their own risk. eThey vitagshould
eN VIbe H
counselled not to give any breast
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l feeds during the first six months. MIXED n e mFEEDING
oW t n ashould
n g e rP
NOT be done during .sretnthe TRA6tamonths.
eC first sixalyhp(Feeding
orp a baby with both breast xes efafeedsS l
and replacement feeds in the first 6 months is known as mixed .gfeeding
nillesnuwhich oc
elpuoC l
fo shtnom 3 tsrif eleads
ht nihtotiw mucosal
ekatredabrasions
nu ot–)PTin M(the ycngutangof erpthe baby facilitating HIV virus entry
through these abrasions) .ylno ycnangerp .gnillesnuoc
Box 14 . s I O r e h t o d n a B T r o f g n i n e e r c S
y l i m a f ot segakniL l
When opting for Exclusive Replacement Feeding, they should fulfil the l
. s e c i v r es AFASS
gninnacriteria
lp
given below: . s I T S r o f t n e m t a e r t d n a g n i n e e r c S l .smodnoc eerF l
dna gninnalp-htrib ,y re1. Safe
viled efaswater,gniviand l evitsanitation
isop no gnare illesassured
nuoC l at the household noitalevelcinuand mmoinc the
community, and can prepare clean feeds ksir hgih rof )CCB(
reh dna nemow
dna esuops fo gnitset V IH The
2. dna gmother
nillesnuor oc other
xes efacaregiver
s dna elpucan oC reliably
l afford to provide.resufficient ntrap
replacement feeding (milk),
.nerdlihc gnivil rehto to support normal growth and development
VIH taepeR l
of the infant,.rand can sustain
etneC TRA ot larrefeR l it un-interruptedly for first 6 ,months
gnitset at
tnuoc 4DC no desab nemigleast. er citcalyhporp VRA ro TRA edivorP l g n i r e disnoc
3. The mother or caregiver can prepare it frequently enough evitiin soap clean
si esumannerops
so that it is safe and carries a low risk of diarrhoea hand gih malnutrition.
evah eh/s ro
.4.
rehtThe
om rmother
of sixalyhorpocaregiver
rp VRA mucan, traptin soPthel first six months dna gnexclusively
ideef tnafnIgive l
replacement .secfeeding,
iv reS gnand innaislPfeasible.
ylimaF l noitirtun
.stisiv emoh hguorht tr5.
oppThe
us gnfamily
ideef tisnasupportive
fnI/tnemecrof ofnthis BE l and accepts it .without
ier Fpractice, gnillesnuoc
forcing
emoh ,gnillesnuoc pu-wher olloto
f hbreastfeed
guorht tropp us laicthe
during os-ofirst
hcy6 sPmonths.
l
4. Only in situations where breastfeeding cannot be done or on individual parents’ informed decision,
then replacement feeding may be considered only if AFASS Criteria for exclusive replacement
feeding is fulfilled (Figure 8).
5. r oExclusive
f raey 1 obreastfeeding
tpu shtnom 6should
retfa sbe
deedone
f tnem
forelatpmleast
oc ot6nmonths,
oitidda nafter i sdewhicheftsaercomplementary
b deunitnoc dnafeeding
.TRA cirbe
should taidintroduced
eaP eviecegradually,
r ohw seibirrespective
ab evitisop DofIEwhether
rof sraeythe 2 oinfant
tpu dnisa diagnosed
seibab evitaHIV gennegative
DIE or
positive by EID. . s k e e w 6 r o f t n a f n i r o f s i x a l y h p o r p V R A m u t r a p t s oP l
6. Mother should be receiving ART during the whole duration.sof debreastfeeding
eftsaerb fo noita(remember
ssec retfa it is
lifelong ART for the mother). .ega fo skeew 6 morf sixalyhporp elozaxomirt-oC l

.dlihc eht
7. For breastfeeding infants Figure 2: Components
diagnosed of PPTCT
HIV negative, Programme should be continued until 12
breastfeeding
months of age ensuring the mother is on ART as soon as possible.
8. The EID is repeated for the 3rd time (when previous 2 EIDs have been negative) after 6 weeks of
stopping breast feeds, repeat EID i.e., Rapid test followed by DBS (if Rapid Test turns positive)
send DBS test. If DBS is positive, do a WBS test. If WBS test is positive, Paediatric ART should
HIV be initiated in ART centre. However,
Negative confirmation
HIV Infected Pregnanttest for HIV has to be done at 18 months using
Women
3 Rapid
Pregnant Tests for all babies lirrespective
Women Antenatalof the(ensure
Care earlier at-least
EID status or the fact thatART/ARV
4 visits)–Monthly Paediatric ART
l Safe
has sex
already been initiated. prophylaxis at ART Centers.
counselling.
9. Couple
For breastfeeding infants who l Counselling
have been on choices of
diagnosed continuation
HIV or medical termination
positive, paediatric ART shouldofbe
l
counselling.
started and breastfeeding to be continued ideally until the baby is 2 years old.
pregnancy only.
10.planning
Breastfeeding should stop once
services. l Screening for TBadequate
a nutritionally and other OIs.
and safe diet without breast milk can
l be provided.
Free condoms. l Screening and treatment for STIs.
communication should NOT belstopped
11. Breast-feeding ABRUPTLY.
Counselling on positive living, safe delivery, birth-planning and
(BCC) for high risk
Refer to Annex 9 for flowchartinfant feeding options.
on counselling mothers and families for infant feeding 0-6
women and her
months of age.
The summary charts given in the next few pages, gives the various action points in the continuum
of the PPTCT activities according to infant feeding practices. Most HIV infected women should
breastfeed
window, theirif infants, unless there are special situations described previously.
period and/or clinical staging.
spouse is positive
orTos/he
usehave
the summary
high Nutrition
charts, lstart from thecounselling andchart
left side of the linkages to Government/other
and continue towards the right
side.
risk Nutrition programmes.
Advice to the mother/child for ART and for ARV prophylaxis, when to stop or continue infant
behaviour.
l Infant feeding and when to continue
NVP prophylaxis, l Postpartum ARV prophylaxis
or stop breastfeeding etc.for
is mother.
described on the headings of the
nutrition
charts. l Family Planning Services.
All babies detected positive <2years of age are given Paediatric ART
Box 15 irrespective of CD4 %
the child.
Chart 1: Exclusive Breastfeeding (EBF)
nesummary
Infant feeding moW tnan gerP llContinuum
charts: a ot secivreofS Prevention
gnitseT dnof
a gHIV
nilleTransmission
snuoC VIH fofrom
reffOParent-to-Child
(PPTCT) through ante natal, labour/delivery, post partum and infant feeding options

Mother antiretroviral drug regimen
HIV positive pregnant woman

ART Infant Feeding
Eligibility
. g n i llesnChoice
uoc
elpuoC l
fo shtnom 3 tsrif eht nihtiw ekatrednu ot–)PTAntenatal M( ycnangerp During Postpartum
Mother .gnillesnuoc
.yln(AN)
o ycnangerLabour
p and
Delivery yl(PP)
imaf ot segakniL l
.sITS rof tnemtaertInitiate
dna gnmother
ineercon
S lifelong
l .smodnoc eerF l
ART, irrespective
HIV Positive .gniARTtset regimen
4DC dnfor a gnigatsoflapregnancy
cinilc OHgestation
W l and Continue egART
nahc ruoivaheB l
throughout AN, labour/delivery, PP throughout
noitacinummEBF oc
trib ,y revilemother’s
dna gninnalp-hPregnant d efas ,gown
nivihealth
l evitisop breastfeeding
no gnillesnuperiod
oC land thereafter life-long
women TDF+3TC+EFV ksir hgih rof )CCB(
reh dna nemow
months of age, irrespective of the results of the earlier EID

Confirmation of HIV status by 3 antibody HIV tests at 18

Introduce complementary feeding at 6 months of age as
Infant NVP: Give first

dose of NVP within EID*results at Stop
.retneC TRA ot larrefeR l BF at ,gnitset
6 to 12 hours of 6 weeks EBF till (Maximum g n i r e Remarks
disnoc
tnuoc and
delivery 4DCcontinue
no desab nemiger citcalyhporp VRA ro TRA edivorPTime l
daily NVP for *** .gnigats lacinilc ro/dna fi doirep ,wodniw

evitisop si esuops
.rehtom rof sixalyhporp VRA mutraptsoP l dna gnideefStopping tnafnI l
status
breastfeeds should
usual
EID negative .6semonths

civ reS gninnalP ylim12 aF months
l n
be doneo i tirtgradually
un
6 weeks minimum
.stisiv eanother
(consider moh hguorht troppus gnideef tnafnI/tnemecrofnier FBE l .gnwithin
illesn1uomonthc
6 weeksemwhen
oh ,mother
gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP l
has been initiated on
ART later in pregnancy .spuorg troppus dna stisiv Infants diagnosed
or post partum) EID positive should
be on ART as per
EID positive 6 months 24 months
national paediatric
)IEH( tnafnI desguidelines
opxE VIH
*EID means DNA /PCR screening at ICTC, and if detected positive, confirmation by Whole Blood Specimen (WBS) at the ART
centre. .TRA cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIE
**Wherever written “HIV positive pregnant women”, kindly read it as “HIV infected pregnant women”.
***6 weeks after cessation of breastfeeds the baby’s 3rd EID should be done if earlier EID tests were negative(Rapid Test
skeewdo6DBS;
positive, & shiftnDBS
om positive;
21 ,shtndoom 6 taifgWBS
WBS; nitsepositive,
t taeperstart
;egaPaediatric
fo skeewART, 6 tairrespective
)DIE( sisoofnbaby’s gaid tnCD4 afni%.ylraE l
+ Follow up as usual at ART centre for routine ART monitoring. . s d e e f t s a e r b f o n o i t a s sec retfa
.dlihc eht
Chart 2: Exclusive Replacement Feeding (ERF)
4.
Offerwomen
Note: HIV infected of HIVwho
Counselling and Testing
become pregnant whileServices to all also
on ART should Pregnant
follow Women
the charts below
Infant feeding summary charts: Continuum of Prevention of HIV Transmission from

Parent-to-Child (PPTCT) through ante natal, labour/delivery, postpartum and infant feeding options
Mother Antenatal (AN) Postpartum
counselling.
HIV positive Pregnant Woman
Infant feeding
ART eligibility Motherl Counselling on choicesDuring
antiretroviral of continuation
labour or (PP)
medical termination
choice of
l Couple drug (MTP)–to
regimen and delivery within the first 3 months of
pregnancy undertake
counselling.
pregnancy only.
l Behaviour change ART regimen
l WHO
for clinical
Initiatestaging
mother and CD4 testing.
on life-long ART, irrespective of
HIV positive
communication
pregnant
mother’s ownl
health pregnancy gestation and continue ART throughout
Counselling on positive living, safe delivery, birth-planning ERFand
high risk TDF+3TC+EFV
(BCC) forwomen AN, labour/delivery, PP and thereafter life- long
women and her
testing,
Infant NVP: Give first EID* results at
EBF till Remarks Confirmation of HIV status by 3 antibody HIV tests at 18
months of age, irrespective of the results of the EID tests
Introduce complementary feeding at 6 months of age as
considering
dose of NVP within 6 to 6 weeks
12 hours of delivery
window, and if
period
continue daily and/or clinical staging.
spouse is positive
NVP for....
usual and continue BF

done earlier
counselling. l EBF6 reinforcement/Infant feeding support through home visits.

EID negative months
6 weeks minimum
visits and support groups. Infants diagnosed EID
(consider another 6 weeks
positive should be initiated
when mother has been
on ART as per national
initiated late in pregnancy
paediatric guidelines
or post-partum)
HIV Exposed Infant (HEI) EID positive 6 months
* EID means DNA/ PCR screening at ICTC, and if detected positive, confirmation by Whole Blood Specimen (WBS) at the
ART l Postpartum ARV prophylaxis for infant for 6 weeks.
centre.
± Follow
l Early
up asinfant
usual atdiagnosis
ART centre(EID) at 6 weeks
for routine of age; repeat testing at 6 months, 12 months & 6 weeks
ART monitoring.
* If pregnant woman is detected HIV
after cessation of breastfeeds. positive do not delay initiation of ART as per National Guidelines.
§ If mother is detected as HIV positive AFTER DELIVERY, her infant should receive infant NVP prophylaxis for minimum of 6
weeks.and
she should be linked from ART
to the closest 6 weeks
Centreof age.
the child.
Chart 3: Antiretroviral Treatment for Women Presenting Directly-In-Labour, Immediately
Postpartum and prophylaxis for their Infants, Including Infant Feeding Options
ART Mother antiretroviral drug regimen Infant feeding
presenting in labour or immediately
eligibility choice
post-delivery and undergoes HIV
Mother Antenatal During labour Postpartum (PP)

Women with unknown status
(AN) and delivery

nemoW EBFtn(6 anmonths,
gerP
screening
VRA/TRA ylhtnoM–Women )stisiv 4 tsael-ta erusne( eraC latanetnA l

in direct
ifxalready
es efaSstarted
Unknown
labour who are .sretneC TRA ta sixalyhporp l
detected HIV .gnillebreast

on snuocfeeds)
fo noitanimreCD4t lacatidem ro positive
noitaunusing
itnoc fo secnone
iohc no gniTDF+3TC+EFV
llesnuoC l TDF+3TC+EFV otherwise
baseline ERFelp(6months
uoC l
fo shtnom 3 tsrif eht whole
nihtiwbloodekafinger
trednu ot–)PTM( ycnangerp
.gnifillalternate
esnuoc feeds
prick testing .ylno ycnangerp
ylimaf ot salreadyegaknstarted)
iL l
.sITS rof tnemtaert dna gnineercS l
Postpartum ART to be initiated as soon as .smodnoc eerF l
possible (sample for CD4 testing .gncollected
itset 4Dby C dna gnigatsInfantlacinNVP:
ilc OHW l egnahc ruoivaheB l
Lab Technician the following day during HIV Give first dose of NVP within noitacinummoc
dna gninnalp-htrib ,y reviled efas ,gnivil ev6itto
confirmation and reached to ART Centre and
iso12
p nhours
o gnioflledelivery
snuoC andl
ksir EID
hgihresults
rof )CCB(
CD4 report handed over to Mother before .scontinue
noitpo gfornidminimum
eef tnafnofi 6
discharge if mother is not likely to go to ART weeks reh dna nemow
dnacentre
esuopwithin
s fo gthe
nitsnext
et V2IHdays)
dna gnillesnuoc xes efas dna elpuoC l .rentrap
After initial 6 weeks, continue
.reinfant
tneC NVP
TRAuntil
ot lamother
rrefeRhasl EID positive,gnitset
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA ed6ivweeks
Mother needs ART for her own health* completed at least orP of
l
gniredisnoc
maternal ART. Thereafter, infant
.gnigNVPats lacan
cinbe
ilcstopped
ro/dna fi EID
doirnegative
ep ,wodniw
evitisop si esuops

.dlihc eht
11
Care and Follow-up of
HIV Exposed Infants
emand
Table 10: A checklist for the care margfollow
orP TCTup
PP factivities
o stnenopmfor
oC all
:2 eHIV
rugiFexposed infants.
Any intervention or ARV prophylaxis given to the HIV exposed newborn should be documented in the
nembefore
child health card oW tnadischarge.
ngerP lla The
ot sfollowing
ecivreS gshould
nitseTbe
dnnoted
a gnilin
lesthe
nuocard:
C VIH fo reffO
• Whether the infant had received ARV prophylaxis and the duration received/advice
• What feeding choice the mother has made? Whether EBF or ERF?
• Date of next follow-up. nemoW tnangerP detcefnI VIH evitageN VIH
11.1 During the First Post-delivery .sretneC TRA taVisit sixalyhat porp6 Weeks/ First xes efaS l
.gnillesnuoc
fo noitImmunization
animret lacidem ro noVisit itaunitnoc fo seciohc no gnillesnuoC l
elpuoC l
.gnillesnuoc
All HIV exposed infants must be checked for the following .ylno ycnaat ngethe rp first immunization visit to ICTC health
facility: .sIO rehto dna BT rof gnineercS l .seciv res gninnalp
. s I T S r o f t n e m t a e r t d n a g
• Co-trimoxazole Prophylactic Therapy (CPT) initiated at 6 weeks of age (decisionn i n e e r c S l .smodnon oc eextending
erF l
Syp NVP to 12 weeks). .gnitset 4DC dna gnigats lacinilc OHW l egnahc ruoivaheB l
dnaAdherence
gninnalp-hoftribinfant
,y reviNVP
led efprophylaxis
as ,gnivil evifor tisothe
p nopastgnill6esweeks.
nuoC l noitacinummoc
•
ksir hgih rof )CCB(
• EID (DNA/PCR) as per National Guidelines. reh dna nemow
• Decision made whether to stop infant.nNVP prophylaxis
erdlihc gnivil rehto or continue as per guidelines
VIH ta(see
epeRbelow) l
• For exclusively breastfed infants whose .retnemothers

C TRA otare larrnot
efeRtakingl ART: , g n i t s e t
tnuoco 4DTheC nopattern
desab nofemfeeding,
iger citcaattachment
lyhporp VRAand ro TR A edivorP &l mother’s breast condition gniredisnoc
positioning fi doirep ,wodnimust w be
enquired. .gnigats lacinilc ro/dna
evitisop si esuops
o Any infant with problems must .have semmaamedicalrgorp noiassessment.
tirtuN .ruoivaheb ksir
o Provide 6 weeks .rehsupply
tom rofofsixinfant
alyhposyruprp VRANVP mutprophylaxis
raptsoP l at ICTCs fordnall a gHIV
nideexposed
ef tnafnIbabies l
(3 bottles of Sy NVP:25 ml).seciv reS gninnalP ylimaF l noitirtun
.stisoiv em oh hgufor
orhmonthly
t troppusfollow-up
gnideef tnofafthe nI/tninfants.
emecrofnier FBE l .gnillesnuoc
Arrange
o Such mothers have to be on life-long ART
• For infants on exclusive replacement feeding, check with the parents and family if any problems
faced so far:
o Emphasise good hygiene, use of clean boiled water, hand-washing. )IEH( tnafnI desopxE VIH
• Any infant with problems must have a medical assessment. NVPsd
) 1 1 ' - 0 1 0 2 s e n i l e d i u G O C A N / O H W I - n o i t p O d e r r e f e r p ( s h t n o m 6 o t p u eeftsaprophylaxis
infant erb evisulcxEis to
l
be
rostopped
f raey 1at otp6uweeks:
shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
o How and what are being given as exclusive replacement feeds?
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeperlife-long
o When has the mother been started on ;ega fo sART keewto6knowta )DItheE( sduration
isongaid t(atleast
nafni ylr24
aE weeks
l
of ART)
o All infants with HIV DNA/ PCR positive results .ega fo stokebe ewreferred
6 morf surgently
ixalyhporto p ethe
lozaART
xomcentre
irt-oC asl per
guidelines.
.dlihc eht
Figure
o Confirmation with Whole 2: Components
Blood Specimenof(WBS)
PPTCTtest
Programme
will be done at the ART centre.
o All infants/children less than 2 years of age with a confirmed Whole Blood Specimen(WBS)
Offer status
positive of HIVatCounselling and Testing
ART centre should Services
be initiated to all Pregnant
on Paediatric Women of CD4 % at
ART, irrespective
the earliest.
o All HIV-exposed infants should be followed-up monthly, in the first year of life and every
3 months thereafter, regardless of the infant feeding practice being adopted.
Pregnant Women
o Any infant clinically suspected
l of having
Antenatal HIV(ensure
Care shouldat-least
be tested for HIV, regardless
4 visits)–Monthly of their age.
ART/ARV
o All HIV exposed infants irrespective of prior status, should have the final confirmatory HIV
counselling.
tests at l Counselling on choices of continuation or medical termination of
l Couple
counselling.
o 18 months in any ICTC using 3 Rapidonly. Anti-body tests, even if the first rapid test is negative.
pregnancy
o No DBS/WBS
planning services. (DNA/PCR) ltesting Screening
to be fordone TBat andorother
afterOIs.
18 months.
Freethat
condoms. l Screening and treatment for STIs.
Activities
l
need to be conducted at each visit are shown below:
Table 10: Activities at Each Follow-up Visit for HIV Exposed Infants and Children < 18 Months
(BCC) for high
Visit Birthrisk 6 wks 10 wks 14 wks 6 mths 9 mths §12 mths 18 mths
women and her
Co-trimoxazole l Start CPTl from 6 weeks
Couple (orsafe
and first sex
immunization visit) and
counselling for allHIV
HIV-exposed
testing infants and children
of spouse and
partner.
prophylactic l Continue CPTother
for all living
babieschildren.
up to 18 months irrespective of EID status and thereafter if
therapy
l Repeat
(CPT) HIV confirms positive
Counselling for Exclusive √ √ √ BF+complementary √ If EID is –ve √
considering breast Provide ART or ARVfeeds prophylactic regimen based stop BF.on CD4 count
Infant feeding l
window, period
feeds for if and/or clinical staging. Continue
spouse is positive
first six BF if EID is
or s/he have months
high l Nutrition counselling and linkages to +ve Government/other
after
risk behaviour. Nutrition programmes. 12 months
l Infant feeding and l Postpartum ARV prophylaxis for mother. up to 2 yrs

Growth
nutrition √
monitoring
√ √
l Family√ √
Planning Services. √ √ √
counselling. l EBF√reinforcement/Infant feeding√support through home√visits.

Developmental √ √ √ √ √
assessment l Psycho-social support through follow-up counselling, home
Immunization BCG OPV 1 OPV 2visits OPVand3 support groups. Measles OPV DPT
& Vitamin A HBV0* DPT 1 DPT 2 DPT 3 + Vit. A and Measles
supplements OPV0 HBV 1* HBV 2 HBV 3 (Booster
doses) Vit.A
Clinical
HIV Exposed√Infant √
(HEI) √ √ √ √ √ √
assessment
HIV testing √ √ +/- (12 √
and continued breastfeeds
(√-if required) (DNA/ in addition to complement (Rapid feeds
Test after 6 months upto 1 yearAllfor
months) 3 Rapid
EID negative babies and PCR) upto 2 years for EID positive + DNA/PCR) √ Rapid TestART.
babies who receive Paediatric Tests(No
+ DNA/PCR) DNA/PCR)
*HBV vaccines as per state approved schedules
Note:l 18Early infant
months – OPVdiagnosis (EID) at 6 weeks of age; repeat testing at 6 months, 12 months & 6 weeks
and DPT booster
after cessation of breastfeeds.to bring infant/child back to ICTC at the earliest.
For any illness – educate parents/caregiver
§ 6 weeks after cessation of breastfeeds, HIV testing to be done (Rapid and DNA/PCR, if former is positive).
the child.
11.2 Confirmation ofemHIV
Status in HIV Exposed Infants should be
done at 18 Months, Regardless of Earlier Diagnosis
• All HIV exposed infants and children regardless of HIV status will be followed-up until 18 months
of age for care, monitoring and the final confirmatory HIV test at 18 months using 3 HIV Rapid
tests (even if HIV-1 rapid test is negative).
• If any HIV exposed infant or child develops clinical signs and symptoms suggestive of HIV infection,
the Medical Officer at the health care facility should start immediate treatment for the acute
.sretnetoC T RA Centre.
ta sixalyhHIV portesting
p xes efaS l
illness, stabilise and refer urgently ART according to the .gnnational
illesnuoctesting
fo noialgorithm
tanimret lafor
cidinfants
em ro nand
oitauchildren
nitnoc fo <18
seciohcmonths
no gnillealsosnuohas
C tol
be done. elpuoC l
.gnillesnuoc
• Follow-up of HIV infected infants and children .ylno ycstarted
nangerpon ART shall be done by ART centres in
collaboration with the Paediatrician
.sIO rehto at dnatheBTinstitution cS l ART Centre.sis
rof gnineerwhere eclocated.
iv res gninInfants
nalp and
children on ART must undergo .sITS rothe
f tnconfirmatory
emtaert dna gthree nineeantibody
rcS l tests at 18-months
.smodnoof c eage
erF inl the
.gnitseof
nearest ICTC, irrespective t 4the
DC results
dna gnigofatthe
s lacfirst
inilcrapid
OHWantibody
l test. egnahc ruoivaheB l
dnaNo gniDBS
nnalp noitacinummoc
• &-WBS
htrib ,(DNA/PCR)
y reviled efatesting
s ,gniviltoevbe
itisodone
p no at
gniorlleafter
snuoC18 lmonths.
ksir hgih rof )CCB(
• dnaInescase reh dna nem18 owmonth
uops fo gnitset VIH dna gnillesnuoc xes efas tests
there is discordance with DNA/PCR dna e(DBS
lpuoC andl
WBS) and subsequent
.rentrap
anti-body test, such cases should be referred to NPO (ART) electronically for further guidance
but to be on or continued paed. ART. (this guidance shall be finalised over the next six months
and intimated accordingly) g n i r e disnoc
evitisop si esuops

.dlihc eht
12
Essential Gynaecologic Care for
emHIV
During the long term follow-up of marginfected
orP TCTPpregnant
P fo stnenowomen,
pmoC :2 erapart
ugiF from ART and pre-ART care, key
areas which must be discussed, are:
nem
• Cervical oW tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO
screening
• Family planning and birth-spacing
• Contraception
12.1 Cervical Screening .sretneC TRA ta sixalyhporp xes efaS l
Women . g n i llescancer.
nuoc The
fo noitinfected
animret with
lacidHIV
em rare
o noatitahigher
unitnorisk
c fo of
secdeveloping
iohc no gnicervical
llesnuoCdysplasia
l leading to cervical
Human e l p uoC Geno
l
fo shPapilloma
tnom 3 tsvirus
rif eh(HPV)
t nihtinfection
iw ekatreisdn more
u otcommon
–)PTM( yin cnHIV
anginfected
erp pregnant women, particularly
.gnillesnuoc
types 16, 18 and others incriminated to be carcinogenic .ylno ycbeing
nangeIARC
rp (WHO) 31,33,35,39,45,51,52,56,
58,59 & 68 more incriminated to cause .sIO recervical
hto dna B cancer.
T rof gniIn
nethe
ercSNational ART Guidelines for adults and
l
.seciv res gninnalp
adolescents, cervical screening .eg. Pap smear or trichloro-acetic
sITS rof tnemtaert dna gnineercS l acid screening of the cervix should be
.smodnoc eerF l
done annually for all HIV infected pregnant women.
12.2 Family Planning and Birth-spacing .snoitpo gnideef tnafni
ksir hgih rof )CCB(
reh dna nemow
With dART
na esand
uopsPPTCT
fo gnitsbeing
et VIH increasingly
dna gnillesnuavailable,
oc xes efas HIV
dna infected
elpuoC pregnant
l women and .men rentraare p now
living longer and healthier lives and desiring .to have children.
nerdlihc gnivil rehto Accordingly, reproductive plans
VIH taepeR l including
pre- conception counselling, and counselling regarding reversible
.retneC TRA ot larrefeR l methods of contraception ,gnitshould
set be
discussed with HIV infected pregnant women of child bearing age. g n i r e d i s n o c
.gnigats lawomen
cinilc ro/d fi doirep ,wodniw
na similar to non-HIV
Pre-conception counselling–HIV infected pregnant are evitisoinfected
p si esuopregnant ps
rehto/tThe
women. nemgoals
nrevoare
G otot improve
segaknithe l dhealth
na gnof illethe
snuwoman
oc noitbefore
irtuN conception
l and hgih evah ehrisk
to identify /s rofactors
for adverse maternal and foetal outcomes. .These semmainclude:
rgorp noitirtuN .ruoivaheb ksir
.rehtom rof sixalyhporp VRA mutraptsoP l d n a gnideef tnafnI l
• Safe sex practice
• Prevent test and treat STI.
• eReproductive
moh ,gnillesnuhistory
oc pu-wincluding
ollof hguonumbers
rht troppofuspregnancies
laicos-ohcysandP loutcomes of pregnancies.
• Length of relationship with current .spuopartner,
rg troppuHIV
s dnstatus
a stisivof partner and couple’s sexual history
including condom use and sexual decision-making or control of reproductive choices.
• Patient’s and partners reproductive desires and discussion of options.
• Reduce/avoid risky behaviour eg. smoking, substance abuse.
• roTake
f raefolic
y 1 oacid
tpu sbefore
htnomconception.
6 retfa sdeef tnemelpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
Family planning counselling5 information includes: .skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP l
sk•
eewInformation
6 & shtnomabout21 ,sheffective
tnom 6 tacontraceptive
gnitset taepermethods
;ega fo sktoeeprevent
w 6 ta )Dpregnancy,
IE( sisongaidual d tnaprotection;
fni ylraE l the
effects of progression of HIV disease on the woman’s health; . s d e e f t s a e r b f o n o i t a s s ec retfa
5
Sexual and reproductive health of women living with HIV/AIDS .egGuidelines
a fo skeew on6care,
mortreatment
f sixalyhpand orpsupport
elozaxfor omwomen
irt-oCliving
l
with HIV/AIDS and.Dtheir

IE hchildren
guorht inevresource-constrained
itisop VIH sa desonsettings.
gaid neWHO/UNFPA
rdlihc dna s2006.
tnafni rof TRA deP dna erac VIH l
.dlihc eht
• The importance of family Figure 2: Components
planning of PPTCT Programme
and birth planning;
• The risk of HIV transmission to an uninfected partner while having unprotected intercourse (for
Offer
instance, of HIV
when tryingCounselling and Testing Services to all Pregnant Women
to become pregnant);
• The risk of transmission of HIV to the infant and the risks and benefits of Antiretroviral prophylaxis
in reducing transmission; and
• Information on the interactions between HIV and pregnancy, including a possible increase in
certain
Safe sex adverse pregnancy outcomes.
l
counselling.
Contraceptive Counselling on choices of continuation or medical termination of
Couple Methods
l
l
counselling.
Most women with asymptomatic HIV and those who
pregnancy only.are on ART can safely use the available forms of
contraception for preventing unintended pregnancies.
Screening for TB and However, prevention of cross-infection of HIV
other OIs.
virusl toFree
thecondoms.
partner as well as STIs isl important Screeningand andhence
treatmentdual for
protection
STIs. with consistent condom use
is important.
l Behaviour Dualchange
protection refers to l
simultaneous
WHO clinical stagingprotection against
and CD4 both unplanned pregnancy and
testing.
STIs and HIV by using:
(BCC) for high risk
• women
Condoms infant feeding options.
and together
her with another effective method of contraception, including emergency
contraception.
Available forms of contraception for HIV infected pregnant women include: Hormonal contraception: is
safe in women living with HIV. These may be either:
• window, period if
Oral contraceptives and/or clinical staging.
spouse is positive
l Nutrition counselling and linkages to Government/other
• orDepot
s/he have high
medroxyprogesterone acetate (DMPA)
DMPA l
is safefeeding
Infant to useand in women living l with HIV asARV
Postpartum wellprophylaxis
as those on for ART.
mother.There is no hormone-drug
interaction with several ARV drugs commonly
nutrition l Family used suchServices.
Planning as NVP, EFV and Nelfinavir.
counselling.
In women living with HIV (whose CD4l isEBF > 350 cells/mm3), hormonal
reinforcement/Infant feedingcontraception
support through homeAdherence
is safe. visits.
to oral contraception needs to be counselled. l Psycho-social support through
Dual protection follow-up
with consistent counselling,
condom use ishome
important.
In women taking ART for their own health, they should be assessed for oral contraception use according
to the WHO Medical Eligibility Criteria for Contraceptive Use guidelines6. There may be hormone-drug
interactions which need dosing to be adjusted or an alternative contraception to be used
Ritonavir
• EIDCombined
negativeoral contraception
babies and upto 2pills years arefor
generally not recommended
EID positive babies who receivefor women taking
Paediatric ART.ritonavir-
l boosted PIs,
Postpartum ARVdueprophylaxis
to the potentially
for infant decreased
for 6 weeks.efficacy of the contraception
7
Medical
Eligibility Criteria for Contraceptivefrom 6 weeks
Use. of age.
4th edition. WHO 2009. http://www.who.int/reproductivehealth/publica-
tions/family_planning/en/index.html
the child.
• Nevirapine emmargorP TCTPP fo stnenopmoC :2 erugiF
o NVP reduces the levels of combined oral contraception (ethinyl estradiol and norethindrone)
neat
but mopresent,
W tnannogerdosage
P lla otmodification
secivreS gare
nitsbeing
eT dnsuggested
a gnillesnuoC VIH fo reffO
• Efavirenz:
o Women taking EFV may be able to take combined oral contraception without loss of
contraceptive efficacy n e m oW tnangerP
• NRTI such as AZT and TDF: .sretneC TRA ta sixalyhporp xes efaS l
.gnillesnuoc
o Women taking AZT and TDF may take combined oral contraception without loss of contraceptive elpuoC l
efficacy .gnillesnuoc
.ylno ycnangerp
Lactational Amenorrhoea Method (LAM) .sIO redoes hto dnnot a Bprotect
T rof gniagainst
neercS STIs, l pregnancy
.seand
civ reHIV.
s gnin Correct
nalp and
. s I T S r o
consistent condom use should be adopted at every sexual encounter. f t n e m t a e r t d n a g n i n e e r c S l .smodnoc eerF l
Male sterilization (NSV): Males should be motivated at every mother-baby pair follow-up noitacivisit
numto moundergo
c
sterilization. No Scalpel Vasectomy (NSV) when the baby attains 18 months/2 ksir hyears
gih roof f )Cage
CB((at 18
months confirmatory test, irrespective of the baby’s HIV status). However, afterreNSV h dnoperation,
a nemow male
d n a e s u o p s f o g n i t s e t V I H d n a g n
should continue to use a condom at every sexual encounter. i l l e s n u o c x e s e f a s d n a e l p u
7 oC l .rentrap
Intra-Uterine Contraceptive Device (IUCD) is a good contraceptive gmethod n i r e disnfor
oc HIV
tnuoc 4DC no desabinfected nemigepregnant
r citcalyhpwomen. orp VRAIUCD ro T8RCopper
A edivoTrP380A l
is recommended
fi doirepby,wMoHFWodniw as
Box 16 a long term reversible.gmethod nigats lacinilc ro/dna
of contraception up to 10 years. evitisopPPsi IUD esuo(Cu-’T’
ps
A-380) to be inserted within 48 hrs of delivery.
PP .IUD rehto- mPostpartum
rof sixalyhpoIUD rp Vrequires
RA mutraspecialised
ptsoP l training before
dna gnthe ideefhealthcare
tnafnI l
personnel undertake .sectheiv resame.
S gninnalP ylimaF l noitirtun

8
.DIE hgfor
IUCD Reference manual uoMedical
rht evitOfficers
isop VI2007.
H sa dFamily
esongPlanning
aid nerdDivision.
lihc dnaMoHFW.
stnafni rof TRA deP dna erac VIH l
.dlihc eht
13
Monitoring and Evaluation Tools
emmathe
Monitoring and evaluation facilitates rgorassessment
P TCTPP fo stnof
enothe
pmoperformance
C :2 erugiF of an individual as well as the
performance of the programme, which forms the basis of decision making, policy planning and resource
allocation andnemid-term
moW tnacorrections,
ngerP lla oift required.
secivreS gnitseT dna gnillesnuoC VIH fo reffO
Client Monitoring
Monitoring of HIV infected pregnant women is an essential component of quality patient care in PPTCT
programme. It involves documenting all client encounters by maintaining regular and accurate records of
key aspects of the services provided to the PPTCT beneficiaries and her baby.
A set . g n i llesnuoc
fo nof
oitM&E
animtools
ret lachave
idembeen
ro noidevised
taunitnoto c foensure
seciohthat c no gcontinuum
nillesnuoC oflcare from detection of HIV infection
among elpuoC l
fo shpregnant
tnom 3 twomen
srif eht to
nihtheir
tiw elinkage
katrednto u ARTot–)Pcentre
TM( yand cnanfor gerEIDp after delivery is well maintained. In
.gnillesnuoc
addition to regular CMIS format of monthly reporting .ylno aycPPTCT nangerpbeneficiary Line-list has been designed,
which shall be updated on an event basis
.sIO rehtobydnICTCsa BT rand of gnART ineecentres
rcS l to ensure delivery
.seciv resofgnthe innacomplete
lp
package of PPTCT services to all.spregnant mtaert dviz
ITS rof tnewomen naAnti-Retroviral
gnineercS l Therapy, Delivery; .smodnoc eerFhistory;
Feeding l
Early Infant Diagnosis along.gwith nitsefinal
t 4DC confirmation
dna gnigats at lac18 inilcmonths.OHW l egnahc ruoivaheB l
ksir hgih rof )CCB(
13.1 Guidance on Data Flow .of snoPPTCT
itpo gnideeBeneficiariesf tnafni
reh dna nemow
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC l .rentrline-list
ap
1. A line-list has been devised for the PPTCT beneficiaries and is labeled as Tool 1. This is
.n e r d l i h c g n i v i l r e h t o
meant for all PPTCT beneficiaries (Pregnant Women in antenatal care, Direct-in-labour & Post- V I H t a e p e R l
delivery; breastfeeding mothers). This .retneline-C TRA listot will

larreoriginate
feR l at the concerned ICTC ,gnitswhere
et a
tnuocpregnant
4DC no dwoman
esab neismdetected
iger citcalto
yhpbe orp VRA ro This TRA will edivobe g n i r e d
rP anl electronic format and shall NOT bei s n o c
positive.
. g n i g a t s l a c i n i l c r o / d n a fi doirep ,wodniw
printed in a register form at present. evitisop si esuops
2. The ICTC generating this line-list will .sefill
mmup argthe orpcolumn
noitirtuN numbers 1 to 17 d; 29 to 37c and 42 &
.ruoivaheb ksir
43 (Colour coded .in rehyellow).
tom rof sixalyhporp VRA mutraptsoP l dna gnideef tnafnI l
3. When this line-list is shared by.sethe civ rICTC
eS gniwith nnalPthe ylimART aF lcentre, where the positive noitirtupregnant
n
.stiswoman
iv emohishgregistered,
uorht troppthe
us gconcerned
nideef tnafART nI/tnecentremecrowill fnierfill FBup E the
l column numbers .g18nilletosn28; uoc38a to
e38d;
moh ,39
gnilto
les41;
nuo44a
c pu-to
wo47
llof (Colour
hguorhtcoded
troppuin
s lagreen).
icos-ohcysP l
4. Columns 23, 24 and 25 can be filled up by ICTC counsellor if and when applicable.
5. The line-lists should be generated at ICTC on the first visit of a new HIV positive pregnant case
presenting either during pregnancy, direct-in-labour or after delivery. )IEOne
H( trow
nafnshould
I desopbe xEassigned
VIH
)1for
1'-0each
102 client.
senilediMost
uG OCoften,
AN/OH the
W first
I-noitvisit
pO diserratefethe
rp( sICTC
htnom when6 otpauwomen
sdeeftsainerb ante-natal
evisulcxEcare l is
detected to have HIV infection. Hence, line-lists will be generated
rof raey 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni sdeeftsaerb deunitnoc dnathere and details shared with
the
.TRAARTcirtaCentre
ideaP efor
vieentry
cer ohof
w relevant
seibab evinformation.
itisop DIE roSometimes
f sraey 2 otpan u dHIV
na sinfected
eibab evipregnant
tagen DIEwoman
may have her first visit at the ART Centre, .skerather
ew 6 rothan f tnafICTC
ni rof eg.
sixaalypositive
hporp VRfemale
A mutraclient
ptsoPalready
l
enrolled at ART centre, gets pregnant or has a second pregnancy after
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE l previously being detected.
In such cases, the line-list will be generated at the ART Centre .sdeeand
ftsaeafter
rb fo the
noitarelevant
ssec retfcolumns
a
have been filled up, the line-list will be shared .ega fo skeew 6 morf sixalyhporp elozaxomirt-oC further
by the ART centre with the ICTC for l
follow-up.
.dlihc eht
6. This line-list should be updated Figure 2:at Components
each activityof PPTCT
in theProgramme
continuum of PPTCT care services eg.
ANC/ICTC visits, CD4 test, ART initiation, delivery, Syp. NVP initiation, CPT initiation, EID visits,
immunization
Offer ofetc. HIVand shared onand
Counselling a weekly
Testingbasis between
Services ICTC
to all and ART
Pregnant centre counsellors
Women
and staff. If it is not possible to share information weekly then the information about all newly
detected HIV positive cases at ICTCs must be given to the ART Centre by the District Supervisor/
DAPCU officer where client wants to get enrolled for the early registration and initiation of ART.
HIV Print outs of this electronically
Negative HIVshared line-lists
Infected on a Women
Pregnant monthly basis after updating them should be
kept in
Pregnant Women a ring- binder file bothl at
Antenatal Care (ensureCentres.
the ICTCs and ART at-least 4 visits)–Monthly ART/ARV
Safe sex
The updated line-lists should beprophylaxis at ARTICTCs
Centers.
l
7. counselling. shared between and ART Centres on a monthly basis at
Counselling
DAPCU/District level monthly co-ordination meetings (which
l on choices of continuation
are held by or the
medical
5th of termination
every month).of
l Couple
List of LFUs should be generated during DAPCU/Monthly co-ordination meetings at District of
counselling.
pregnancy (MTP)–to undertake within the first 3 months and
pregnancy only.
l shared with
Linkages to family respective ICTCs/ANMs/ ASHAs /Outreach workers/District Level Networks for follow-
up. District Nodal persons should take responsibility of linkages of all the newly detected HIV
l Free
casescondoms.
with ANMs/ASHAs /Community l Screening and treatment
Out-reach for STIs. Networks of Positive People
Workers/District
l Behaviour
as well aschangetracking of LFU cases. l WHO clinical staging
Accompanied andby
referral CD4 testing.
them should be ensured so that the
communication
pregnant woman reaches thel ART Counselling
Centre ason positive
soon living, safe delivery, birth-planning and
as possible.
(BCC) for high risk
8. women
In caseand her
the expected place of delivery is in another district, it is the responsibility of ICTC counsellor
of the centre where her original registration was done, to inform the ICTC counsellor of expected
l
place of delivery with copy to DAPCU/District Supervisor and other concerned officials at SACS.
testing, Referral
This is to ensure that this woman l
is nottolost
ART-toCenter.
-follow-up and is not registered again at another
considering
ICTC where
window, period sheif delivers. This will ensure that thereprophylactic
l Provide ART or ARV is no double regimen
countingbased on CD4The
of cases. count
ICTC
Counsellor and/or clinical staging.
at second ICTC will be responsible for updating the line- list of this woman, linking this
spouse is positive
orpatient to EID
s/he have and ART services.
high l Nutrition
Once this womancounsellingcomesand backlinkages to Government/other
to the original (previous) ICTC, the
data in the line-list should also be transferred to this ICTC and ART Centre.
9. nutrition
At district level, the updatedlline-lists from all ICTCs
Family Planning should be compiled into one Consolidated
Services.
list and updated on a monthly
counselling. l
basis
EBF by DAPCU/ Nodal Person
reinforcement/Infant for HIV
feeding in the
support district.
through The visits.
home compiled
district level line-list should be cross checked and validated by the nodal person in district and
then sent to M&E officer at SACS with copy to JD (BSD) and PPTCT focal person in SACs by 10th of
every month. The responsibility of compilation of District level, PPTCT beneficiaries line–lists lies
with District Supervisor (in DAPCU Districts) and ICTC Counsellor/s (preferably located in Gynae
OPD) of District headquarters.
10. The
l M&E breastfeeds
Exclusive officer at SACS uptowill then compile
6 months these
(preferred districtWHO/NACO
Option-I level line-lists into one 2010-'11)
Guidelines State level line-
list.continued
and This Statebreastfeeds
level line-list in of PPTCT to
addition beneficiaries
complementshould feeds be sent
after by JD (BSD)
6 months upto 1 at year
SACSforto BSD
Division
EID and babies
negative CST Division
and uptoat NACO
2 yearswithforcopy
EID to RCs bybabies
positive 15th who
of every month.
receive Paediatric ART.
Postpartum
11. The
l ARV prophylaxis
generation and compilationfor infantofforline-lists
6 weeks. at District/State/NACO level is primarily the
l Early infant diagnosis
responsibility of BSD(EID) at 6 weeks
division. Only the of age;
ARTrepeat testingofatthe
component 6 months,
line- list12shall
months & 6 weeks
be filled in and
after cessation
updated by ART of breastfeeds.
Centres and shared with ICTCs after each activity is accomplished electronically
l Co-trimoxazole
&/or in the monthly prophylaxis
meetings.from 6 weeks of age.
the child.
emmargoNACO
12. The M&E officer at BSD Division, rP TCTPshall
P fo scompile
tnenopmoand
C :2 analyse
erugiF these reports every month and
give feedback to the concerned person at BSD and CST at NACO on gaps in the cascade of service
delivery
nemtooPPTCT
W tnanbeneficiaries
gerP lla ot so
secthat
ivremeasures
S gnitseTtodnfilla in
gnthese
illesngaps
uoC can
VIHbe
fo instituted.
reffO
13. Another tool shall be used by ART centre for reporting on PPTCT and EID indicators. This is
presently being sent as a separate tool (Tool-2) but ultimately will be part of monthly reporting
format from ART centres (once new form page format is rolled -out across the country.)
15.2 Tool 1: PPTCT Beneficiary
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l Line-List (ICTC-ART) n e m oW tnangerP
.sretnfor
eC the
TRA ta sixalyhporp xes efaS l
Name of the State: Updated month:
.gnillesnuoc
elpuoC l
Year: .gnillesnuoc
.ylno ycnangerp
District:
.sITName
S rof tof
neMOmtaI/cerof
t dICTC:
na gnineercS l .smodnoc eerF l
dna gninnalp-htrib ,y reviled efas Contact
,gnivil eNo.
vitiof
soMO:
p no gnillesnuoC l noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
Name dnofaICTC:
esuops fo gnitset VIH dna gne-mail
illesnid:
uoc xes efas dna elpuoC l .rentrap
(where generated) Name of.rSMO/MO
etneC TRA ot larrefeR l
of ART Centre: ,gnitset
.gniof
gaSMO/MO
ts lacinilc ro/dna fi doirep ,wodniw
Contact No.
evitisop si esuops
Name of ART: e-mail id:
(with whom shared) Name of DAPCUO/Nodal Officer I/c of HIV Programme: .gnillesnuoc
Designation of I/c Officer
Contact No.:

)11'-0102 senilediuG OCAN/Oe-mail HW Iid:
-noitpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
Pertains .to
TRICTC
A cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIE
skeewto6ART
Pertains & shcentre
tnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE l
.ega fo15.2skeTool
ew 1:
6m orf sixalyhporp elozaxomirt-oC l
PPTCT Beneficiary Line-List (ICTC-ART) Contd....
.dlihc eht
15.2 Tool 1: PPTCT Beneficiary Line-List (ICTC-ART) Contd....

Expected Date
of Delivery
(EDD)
11
Gestational
Age (in
weeks)
10
Type of Client
Safe sex
Post-delivery
ANC/ Direct-
in -Labour/
l
mother
counselling.
9
l Couple
counselling.
pregnancy only.
Linkages to family
Name of the
ICTC where
l
tested
8

ICTC PID
Number
(BCC) for high risk

7
women and her

(Confirmatory
l
HIV Test
testing,
Date of
Referral to ART Center.

test)
l
6

spouse is positive
Father’s name
Block/ Taluka/
and Parental

and contact
State) with
Landmark,
(including
l
or s/he have high
Door no./
Pin Code
Address
District/
number
Village/

5

nutrition Family Planning Services.
...15.2 Tool 1: PPTCT Beneficiary Line-List (ICTC-ART) Contd.
l
Block/ Taluka/
and contact
State) with
Landmark,
counselling.
Husband’s
name and
(including
Door no./
Pin Code

Address
District/
number
Current
Village/
l
4

(in years)
Age

Post- delivery
ANC/ Direct-
Name of the
Women in
in labour/
Pregnant
mother
Clients Sl. No.
Early infant diagnosis (EID) at 6 weeks of age; repeat testing at 6 months, 12 months & 6 weeks
(Expandable)

iii
iv
1
ii
i

the child.

Clinical
Stage
WHO
21
CD4 Count nemoW tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO
count and
Baseline
of CD4
Date
20
Registration
Registration
Centre and
nemoW tnangerP
Pre-ART

Date of
at ART
No.
19

.gnillesnuoc
elpuoC l
New Case/
Registered

Already
at ART
.gnillesnuoc
18
.ylno ycnangerp
months
at 18
17d

17. Infant feeding practice
ksir hgih rof )CCB(

months
at 12
reh dna nemow

17c
months
17b
at 6
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l gniredisnoc

evitisop si esuops
at 6 weeks

17a

Status of
delivery
up to 6
Mother
(Alive/
weeks
Dead)
after
16

Outcome of
(Live Birth/
Still Birth/
Pregnancy

Abortion)
MTP/
15
guidance)

Delivery
Place of
(refer to
14

Delivery
Date of
13

Expected
Delivery
Place of
12

.dlihc eht

Syp at birth weeks of NVP for stopping NVP
If stopped before
starting NVP completing 6 6 weeks, reason
Syp
31
Syp dd/mm/yy
Date of

30

counselling.
dd/mm/yy
Counselling on choices of continuation or medical termination of

Date of
l
Couple
29
l
counselling.
pregnancy only.
Reason for
Stopping
ART *
Free condoms. Screening and treatment for STIs.

28
l l

stopping ART
(BCC) for high risk

dd/mm/yy

Date of
women and her

27
testing,
Date of ART

dd/mm/yy
initiation
l
considering
26

spouse is positive
ART Registration
l
or s/he have high
dd/mm/yy
risk behaviour.
no.
25


Completing ATT
Psycho-social support through follow-up counselling, home

(DOTS/ Non-
(dd/mm/yy)
l
Date of
DOTS)

24

of starting ATT
is “Yes”, date
If Column 22
(DOTS/Non-
(dd/mm/yy)
Exclusive breastfeeds upto 6 months (preferred Option-I WHO/NACO Guidelines 2010-'11)

DOTS)
l
23
diagnosed as
having TB
Whether
(Yes/No)
l
22

the child.

back to ICTC
(dd/mm/yy)
2nd WBS,
If infant is
negative
Referral
Date of
with
38d
discordance)
38. DNA/ PCR: WBS tests
Positive or
(in case of
2nd WBS
1st WBS
Result of
Negative
DBS &
38c
test Positive
or Negative
Specimen
Result for

38b
WB
.gnillesnuoc
elpuoC l
.gnillesnuoc
.ylno ycnangerp
collection
specimen
date (dd/
mm/yy)
38a
WB

breastfeeds
egnahc ruoivaheB l
stopping of

at 6 weeks
after
37c

37. DNA /PCR: DBS tests
ksir hgih rof )CCB(

reh dna nemow
at 6 months
(positive or
.rentrap
negative)
37 b

(positive or
at 6 weeks
negative)

37a
evitisop si esuops
Unique DNA
infant code

36


ICTC ID of
infant
35

Name of
Infant

34

At 6 weeks,
FP method
Protection)
or OCP) in
temporary
(Copper-T
condoms
to use of
followed
addition
is being
(Dual
what
33

CPT in baby
initiation of
dd/mm/yy

Date of
32

.dlihc eht
46. Whether immunization Remarks***
2. Information on authorized attendant to

whom ART can be dispensed(from 6 months
3. Any other important information on related or

of pregnancy upto 2 months post delivery)
47
***Relevant information to be captured, eg:

First booster
1. Client’s current location with date

dose at 18
months
(Y/N)
46b
completed

discontinuation** measles and
Vitamin A
Pregnant Women
including

Primary
(Y/N)
46a
to client her baby

counselling.
l Couple
reason for ART
45. ART/ ARV prophylaxis
counselling.
Date and
pregnancy only.
45b
Linkages to family
Outcome (Child)

Alive & On
Treatment
l l
45a

(BCC) for high risk
women and her
/discontinuation**
Date and reason
partner.
(code) for ART
l
44. ART Outcome (Mother)
E – opted out of the programme

B – Stopped on Medical advice,
44b
D – Lost to follow up.(LFU)

**A – Maternal death,

C – Transfer out,
spouse is positive
Alive & On
Treatment

44a
l
or s/he have high
stopping
CPT dd/
Date (dd/mm/ Date of
mm/yy

43

Tests (Rapid)
conducted at
- Confirmed

negative or
18 months
& result of
Confirmed
Antibody
l
positive
yy)
42
*1. After one week of stopping breastfeeding

Initiation of
(dd/mm/yy)
Paed ART
Date of

41
4. Parent/Guardian decision

HIV +ve infant
Date (dd/mm/ CD4 count
Baseline
CD4 %
3. Death of mother
5. Medical Reason
40
or
2. Death of baby

ART Number
Registration
l
yy) and Pre

39

the child.
emminarPPTCT
15.3 Definition of Tool 1 Variables gorP TCTBeneficiary
PP fo stnenopLine-list
moC :2 erugiF
Tool 1: Definition of Different Variables in PPTCT Beneficiary Line List

Sl. No. Variable Description
1 Sl. No. It is a number provided to the each client coming
to avail the PPTCT package of service on her first
visit.
2 Name of the Pregnant Women/ Direct-in- labour ANC/Post- Write the complete name of the Client here in
VR A/TRAmother
delivery ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnblock
A lletters. nemoW tnangerP
.sretneC TRA ta sixalyhpoWrite rp the age of the Client in years. xes efaS l
3 Age (In Years)
.gnillesnuoc
fo4 noitaHusband’s
nimret laname
cidemand ro Current
noitaunAddress
itnoc fo(including
seciohcDoor no gNo./
nillesnuoWrite C lthe address of the client where currently
elpuoC l
fo shtnVillage/Block/
om 3 tsrif Taluka/
eht niDistrict/State)
htiw ekatrewith dnu Landmark,
ot–)PTMPin ( ycCode
nangeresiding:
rp Husband’s name, along with Door No./
and contact number .gnillwith
esnulandmark
oc
.ylno ycnangeVillage/Block/Taluka/District/State
rp
ylimafNumbers
and Pin code and Contact ot segakniL l
.sIO rehto dna BT rof gnineercS l .seciv rofesfather
gninnofalthe p
5 Father’s name and Parental Address (including Door no./ Write the name and address
. s I T S r o f t n e m t a e r t d n a g n i n e e r c S
Village/Block/ Taluka//District/State) with Landmark, Pin Code client along with Father’s.name/Door
l smodnoc No./Village/
eerF l
and contact number .gnitset 4DC dna gnigats lacinilc OHBlock/Taluka/District/State W l egnah with
c rulandmark
oivaheBandl
Pin code and Contact Numbersnoitacinummoc
6 Date of HIV Test ksir hgihwhen
Mention the Date (dd/mm/yy) rof )HIV
CCBTest ( of
.snoitpo gnideef tnathe fni client conducted. This should be a test at
reh dna nemow
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoICTC C (and
l not the screening test)
.rentrap
7 ICTC PID Number .nerdlihc gnivil rehto Mention the PID number provided
VIH tto aeclient
peR from l
the ICTC, where she got tested for HIV
.retneC TRA ot larrefeR l , g n i t s e t
8 Name of ICTC where tested Write the Name of the ICTC where gniredthe isnclient
oc got
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivotested rP lfor HIV
.gnigats lamothercinilc ro/dMention
9 Type of Client ANC/ Direct-in- Labour/ Post-delivery whether the eClient
vitisoispANC
si ecase
suopors
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuDirect-in- N l Labour Casehor a post-delivery case
gih eregistered
vah eh/spost ro
.semmargorp noitirtu(who N have been diagnosed/ .ruoivaheb ksir
delivery)
.rehtom rof sixalyhporp VRA mutraptsoP l d n a gnidhereefGestational
tnafnI l
10 Gestational Age (in Weeks) If the client is ANC case write
.seciv reS gninnalP ylimAge aF inl weeks. noitirtun
.stisivExpected
11 emoh hDateguorofhtDelivery
troppu(EDD)
s gnideef tnafnI/tnemecrofnier FB For l case, write the date.g
E ANC nillesnuoc
(dd/mm/yy) on
emoh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcywhich
sP lshe is expected to deliver.
12 Expected Place of Delivery .spuorg troppus dna stisiv ANC Case, Write the name of the place
For
(Health Facility) where she opts for delivery.
13 Date of Delivery Write the date (dd/mm/yy) when she has
delivered.
14 Place of Delivery (refer to guidance) Write the name)Iof EHthe ( tplace
nafnI(Health
desopFacility,
xE VIH
)11'-0102 senilediuG OCAN/OHW I-noitpO derreferp( shHome tnomdelivery
6 otpuetc) sdewhere
eftsashe
erb has evisdelivered.
ulcxE lIn
this case data needs to be transferred to ICTC at
rof raey 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noiplace tiddaofndelivery.
i sdeeftRefer saerbtodpointeuni7tnin ocdata
dnaflow for
.TRA cirtaideaP eviecer ohw seibab evitisop DIE rof sradescription ey 2 otpuofdthis na sindicator.
eibab evitagen DIE
15 .skeew 6 rof tnafni rof sixalyhporp Vof
Outcome of Pregnancy (Live Birth/ Still Birth/ MTP/ Abortion) Write here the outcome RAthe mPregnancy
utraptsoP l
whether it is a Live Birth, Still Birth, Medical
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeTermination ew 6 ta )Dof IEPregnancy
( sisongaior d an tnaAbortion.
fni ylraE l
16 Status of Mother after delivery up to 6 weeks (Alive/ Dead)
. s d e e f t s a e r b f o n o i t a s
Mention here the status of client after delivery
s ec retfa
.ega fo skeewand 6m upotorf s6ixweeks
alyhp(whether
orp elozalive axom orirdead)
t-oC l
.dlihc eht

17 Infant feeding practice at: Please ask the mother at each of the 4 visits:
(a) 6weeks: regarding infant feeding practice.
1. Exclusive Breast Feeding (a) At 6 weeks, whether the baby is receiving Exclusive Breast
2. Exclusive Replacement Feeding feeds only or Exclusive Replacement feeds or if any Mixed
3. Mixed feeding* feeding has occurred (Baby is receiving both breast feeds and
HIV Negative
(b) 6months: HIV Infected Pregnant Women
replacement feeds within first 6 months).
Pregnant1. Women
Continued Breast Feedingl +Antenatal (b)
CareAt (ensure
6 months,at-least
enquire 4 visits)–Monthly
whether ART/ARV
baby which is continued on
Safe sex Complimentary feeds & semiprophylaxis
solids breast feeds has also been started on complementary feeds
l
2. Continued Replacement feeding +
atand
ART Centers.
semisolids or whether the baby was getting exclusive
counselling.
semi solids l Counselling on choices offeeds
replacement continuation ormonths
for the first 6 medical andtermination
now has beenof
l Couple started on semisolids. Enquire
3. Whether mixed feeding occurred
pregnancy (MTP)–to undertake within also
thewhether
first 3any mixed of
months
counselling.between 6 weeks to 6 months feeding happened any time from 6 weeks up to 6 months.
pregnancy only.
l Linkages (Yes/No)
to family (c) At 12 months, enquire from the mother whether breast feeds
(c) 12 months:
planning services. l Screening for has
TB been
and other OIs.
stopped. If yes, indicate date (dd/mm/yy)
1. Continued Breast Feeding (d) At 18 months, enquire whether 1. Breast feeding is being
2. Breast Feeds stopped (dd/mm/yy) continued or 2. Breast- feeding has been stopped. If stopped,
l Behaviour change
(d) 18 months: l WHO clinicalindicate
stagingdate
andofCD4 testing.
stopping (dd/mm/yy).
communication
1. Continued Breast Feedingl Counselling on positive living, safe delivery, birth-planning and
(BCC)2. forStopped Breast Feeding (dd/mm/yy)
high risk
18 women and Already
New Case/ her Registered at ART Mention whether the client availing the service is a fresh case or
partner. l Couple andhas safe sex counselling
already been registered and HIVwith
at ART testing of spouse
Pre ART number.and
Write
“New Case”
other living children. for fresh case and “Already Registered at ART” for
l Repeat HIV client registered at ART.
19 Date of Registration at ART Centre and Pre- Mention the Date (dd/mm/yy) of registration of the client under
considering
ART Registration No. l Provide ART HIVor ARV prophylactic
(Pre-ART) regimen based on CD4 count
care at ART Centre.
window, period if
20 Date of CD4 count and Baseline CD4and/orCount clinical staging.
Mention the date (dd/mm/yy) of assessment of CD4 count of the
spouse is positive
or s/he have high l Nutrition counselling theand
client. Mention baseline CD4 count
linkages to of Government/other
the client.
21 WHO Clinical Stage
Write the WHO Clinical stage (whether I,II,III or IV) of the client
here.
22 Whether Diagnosed as having TB (Yes/No) If the client have been diagnosed as having TB write YES, if not
nutrition l Family Planning
write NO
Services.
23 If Column 22 is “Yes”, date of starting ATT If yes, date of starting of TB treatment (ATT)
(DOTS/Non-DOTS) (dd/mm/yy) l Psycho-social support through follow-up counselling, home
24 Date of completing ATT (dd/mm/yy) visits and support
Write the groups.
exact date when TB treatment (ATT) was completed
25 ART Reg no. When initiated on ART, write the ART registration number
allotted to the client.
26 Date of ART initiation Write the date (dd/mm/yy) of initiation of ART to the client.
27 Date of stopping of ART If ART stopped, write the date
(dd/mm/yy)
28 Reason for Stopping ART* *Mention the Reason for stopping of ART
EID1.negative babies and upto 2 years for EID here,positive
The reasonbabies who receive Paediatric ART.
could be:
l
2.
Postpartum ARV prophylaxis for infant for 6 weeks. 1. After one week of stopping breastfeeding
3. 2. Death of Baby
l Early
4. infant diagnosis (EID) at 6 weeks of age; 3. repeat
Death oftesting
Mother at 6 months, 12 months & 6 weeks
5. 4. Patient/Guardian’s decision
5. Medical Reason
the child.

29 Date of starting NVP Syp at birth dd/mm/yy Mention the date (dd/mm/yy) when NVP
syrup was initiated after birth
30 Date of completing 6 weeks of NVP Syp dd/mm/yy Mention the date (dd/mm/yy) when NVP
syrup (6 weeks) to baby has been completed
nemoW tnangerP detcefnI VIH
and stopped. evitageN VIH
31 VRIf Astopped
/TRA ybefore
lhtnoM 6– )stisivreason
weeks, 4 tsaeforl-tstopping
a erusneNVP ( eraSyp
C latanetnA Try nemoasWtotn
l to find out the reason angSyp
why erPNVP
.sretneC TRA ta sixalyhporp was stopped xes efaS l
32 Date of initiation of CPT in baby dd/mm/yy .gnthe
At 6 weeks, find out from illemother
snuocthe
date (dd/mm/yy) when baby was elpuinitiated
oC l on
fo shtnom 3 tsrif eht nihtiw ekatrednu ot–)PTM( ycnangerp Co- trimoxazole prophylactic
.gnillesnuoc(CPT)
therapy
.ylno ycnangerp
33 At 6 weeks, what temporary FP method is being followed (Copper-T ylienquire
At 6 weeks visit, maf otfromsegthe
aknmother
iL l
or OCP) in addition to condoms.s(dual IO reprotection)
hto dna BT rof gnineercS as
l to whether she has had a Copper-T
.seciv res gninnalp
.sITS rof tnemtaert dna gnineercS inserted or is taking Oral Contraceptive pills
l .smodnoc eerF l
in addition to her spouse or she using a
.gnitset 4DC dna gnigats lacinilc OHW e g n ahc ruoivaheB l
condom as(dual protection)
l
dna gName
34 ninnaof lp-Infant
htrib ,y reviled efas ,gnivil evitisop no gnillesnuoC Write
l
noitacinummoc
the name of the baby.
ksir hgih rof )CCB(
35 ICTC ID of infant .snoitpo gnideef tnafni Write the ID given to infant by the ICTC.
reh dna nemow
36dna eUnique
suopsDNA fo gninfant
itset code
VIH dna gnillesnuoc xes efas dna elpuoC Write
l the unique DNA infant .rcode entrforapall
.nerdlihc gnivil rehto babies registering for DNA PCR testing
VIH taepeR l
37 DNA PCR: (1) DBS tests: The DNA PCR DBS test when,gdone nitseatt
a) At 6 weeks: Positive/Negative 6 weeks is negative; repeat it again at 6
tnuoc 4b)DAt C n6months:
o desabPositive/Negative
nemiger citcalyhporp VRA ro TRA edivorP gniredisnoc
months.
l If negative again, it should be
c) At 6 weeks after stopping breast-feeds:.gPositive/Negative
nigats lacinilc ro/dna repeated 6 weeksfiafter
doirbreastfeeds
ep ,wodnihas w been
stopped. e v i t i s o p s i e s u o p s
h g i h e v a h e h / s r o
38 DNAPCR: a) WB specimen collection .sem date
ma(dd/mm/yy)
rgorp noitforirtuN Write the date (dd/mm/yy) when whole
WBS tests DBS test 37a or 37b or 37c .ruoivisah
Blood Specimen of infant eb ksir
collected.
.rehSpecimen
b) WB tom rof sResult
ixalyhfor poDBS
rp VR Am
test 38ut(38a
raptor
soP l d n a g n i d e e f tnafnI l
Write the result of the Whole Blood
38b )-Positive or .Negative
seciv reS gninnalP ylimaF Specimen of the infant. In case tthere
l n o i irtunis a
c) Result of 2nd WBS(in case of DBS & 1st WBS discrepancy in DBS and.gfirst nillWBS,
esnuowrite c the
.stisiv emoh hguorht trdiscordance)Positive
oppus gnideef tnaorfnNegativeI/tnemecrofnier FBE l
result of 1st and 2nd WBS in columns 38c
emoh ,gnillesnuod)c Ifpuinfant
-wollisofnegative
hguorhwith t tro2nd
ppuWBS,
s laicoDate
s-ohofcysP &l 38c
Referral back to ICTC
.spuorg troppus dna stisiv If infant is negative, write the date
(dd/mm/yy) of referral back of infant to ICTC.
39 HIV +ve Registration Date (dd/mm/yy) and Pre ART Number If infant is positive, write the Pre ART
infant registration number allotted to infant.
40
)11'-0102 senileBaseline
diuG OCCD4 AN/count
OHWorI-CD4
noit%pO derreferp( shtnom Write the baseline CD4 count or CD4 % of
6 otpu sdeeftsaerb evisulcxE l
the infant.
41 Date of Initiation of Paed. ART (dd/mm/yy) Write the date (dd/mm/yy) of registration of
.TRA cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2infant otpuatdART
na sCentre.
eibab evitagen DIE
42 .skeewTests
Date (dd/mm/yy) & result of Antibody 6 ro(Rapid)
f tnafni rWrite
of sixthe
alydate
hpor(dd/m/yy)
p VRA mofutantibody
raptsoP(Rapid)l
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE lof
conducted at 18 months - Confirmed negative or tests conducted for the infant at the age
Confirmed positive 18 months for confirmation.
.sdethe
Write eftresult
saerbwhether
fo noitathe
ssebaby
c retisfa
.ega fo skeew 6 mconfirmedorf sixalyashpHIV
orppositive
elozaxorom irt-oC l
negative
.dlihc eht

43 Date of stopping CPT dd/mm/yy Write the date when CPT for infant has been stopped.
It is advised that CPT be continued for 18 months in
children even if the EID results are negative at
6 weeks or 6 months or after 6 weeks of stopping
breastfeeds, as it reduces infant mortality due to inter-
Pregnant Women l Antenatal Carecurrent
(ensure at-least
infections, like4 diarrhoea
visits)–Monthly
and ART/ARV
l Safe sex prophylaxis atrespiratory
ART Centers.infections or other OIs.
counselling.
44 ART** Counselling onTick
a) Alive & On Treatment
l choices
this cellofifcontinuation or medical
the client is alive and on ART termination of
l Couple
Outcome pregnancy
b) Date and reason (code) for (MTP)–to
**Put the appropriate Code in this Cell with 3date
undertake within the first months of
counselling.
(Mother) pregnancy only. A – Death,
ART discontinuation
planning services. l Screening for TBBand other OIs.
– Stopped on Medical advice,
C – Transfer-out,
l Behaviour change l
D – Lost-to-follow-up
WHO clinical staging and CD4 testing. (LFU)
communication E – opted out of the programme
45 (BCC) for high risk
Antiretroviral a) Alive & On Treatment Tick this cell if the client is alive and on ART
women and her a) Date and reason for ART/ ARVs **Put the appropriate Code in this Cell with date
treatment
partner.
Outcome
l Couple and safe sex counselling and HIV testing of spouse and
discontinuation A – Death
l Repeat HIV
(Child)** other living children.
B – Stopped on Medical advice
C – Transfer-out,
considering l Provide ART or ARV prophylactic regimen
D – Lost-to-follow-up (LFU) based on CD4 count
E – Opted out of the programme on her own
spouse is positive
46
or s/he have high
Whether immunization
l Nutrition counselling
(a) Write “Yes” andif all linkages to Government/other
primary immunization has been
risk behaviour. completed: Nutrition programmes.

completed or “No” if any immunization, including
l Infant feeding and l Postpartum ARV measles

(a) Primary immunization, prophylaxis for mother.
and Vitamin A have not been received (the baby
nutrition including measles
l
and should
Family Planning Services. be sent for completion of immunization schedule
counselling. Vitamin A (Y/N) within a week)
(b) Whether 1st booster dose at Write “Yes” if DPT/ OPV have been received at 18 months or
18 months received “No” if baby has not yet received (ensure baby receives the
(Yes/No) visits and support
samegroups.
within a week)
47 Remarks*** This column is common for both ICTC and ART centres
***Relevant information to be captured, eg:
HIV Exposed Infant (HEI) 1. Client’s current location with date
l Exclusive breastfeeds upto 6 months (preferred 2. Option-I
Information of authorizedGuidelines
WHO/NACO attendant to 2010-'11)
whom ART can
and continued breastfeeds in addition to complement be dispensed(from

feeds after 66 months
months of upto
upto two months
1 year forpost
delivery)(refer letter of ADG, CST, NACO, dated 28
August 2012)
3. Any other important information related to client or her
l Early infant diagnosis (EID) at 6 weeks of age; repeat babytesting at 6 months, 12 months & 6 weeks
the child.
emm
15.4 Tool 2: Reporting on PPTCT argoEID
and rP Tfrom
CTPP fART
o stneCentres
nopmoC :2 erugiF
3 a. PPTCT
3.1a Cumulative number of Pregnant women ever registered/ reported in HIV care
0
till the end of this month (Out of 2.5)
3.2a Cumulative number of pregnant women ever initiated on ART till the end of
0
this month (out of 3.1a)
3.3a Cumulative number of pregnant women neinitiated
moW tnonanPPTCT
gerP dARV
etceprophylaxis
fnI VIH evitageN VIH
from 1stVSept
RA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnAfor AP
2012 till the end of December 2013 (Out of 3.1 a)(applicable l , nemoW tnangerP0
Karnataka, Tamil Nadu) xes efaS l
3.4a Total number of pregnant women ever initiated on ART/ ARV prophylaxis
0 . g n i llesn0uoc 0
fo noitanim
(3.2a+3.3a) ret lacidefor
(applicable mAPro, nKarnataka,
oitaunitnTamil
oc foNadu)
seciohc no gnillesnuoC l
elpuoC l
3.5a Number of pregnant women currently on ART .gnillesnuoc 0
.ylno ycnangerp
3.5a.1 Number of women currently on PPTCT ARV prophylaxis (dynamic figure, ylimaf ot segakniL l
as and when pregnancy/ lactation completed.sIOand
rehtARV
o dnprophylaxis
a BT rof gnstopped
ineercS reduce
l
.seciv res gninnalp 0
from this section9 (applicable for AP,.sKarnataka,
ITS rof tneTamil
mtaeNadu
rt dnafor
gnbreast
ineercfeeding
S l .smodnoc eerF l
mothers: max period applicable is Dec 2014)
EID
3.6a Cumulative number of children registered at ART centre with DBS reactive for ksir hgih rof )CCB( 0
DNA/PCR .snoitpo gnideef tnafni
reh dna nemow
3.7adOut
na eofsu3.6a
ops cumulative
fo gnitset Vnumber
IH dnaofgnchildren
illesnuwho
oc xeunderwent
s efas dnaWBS
elputesting
oC lat .rentrap 0
the ART centre .nerdlihc gnivil rehto VIH taepeR l
3.8a Out of 3.7a cumulative number of children who are WBS reactive for DNA/ ,gnitset 0
PCR
3.9a Out of 3.8a cumulative number of children initiated on ART fi doirep ,wodniw 0
3.10a Out of 3.9a cumulative number of children initiated on LPV/r based regimen evitisop si esuops 0
3.11a Out of 3.8a cumulative number of children found HIV+ve by 3 antibody tests
at 18 months of age
0
ART Centres Reporting .seciv reS gninnalP ylimaF l noitirtun
(Section 3a of CMIS – PPTCT)
(Refer to the remarks column of the HIV.scolumn puorg tr6 opand
pus d23
naof
sti“Pre
siv ART’ register, column no. 16 of ART
enrolment register, any separate register maintained for pregnant women, if required from individual
white card or from the PPTCT line-list)
3.1a Cumulative number of Pregnant women ever registered/ reported in )HIV IEH(caretnaftill nI dthe
esoend pxEof VIthis
H
)1 1 ' - 0 1 0 2 s
month (Out of 2.5)e n i l e d i u G O C A N / O H W I - n o i t p O d e r r e f e r p ( s h t n o m 6 o t p u s d e e f t s a e r b e v i s u l c x E l
Number of HIV positive pregnant women ever registered at your ART centre since the beginning. These can
be new registrations or those already registered.satkethe ew 6 ART rof tcentre
nafni roand f sixthen
alyhplater
orp Von RAbecome
mutraptspregnant.
oP l
Generation
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE 23
of this figure will be a onetime exercise and can be done from column no. 16 and l
of
the HIV Care register, column no. 16 of ART enrolment register, any .sdeseparate
eftsaerb fregister
o noitassmaintained
ec retfa for
pregnant women or if required from individual white .egacards.
fo skeeOnce w 6 mthisorf sisixfirmed
alyhporup, p elonew zaxoregistrations
mirt-oC l to
be added to this .DIfigure
E hguoevery rht evmonth,
itisop VIfrom
H sa next
desonmonth gaid neonwards.
rdlihc dna stnafni rof TRA deP dna erac VIH l
.dlihc eht
Figure women
3.2a Cumulative number of pregnant 2: Components of PPTCTon
ever initiated Programme
ART till the end of this month
(out of 3.1a)
Offer ofwomen
Total no. of pregnant HIV Counselling
ever initiatedand Testing
on ART (who Services
are eligibletofor
allART,
Pregnant
for theirWomen
own health) at this
centre from the beginning of this centre.
3.3a Cumulative number of pregnant women initiated on PPTCT ARV prophylaxis from 1st Sept 2012
till the end of December 2013 (Out of 3.1 a) (Applicable for AP, Karnataka and Tamil Nadu)
Total no of pregnant
Pregnant Women women initiated PPTCT ARV
l onAntenatal Careprophylaxis treatment
(ensure at-least for PPTCT (not
4 visits)–Monthly for their own
ART/ARV
health)
l Safe
fromsex1st Sept 2012 onwards. prophylaxis
This only includes
at ART those women who have been given triple drug
Centers.
counselling.
ARV prophylaxis for PPTCT. Applicable only for AP; Karnataka & Tamil Nadu States which rolled out
triple Couple
l drug ARV Prophylaxis. (This does not include sd NVP undertake
prophylaxis).
pregnancy (MTP)–to within the first 3 months of
counselling.
3.4al
Linkages
Total number of pregnant womenpregnancy
to family
only.on ART/ ARV prophylaxis (AP, Karnataka and TN)
ever initiated
(3.2a+3.3a)
Total
l
noFree condoms.
of women l
ever initiated on ART/ Screening and treatment
ARV prophylaxis, sum offor3.2a
STIs.and 3.3a
3.5a communication
Number of pregnant women currently on ART
(BCC)pregnant
Total no.of for highwomen
risk currently on ARTfeeding
at this options.
centre. Remember to reduce the numbers as and
infant
women and her
when pregnancy is completed and then this particular women becomes like other women on ART
partner. l Couple and safe sex counselling and HIV testing of spouse and(non
pregnant) already being reflected in column no. 3.10 of monthly ART centre report.
3.5a.1 testing,
Number of women currently l on PPTCTtoARV
Referral ART prophylaxis
Center. (dynamic figure, as and when
considering
pregnancy/ lactation completed l
and ARV prophylaxis stopped
Provide ART or ARV prophylactic reduce
regimenfrombased
this section)
on CD4 count
window, period if and/or clinical staging. at this centre. Remember to reduce the
Total no. of pregnant
spouse women currently on
is positive PPTCT ARV prophylaxis
numbers as and
or s/he when
have highpregnancy/lactation
l Nutrition counselling
completed and ARV and linkages
prophylaxis has to
beenGovernment/other
stopped.
EIDl Infant feeding and l Postpartum ARV prophylaxis for mother.
(Refer nutrition
to EID register and for 3.10a land Family Planning
3.10b, Services.
patient white card)
3.6a Cumulative number of children registered at ART centre with DBS reactive for DNA /PCR
Cumulative no. of children entered in the EIDand
visits register
support groups.
3.7a Out of 3.6a cumulative number of children who underwent WBS testing at the ART centre
Out of the total children detected DBS positive, cumulative no. of children who have undergone Whole
BloodHIV Exposed(WBS)
Specimen Infant testing
(HEI) (column no. 10 of EID register)
3.8a Out of 3.7a cumulative number of children who are WBS reactive for DNA /PCR
Out of the
EID total children
negative babies who underwent
and upto 2 years WBSfor testing, cumulative
EID positive no.who
babies of children
receive who
Paediatric ART.positive
have had
results
l
(column no.ARV
Postpartum 11 of EID register)
prophylaxis for infant for 6 weeks.
3.9a l Early infant
Out of 3.8adiagnosis
cumulative (EID) at 6 weeks
number of age;initiated
of children repeat testing at 6 months,
on Paedtric ART 12 months & 6 weeks
Out of the total children who had positive WBS results (column no. 11 of EID register) how many were
initiated on Paediatric ART (column no. 16 of EID register)
the child.
3.10a Out of 3.9a cumulativeenumber
mmargorPofTCchildren
TPP fo stninitiated
enopmoCon:2 eLPV/r
rugiF based regimen due to previous
exposure to sd NVP.
nechildren
Out of the total moW tnwho
angeinitiated
rP lla otonsePaed
civreART
S gnunder
itseT the
dnaEID
gnprogramme,
illesnuoC Vcumulative
IH fo reffOno. of children
who have been started on LPV/r based regimen due to previous exposure to sd NVP
3.11a Out of 3.8a cumulative number of children found HIV+ve by antibody tests at 18 months of age:
Of all the patients with WBS positive, how many children had HIV +ve status at 18th n e mmonth
oW tnof anage.gerP
3.12 a. Out of the total no. of live births.s18 retnmonths
eC TRAago, ta sixno.
alyofhpchildren
orp reported to be living:xes efaS l
.gnillesnuoc
b. No. of children born to HIV positive pregnant women born 18 months ago, reported to be dead elpuoC l
.gnillesnuoc
c. No. of children born to HIV positive pregnant women .ylno ycborn
nang18 erpmonths ago tested for confirmation of status
at 18 months: .sIO rehto dna BT rof gnineercS l .seciv res gninnalp
15.5 SIMS Monthly Progress .gnReport
itset 4Dfor C dPPTCT
na gnigats lacinilc OHW l egnahc ruoivaheB l
Monthly Input Formats for Integrated Counselling and Testing Centres (ICTC) ksir hgih rof )CCB(
NRHM-NACO Convergence Action Section D: Progress during the month (only for Pregnant Womenre) h dna nemow
i. Pregnancy, delivery and breastfeeding .rentrap
S. No. Indicators
.nerdlihc gnivil rehto During ANC VIH taepeR Total
Directly-in-labour l
.retneC TRA ot larrefeDuring ,

R l this Month During this Month g n i t s e t
tn1uoc 4Number
DC no ofdeNew
sab ANC
nemRegistrations
iger citcalyhporp VRA ro TRA edivorP l gniredisnoc
.gnigats lacinilc ro/dna fi doirep ,wodniw 0
2 Number of pregnant women provided with pre-test evitisop si esuops 0
rehto/tncounselling
emnrevoGout ofot all sregistered
egaknil dna gnillesnuoc noitirtuN l hgih evah eh/s ro
3 Number of pregnant women tested for HIV .semmargorp noitirtuN .ruoivaheb ksir 0
4 .r e h t o m r o f s i x a l y h
Total number Among those detected infected, number in p o r p V R A m u t r a p t s oP l dna gnideef tnafnI l
of pregnant first trimester .seciv reS gninnalP ylimaF l noitirtun
women Among those detected infected,
.stisiv emoh hguorht troppus gnideef tnafnI/tnemecrofnier FBE l number in .gnillesnuoc
detected HIV second trimester
emInfected
oh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP l
Among those detected infected, number in
third trimester .spuorg troppus dna stisiv
5 Number of pregnant women who received post-test 0
counselling and given test results
6 Number of pregnant women referred by the F- ICTC
)IEH( tnafnI desopxE VIH0
Govt(Fixed/Mobile) after HIV screening test
6.1 Out of the above, Number of pregnant women diagnosed HIV 0
rof infected
raey 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
7 .TR A cirtaofidpregnant
Number eaP eviewomen
cer ohreferred
w seibby
abthe
eviPPP
tisopICTC
DIE(Fixed/
rof sraey 2 otpu dna seibab evitagen DIE 0
Mobile) after HIV screening test .skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP l
s7.1
keew 6Out & sofhthe
tnoabove
m 21Number
,shtnomof 6 ta gnitwomen
pregnant set taep er ;ega fHIV
diagnosed o skeew 6 ta )DIE( sisongaid tnafni ylraE l0
infected .sdeeftsaerb fo noitassec retfa
8 Number of pregnant women referred by the PHC/Sub Centre/
.ega fo skeew 6 morf sixalyhporp elozaxomirt-oC l0
ANM after HIV screening test
.dlihc eht
8.1 Out of the above, Number of pregnant women diagnosed HIV 0
infected
9.a. Number of spouses/partners
Offer of HIV infected
of HIV Counselling and pregnant
Testingwomen
Services to all Pregnant Women 0
tested
9.b. Number of spouses/partners of HIV infected pregnant women 0
found HIV infected
10 Number of HIV infected pregnant women who underwent 0
HIV Negative
MTP during the month HIV Infected Pregnant Women
Pregnant
11 NumberWomenof HIV infected pregnantl women Antenatal Care
expected to (ensure
deliver at-least 4 visits)–Monthly ART/ARV 0
l Safe sex this month
during prophylaxis at ART Centers.
counselling.
Monthly Input Formats for Integrated Counselling l Counselling
and Testing on choices
Centres of continuation or medical termination of
(ICTC)
l Couple
NRHM-NACO pregnancy (MTP)–to undertake
Convergence Action Section D: Progress during the month (only for Pregnant within
Womenthe) first 3 months of
counselling.
pregnancy only.
Linkages
i. Pregnancy,
l to and
delivery family
breastfeeding
S. No.planning services.
l Screening for TB and other OIs.
Indicators During ANC Directly-in Total
l Free condoms. l Screening and treatment for STIs. -labor
l Behaviour change l WHO clinical staging and CD4 testing. During this During this
communication Month Month
12 (BCC)
Totalfor high risk a. In same Facility
number 0
women and her
of HIV infected
b. In other Govt hospitals
deliveries this
partner. l Couple and safe sex counselling and HIV testing of spouse and0
month: c. Pvt Hospitasl/ any other facilities 0
d. Home Deliveries 0
13.a.considering
Total number of normal (vaginal) deliveries of HIV infected pregnant women 0
during this month
13.b.spouse
Total is positive
number of deliveries by Caesarean section of HIV infected pregnant 0
women
or s/he during
have this month
high l Nutrition counselling and linkages to Government/other
14 riskOutcome
behaviour.of HIV a. Number live male child 0
l Infant feeding
infected and b. Number llivePostpartum
deliveries female child
ARV prophylaxis for mother.
0
this month
c. Still births 0
d. Deaths 0
15 l Psycho-social support
Total number of mother-baby pairs who received Nevirapine (single dose) through follow-up counselling, home 0
(whenever new guidelines not rolledvisits out) and support groups.
16 Number of HIV infected pregnant women (only) received Nevirapine (single 0
dose) during the month (whenever new guidelines not rolled out)
17 Number of babies(only) of HIV infected mothers received Sy. Nevirapine x 0
6 weeks during month
22 Number of HIV infected pregnant mother opting for exclusive breast feeding 0
andforcontinued
first 6 monthsbreastfeeds in addition to complement feeds after 6 months upto 1 year for
23 EIDNumber
negative babies
of HIV and
infected upto 2mother
pregnant yearsopting
for EID positiveReplacement
for exclusive babies who receive Paediatric ART. 0
l Postpartum ARV6prophylaxis
feeding for first months for infant for 6 weeks.
24
l Early infant
Number HIVdiagnosis (EID) atwomen
infected pregnant 6 weeks of age;
registered repeat
at ART testing at 6 months, 12 months & 6 weeks
centre 0
25 after cessation
Number of HIVofinfected
breastfeeds.
pregnant women whose CD4 count is < 350 0
the child.
Monthly Input Formats for Integrated Counselling and Testing Centres (ICTC)
ii. Age-wise distribution

Agewise Distribution Number of pregnant Number of pregnant women
women tested for HIV detected infected
1. 15-19 years
2. 20-24 years nemoW tnangerP detcefnI VIH evitageN VIH

3. 25-34VR A/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l
years n e m oW tnangerP
4. >35 Years
.gnillesnuoc
Total elpuoC l
.gnillesnuoc
iii. Follow -up .ylno ycnangerp
Description .sIO rehto dna BT rof gnineercS This l month
.seciv res gninnalp
A. Visit for DBS and WBS Test . s I T S r o f t n e m t a e r t d n a
First Visit g n i n e e r c S l Second Visit .smodnocThird eerFVisit
l
.gnitset 4DC dn6a weeks gnigat–s lac6inmonthsilc OH–W 6lmonths – 12egmonths nahc ruoi12 vahmonths
eB l –
dna gninnalp-htrib ,y reviled efas ,gnivil e6vmonths itisop no g18 nillmonths
esnuoC 12 l months
noitacinum
– 18 months mmonths
18 oc
ksir hgih rof )CCB(
1. Number of infants/children visited .snoitpo gnideef tnafni
reh dna nemow
d n a e s u o p s f o g n i t s e t V
2. Number of infants/children tested for HIVI H d n a g n i l l e s n u o c x e s e f a s d n a e l p u o C l
.rentrap
using DBS-DNA PCR/Antibody test .nerdlihc gnivil rehto VIH taepeR l
3. No of infants/children who were found .retneC TRA ot larrefeR l ,gnitset
tnupositive
oc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l g n i r e disnoc
4. Number of infants on exclusive breast
e vitisop si esuops
rehfeeding
to/tne(EBF)
mnrevoG ot segaknil dna gnillesnuoc noitirtuN l hgih evah eh/s ro
5. Number of infants on exclusive replacement .semmargorp noitirtuN .ruoivaheb ksir
feeding (ERF) .rehtom rof sixalyhporp VRA mutraptsoP l dna gnideef tnafnI l
6. Number of infants on CPT –initiated at 6.seciv reS gninnalP ylimaF l noitirtun
weeks and continuing .gnillesnuoc
7. No. of infants registered at ART centre

C. Details at 18 months:
1. Number of infants who came for follow- up

at 18 months )IEH( tnafnI desopxE VIH
)11'-01
2. Number of0infants
2 senwho
ilediwere
uG Otested
CAN/(using
OHW I-noitpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
3 antibody tests)
.TRAofcinfants
3. Number irtaideHIV
aP einfected
viecer ohw seibab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIE
4. No. of infants registered at ART centre .skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP l
.dlihc eht
iv. Outreach Linkages for HIV Positive Pregnant Women Number
(By Out Reach Worker)
1. Number of Offer
outreachofworkers (ORWs) (IL &FS)/
HIV Counselling andANMs/
Testing Services to all Pregnant Women
ASHAs/DLNs
2. Number of HIV infected pregnant women visited at home
by the outreach worker during the month (specify who
visited)
3. HIV Negative
Number of HIV infected pregnant women HIVwho
Infected
were Pregnant Women
Pregnant Women
expected to deliver this month, visited by
l the outreach
worker
Safe(specify)
sex
l
counselling.
4. Number of HIV infected women visited post delivery by
ORWs/ANMs/ASHAs/DLNs l Counselling on choices of continuation or medical termination of
l Couple
counselling.
i. Before 6 weeks
pregnancy only.
Linkages
ii. 6l weeks to family
to 6 months
planning Screening for TB and other OIs.
to 12services.
l
iii. 6 months months
iv. 12 months to 18 months
v. 18 months until the time baby is breastfed
(BCC) for high risk
women and her
spouse is positive

the child.
14
Roles and Responsibilities of Staff at Different Levels
Figure 2: managers
Roles and Responsibilities of programme Componentsand
of PPTCT Programme
staff in PPTCT services is shown in (Table:11)
PPTCT program is to be implemented through the ICTC and ART centres and also needs to be an
Offer of
integrated response HIV
with Counselling
general and Testing
health system. Services
Following tableto all Pregnant
details terms of Women
reference of staff at
different level regarding their roles and responsibilities in implementation of PPTCT programme:
Table 11: Roles and Responsibilities of Programme Managers and Staff in PPTCT Programme
Sl.HIV
No. Negative
Designation of Official/staff HIV Infected Pregnant Women
Role in PPTCT Implementation
Pregnant Women l 1. Antenatal
Facilitate Care (ensure
development of at-least 4 visits)–Monthly
state micro-plan ART/ARV
for implementation of PPTCT
l Safe sex programme
counselling. 2. Facilitate establishment of Joint State PPTCT programme implementation
l Counselling
committee on choices of continuation or medical termination of
l Couple 3. pregnancy (MTP)–to
Facilitate regular meetings undertake within thecommittee
of the implementation first 3 months
for of
counselling. programme review and policy decisions
pregnancy only.
l Linkages to family 4. Advocacy with Principal Secretary, Health & Family Welfare and MD-
planning services. l Screening
NRHM to for ensureTB and otherofOIs.
ownership PPTCT programme by Director, Health &
Family Welfare Services, state RCH officer
5. Facilitate formation of the Joint District PPTCT implementation committee
l
1
Behaviour changeState AIDS
Project Director l WHO clinical
and Case staging and
Management TeamCD4 in alltesting.
districts of the state
Control Society (SACS)
communication 6. Facilitate measures to ensure ownership of the programme at district level
l Counselling on positive
by District Health & Family living, safe
Welfare delivery,
Officer, CMHO, birth-planning and
Civil Surgeon, District
(BCC) for high risk
infant
RCHfeeding
officer etc.options.
women and her 7. Advocacy with Secretary Medical Education to ensure adherence to
partner. l Couple
Nationaland safe sex guidelines
programme counselling and
so as HIV testing
to minimize of spouse
linkage and
loss in medical
l Repeat HIV college hospitals
other living children.
8. Facilitate joint review meetings of NACP-NRHM and Medical Education
testing, l Referral
programmeto ART Center.
managers at regular intervals
considering l
9. Facilitate involvement
Provide ART or ARV prophylactic of professional regimen
organizations
basedlike FOGSI,
on CD4 IAPcount
, IMA
window, period if to ensure systematic involvement of private sector
spouse is positive 10. Overall leadership of programme with regular monitoring of progress
or s/he have high l
1. Nutrition
Ensure close counselling and linkages
coordination between to Government/other
the Basic Services division and Care
and Support & Treatment division at state and district level
2. Establish close liaison with State RCH officers and other key stakeholders
l Infant feeding and l Postpartum
in NRHM
ARV prophylaxis for mother.
nutrition l 3. Family Planning
Establish Services.
close liaison with state level office bearers of professional
counselling. organizations like FOGSI for systematic involvement of private nursing
homes
l 4. Psycho-social support
Facilitate formation of thethrough follow-up
Joint District PPTCTcounselling,
implementation home
committee
and Case Management Team in all districts of the state
5. visits andregular
Ensure support groups.
meeting of Joint District PPTCT implementation committee
through supportive supervision and monitoring
6. Establish mechanisms for monitoring progress in linking up of HIV
Nodal Officer for PPTCT in
2 infected pregnant women to PPTCT services e.g. use of google doc. for
the SACS
HIV Exposed Infant (HEI) tracking and monitoring at state level
7. Establish Stand-alone ICTCs at all CHC level health facilities
l Exclusive breastfeeds upto 6 months (preferred
8. Ensure Option-I
availability WHO/NACO
of HIV screening Guidelines
facilities 2010-'11)
at all high delivery points
and continued breastfeeds in additionbelowtoCHCs in the form feeds
complement of F-ICTCs
afterand
6 sub-centre
months upto level screening
1 year forusing
WBFPT
EID negative babies and upto 29. years foravailability
Ensure EID positive babies
of PPTCT whoatreceive
services Paediatric
all high delivery ART.
points
l 10. Ensure mechanisms
Postpartum ARV prophylaxis for infant for 6 weeks. for quick linkage of screened positive pregnant
women to SA-ICTCs for confirmation, to ART Centre for life-long ART and
l Early infant diagnosis (EID) at 6 weeks of age;for
EID services repeat testingbabies
HIV exposed at 6 months, 12 months & 6 weeks
after cessation of breastfeeds. 11. Monitoring of compliance of infected pregnant women with PPTCT
guidelines through regular follow-up visits of NACP outreach workers and
other health system human resources
the child.
Sl. No. Designation of Official/staff Role in PPTCT Implementation
1. Facilitate ownership of the PPTCT programme by the District Health &
t seFamil;y
nemoW tnangerP lla o2. civreSWelfare
gnitseOfficers
T dna(CMHO,
gnilleCivil
snusurgeon)
oC VIH fo reffO
Facilitate ownership of PPTCT activities by PHC medical officers and the
field staff
3. Facilitate provision of support for confirmation of HIV status of pregnant
women, travel to ART centre for enrolment and drug collection along with
facilities for institutional delivery
n4.
emFacilitate
oW tnanestablishment
gerP detcefn VIHscreening facilities at allehigh
ofI HIV vitadelivery
geN VIH
3 State RCH Officer points in the form of F-ICTCs and sub-centre level screening using WBFPT
VRA/TRA ylhtnoM–)stisiv 4 tsa5. el-taEnsure
erusnavailability
e( eraC laof tanPPTCT
etnA services
l n e m o W
at all high delivery points t nangerP
6.
.sreFacilitate
tneC TRA regular
ta sixmeeting
alyhpoof xes efaS l
rpthe Joint District PPTCT implementation
committee .gnillesnuoc
fo noitanimret lacidem ro noitaunitno7.
c foFacilitate
seciohcinvolvement
no gnillesnofuPHCoC medical
l officers and concerned ANM and
elpuoC l
fo shtnom 3 tsrif eht nihtiw ekatrednotheru ot–health
)PTMsystem
( ycnafunctionaries
ngerp in the Case Management Team
8. Ensure involvement of medical officers at PHCs and ANMs .gnillinesmonitoring
nuoc
of linkages.yto
lnoICTCs,
ycnaARTngercentres
p and compliance
y l i m off HIV
a o t infected
s e g a kniL l
.sIO rehpregnant
to dna Bwomen
T rof gtoniPPTCT
neercSregimenl
.seciv res gninnalp
.sITS 1.
rof tEnsure
nemtaformation
ert dna gof ninthe
eeJoint
rcS District
l
PPTCT implementation committee
.smodnoc eerF l
and Case Management Team in all districts of the state
.gnitset 4D2.
C dEnsure
na gnigregular
ats lacmeeting
inilc OH JointlDistrict PPTCTeimplementation
of W gnahc ruoivahcommittee eB l
3. Establish Stand-alone ICTC at all CHC level healthno facilities
itacinummoc
dna gninnalp-htrib ,y reviled efas ,g4.
nivilEnsure
evitisoavailability
p no gnillofesHIV
nuoscreening
C l facilities at all high delivery points
below k s i r h g ih screening
rof )CCBusing (
.snoCHCs
itpo ginnithe
deeform
f tnaoffnF-ICTCs
i and sub-centre level
WBFPT reh dna nemow
dna esuops fo gnitset VIH dna gnil5. lesnEnsure
uoc xeavailability
s efas dnaofelPPTCT
puoC services
l at all high delivery points .rentrap
6. Ensure mechanisms for quick linkage of screened positive pregnant
women.nertodlSA-ICTC
ihc gnivforil rconfirmation,
ehto to ART Centre forVinitiation
IH taepofeRlife l
-long ART and EID services
.retneC TRA ot larrefeR l for HIV exposed babies ,gnitset
7. Monitoring of compliance of infected pregnant women gwith n i r ePPTCT
disnoc
tn4uoc 4DDistrict
C no dHIV
esaprogramme
b nemiger citcalyhpoguidelines
rp VRA rthrough
o TRA regular
edivorP follow-up
l visits of NACP outreach workers and
Manager – DAPCU / DNO
.gnihealth
other gats lasystem
cinilc human
ro/dnaresources fi doirep ,wodniw
8. Training load assessment evitisop si esuops
rehto/tnemnrevoG ot segaknil d9. na Establish
gnillesnclose
uoc liaison
noitiwith
rtuNDistrict
l Health & Family
hgihWelfare
evah eOfficers
h/s ro
.semmDy.
(CMHO/ argCMHOs/
orp noitRCHirtuNOfficers) .ruatoithe
vahdistrict
eb kslevel
ir
10. Overall planning and implementation of programme
.rehtom rof s11.
ixalyEnsure
hporpup VR–to-
A mdate
utrarecording
ptsoP atl all facilities anddnatimely gnidreporting
eef tnafn toI state
l
.selevel
civ reS gninnalP ylimaF l noitirtun
12. Supervisory visit to ART centres, ICTCs and other HIV screening centres
.stisiv emoh hguorht troppus gnide13. ef tnClose
afnI/liaison
tnemewith nier FBE lassociation like FOGSI,.gIAP
crofprofessional ni,llIMA
esnutooc
facilitate involvement of private nursing homes & institutions
emoh ,gnillesnuoc pu-wollof hgu14.
orhAdvocacy,
t troppusCommunication
laicos-ohcysPandlsocial mobilization activities for effective
.simplementation
puorg troppusofdPPTCT
na stisservices
iv
1. Advocacy with District Health & Family Welfare Officers (CMHOs Civil
surgeons) for ownership of PPTCT programme
2. Ensure ownership of PPTCT activities by PHC medical officers and the
field staff
3. Ensure provision of support for confirmation )IEHof( HIV tnafstatus
nI deof sopregnant
pxE VIH
)11'-0102 senilediuG OCAN/OHW Iwomen,-noitpOtravel
derrto
efeART
rp( centre
shtnofor m enrolment
6 otpu sdand eefdrug
tsaecollection
rb evisulalong cxE withl
facilities for institutional delivery
rof raey 1 otpu shtnom 6 retfa 4.
sdeeFacilitate
f tnemeestablishment
lpmoc ot noofitiHIV ddascreening
ni sdeeffacilities
tsaerb d ateall
unhighitnocdelivery
dna
5 District RCH Officer
.TRA cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIWBFPT
points in the form of F-ICTC and sub-centre level screening using E
5. Ensure availability of PPTCT services at all high delivery points
6. Ensure .regular
skeewmeeting
6 rof tnofafJoint
ni roDistrict
f sixalyPPTCThporpimplementation
VRA mutraptscommittee oP l
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraother
7. Ensure involvement of PHC medical officer, concerned ANM and E l
health system functionaries in Case Management Team so as to ensure
. s d e e f t s a e r b f o n o
linkage to screened positive pregnant women to ICTCs for confirmation,i t a s s e c r e t f a
to ART centre for enrolment and to monitor compliance with PPTCT
programme guidelines

.dlihc eht
Monitoring and evaluation 1. Maintenance of consolidated PPTCT line-lists
assistant at DAPCU /ICTC 2. Updating
Offer of HIV Counselling PPTCT Services
and Testing line-lists with
toallall
events, compilation,
Pregnant Women analysis and
6
counsellor at the district interpretation etc.
headquarter 3. Timely reporting of PPTCT line-lists to SACS
1. Supervisory visit ART centres, ICTCs and other HIV screening centres (TB
and STI)
HIV Negative 2. SupportivePregnant
HIV Infected supervisionWomen
of ICTC
3. Facilitate co-ordination between ICTC/ART centre staff with general health
Pregnant Women l Antenatal
staff (RCHCare (ensure at-least 4 visits)–Monthly ART/ARV
/ NRHM)
l Safe sex 4. prophylaxis
Ensure preparedness for conducting HIV positive deliveries at delivery
at ART Centers.
7 counselling.
District ICTC supervisor points
l 5. Counselling
Ensure linkage on of
choices of continuation
HIV exposed infants (HEIs)ortomedical termination
Early Infant diagnosis of
l Couple
pregnancy
sites ICTCs (MTP)–to
where DBC is undertake
being done within the first 3 months of
counselling. 6. pregnancy
Ensure follow-up
only. visits to HIV infected pregnant women by health staff /
l Linkages to family outreach workers/District Level Networks
l 7. Screening for TB and
Facilitate reporting other
of all OIs. to district M and E assistants for
key events
planning services.
updating line-lists
l Free condoms. l
Behaviour change 1. Measures to ensure 100% screening of all pregnant women enrolled into
Ante-Natal Care
communication l 2. Counselling on positive
Measure to ensure living,
HIV, STI, safe delivery,
TB screening early birth-planning and
(BCC) for high risk 3. Ensure uninterrupted availability of test-kits, drugs, referral forms and
women and her registers
l 4. Couple
Ensureand safereferral
prompt sex counselling
and linkage of and
HIVHIV testing
infected of spouse
pregnant and
women to
partner.
ART centres
l Repeat HIV medical officer at
In-charge
5. Ensure safe institutional deliveries
8 testing,
ICTC l 6. Referral
Ensure to ART Center.
provision of ARV prophylaxis for the baby for 6 weeks – Sy.NVP for
considering l
6 weeks (3 bottles each) 25ml
window, period if 7. Ensure linkage of the baby to EID services
8. and/or clinical
Clinical staging.
assessment and care of patients while on ART
spouse is positive 9. Monitoring adherence to ART
10. Ensure home visits to the infected pregnant women at prescribed
risk behaviour. Nutrition
frequency
programmes.
l Infant feeding and Postpartum
l 11. Ensure timelyARV prophylaxis
follow-up visits of for mother.
infected pregnant women to ART centres
nutrition l 1. Family Planning
Provision Services.
of preventive health education to all Ante-natal care women and
counselling. explain about screening of women for HIV, Syphilis and TB
l
2. EBF reinforcement/Infant
Ensure feeding
coverage of all registered ANCssupport through
in the area home visits.
of jurisdiction with HIV
l Psycho-social support
counselling testing through
Provision follow-upsupport
of psychosocial counselling, homewomen
to all infected
3. Ensure prompt referral of infected ANCs with ART centres
4. visits and support
Coordination groups.
with ART / LAC Plus / LAC for confirmation of linkages and
follow- up
Counsellor stand-alone ICTC
5. Track evaluation at ART centre, initiation of ART and referral back for care
9
/ F-ICTC 6. Maintaining record of referral, its outcomes, planned place for delivery,
HIV Exposed Infant (HEI) planned follow -up dates, person responsible for follow-up etc.
7. Ensure hospital delivery
l Exclusive breastfeeds upto 6 months
8. Ensure(preferred
provisionOption-I
of ARV to WHO/NACO Guidelines 2010-'11)
baby as prescribed
and continued breastfeeds in addition
9. Ensure to provision
complement
of ART feeds after 6 labour
to all direct-in- months upto 1 year for
cases
10. Maintain up- to-date recording of all events and communication of the
same to District M&E Assistants
l Postpartum ARV prophylaxis for11.
infant for linkage
Ensure 6 weeks.of HIV exposed infants (HEIs) to EID
l Early infant diagnosis (EID) at 61. weeks Nurseofatage; repeat
F-ICTCs testing at
–all activities 6 months,
mentioned 12 months & 6 weeks
for counsellors
2. Administration of ART (TDF+3TC+EFV) to pregnant women presenting
10 after Nurse
cessation of breastfeeds.
directly- in- labour and initiation of Sy. Nevirapine for 6 weeks to HIV
l Co-trimoxazole prophylaxis from 6 weeks exposedofbabies
age.
the child.
1. Screening test for HIV and Syphilis using WBFPT for all ANCs registered.
nemoW tnangerP lla ot seIfcireactive,
vreS grefer
nitsetoTART,
dnaSTIgnand
illeGene-xpert
snuoC Vtesting/DMC
IH fo reffO
for TB screening
2. Screening the pregnant women for Syphilis using WBFPT, if reactive then
refer to STI clinic/PHC for RPR confirmation
3. Screening the pregnant women for TB if symptomatic refer to a health
facility where Gene-xpert testing is done or PHC with DMC
n4.
emEnsure
oW tnaconfirmation
ngerP detcofeHIVfnI Vstatus
IH among screened positive evitANCs
ageN VIH
11. ANM
5. Establishing linkage
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l of HIV infected pregnant women
n e to
m oART
W tCENTRE
nangerP
6. Facilitate institutional deliveries
.sreFollow-up
tneC TRAwith ta sthe
ixamother xes efaS l
lyhporpafter delivery to monitor compliance
7. in ART
consumption
. g n i llesnuoc
elpuoC l
fo shtnom 3 tsrif eht nihtiw ekatr8. ednFacilitate
u ot–)PT linkages
M( ycof naHIV
ngeexposed
rp babies to EID
9. Provide reminders to mother on ART regarding visit to.g nillcentre,
ART esnuocCD4
.ylno ycnangerp
test, etc. ylimaf ot segakniL l
1. Conduct HIV testing as per guidelines and provide feedback to referring
.sITS rof tPHC
nemMO taerregarding
t dna gnistatusneercwithS lconcurrence of patient .smodnoc eerF l
.gnitset 4D2.
C dLiaison
na gnigwith ats lF-ICTCs
acinilc and OHW e g n ahcstaff
Sub-centre screening facility
l ruofor ivaearly
heB l
information on
dna gninnalp-htrib ,y reviled efas ,gnivil evitisop no gnillesnuoC lscreening positive women and tracknoitacinummforoc
their arrival
confirmation collection and dispatch of blood kspecimen sir hgihfor rofCD4 )CCtesting
B(
12 ICTC Lab technician .snoitpoand
3. Collection gndispatch
ideef tnaoffnblood
i specimen for CD4 testing
reh dna nemow
dna esuops fo gnitset VIH dna gnil4. lesnMaintaining
uoc xes efastock s dnaofeWBFPT
lpuoC forl F-ICTCs and sub-centre screening .rentrap
facilities
5. Ensure uninterrupted supply of test kits to Screening facility VIH tin aethepeR l
.retneC Twith
jurisdiction RA ocold t lar-chain
refeR maintenance
l , g n i tset
tnuoc 4DC no desab nemiger citcaly6. hpoRecord
rp VRmaintenance
A ro TRA edand ivotimely g n i r e
rP l reporting to district and state level d i s noc
.gnigatpregnant
s lacinilwomenc ro/dnscreened
a fi doirep ,wodniw
1. Mobilize positive with WBFPT to visit ICTC for
e vitisop si esuops
rehto/tnemnrevoG ot segaknil dna confirmation gnillesnuoc noitirtuN l h gihto eART
vahcentreeh/s or ro STI
2. Facilitate
.semmaLinkage rgorp nofoHIV itirtuinfected
N pregnant women
clinic or Gene-xpert testing site/DMC for TB .ruoivaheb ksir
Outreach worker (ILFS/
.rehtom rof s3.
ixalyFacilitate
hporp Vinstitutional
RA mutrapdelivery tsoP l
13 Link-workers, CSC outreach
d n a gnideef tnafnI l
4. .se c i v r
Facilitatee S g n i
visit n n
of a l
theP y l
HIV i m aF
Exposed
l Infants(HEIs) to ICTC for noEID itirtun
worker, etc.)
5. Facilitate regular follow-up visits to ART centre for ART, .gnillestesting
CD4 nuoc etc.
6. Home visit to monitor adherence to ART medication
emoh ,gnillesnuoc pu-wollof hgu7. orhLiaison
t troppwith
us laANMs/ASHAs/Community
icos-ohcysP l Outreach Workers/DLNs for follow-
up with the infected Pregnant
.spuorg troppus dna stisiv women
1. Ensure safe delivery practices, availability of safe delivery KITs

2. Ensure continuation of ART during labour and delivery
3. Provide ART (TDF+3TC+EFV) for direct- in- labour positive pregnant
Medical Officer of facility women and Nevirapine suspension for 6)IweeksEH( ttonaHIV
fnI exposed
desopxnewE VIborns
H
14
)11'-0conducting
102 senipositive
lediuGdelivery
OCAN/OH4.
W IEnsure
-noitpO derreferpof( sHIV
confirmation htnstatus
om 6ofodirect-in-
tpu sdeelabour
ftsaercases
b eviat
suearliest
lcxE l
5. Counsel the infected pregnant women regarding importance of enrolling
ART centre and receiving life-long ART
.TRA cirtaideaP eviecer ohw se6. ibaCounsel
b evitisinfected
op DIE pregnant
rof sraewomen
y 2 otpregarding
u dna simportance
eibab evitofagEID
en DIE


.dlihc eht
1. Prompt evaluation of HIV infected pregnant women at ART centre
2. Prompt
Offer of HIV Counselling initiation Services
and Testing of life-long ART (TDF+3TC+EFV)
to all to every infected
Pregnant Women
pregnant women regardless of CD4 levels or clinical stage
3. Ensure feedback to referring ICTC regarding receipt of case at ART centre,
outcome of evaluation and prescribed drug regimen for the patients
4. Formulation of Case Management Team comprising ICTC counsellor,
15 ART centre SMO/MO
concerned ANM, concerned out-reach worker
5. Draw plan for follow-up visits including linkage to LAC in consultation
Pregnant Women l Antenatal Care (ensure
with the infected pregnantat-least
women 4 forvisits)–Monthly ART/ARV
assessment and drug collection
l Safe sex 6. Ensure uninterrupted supply of drugs and logistics to LAC-Plus, LAC
counselling. 7. Ensure provision of information on all events to the districts M&E assistant
l Counselling
for updatingon choices
in PPTCT of continuation or medical termination of
line-lists
l Couple
counselling. 1. pregnancy (MTP)–to
Prioritisation undertake
of HIV infected pregnantwithin
women for theART
first 3 monthsandof
preparedness
pregnancy
adherence only.
counselling
l Linkages to family 2. Counselling on important components of PPTCT programme like role of
ART, duration, safe hospital delivery, EID, breastfeeding etc.
l 3. Screening
Up-to-dateand treatment for STIs.
16 Free condoms.
l ART centre counsellor/ staff record keeping and documentation of follow- up and ensure
nurse change
Behaviour tracking of missed cases
4. Liaison with referring ICTC counsellor, outreach workers to track
communication l Counselling
compliance on andpositive living,
adherence safe delivery,
to schedule birth-planning
of follow-up and
visit to ART centre
(BCC) for high risk 5. infant
Liaison with referring ICTC counsellor for whole blood specimen testing of
feeding options.
women and her DBS positive babies at ART Centres
spouse is positive

the child.
Annexures
(1-20)
Annex 1: Guidelines forFigure 2: Components of PPTCT Programme
Rollling out NACP and NRHM Convergence
Plan in No X-19020/17/2009-NACP (IEC), 10 August 2010

counselling.
l Couple
counselling.
pregnancy only.
(BCC) for high risk
women and her
spouse is positive

the child.
emmNACP
Annex 1: Guidelines for rolling out argorPand
TCTPNRHM
P fo stneconvergence
nopmoC :2 erugplan
iF in the states.
No. X-19020/17/2009-NACP(IEC), 10 August 2010

.gnillesnuoc
elpuoC l
.gnillesnuoc
.ylno ycnangerp
ksir hgih rof )CCB(
reh dna nemow
evitisop si esuops

.erac tnafni enituor dna snoitazinummI l101
.dlihc eht

counselling.
l Couple
counselling.
pregnancy only.
(BCC) for high risk
women and her
spouse is positive

the child.

.gnillesnuoc
elpuoC l
.gnillesnuoc
.ylno ycnangerp
ksir hgih rof )CCB(
reh dna nemow
evitisop si esuops

.dlihc eht

counselling.
l Couple
counselling.
pregnancy only.
(BCC) for high risk
women and her
spouse is positive

the child.

.gnillesnuoc
elpuoC l
.gnillesnuoc
.ylno ycnangerp
ksir hgih rof )CCB(
reh dna nemow
evitisop si esuops

.dlihc eht

counselling.
l Couple
counselling.
pregnancy only.
(BCC) for high risk
women and her
spouse is positive

the child.

.gnillesnuoc
elpuoC l
.gnillesnuoc
.ylno ycnangerp
ksir hgih rof )CCB(
reh dna nemow
evitisop si esuops

.dlihc eht

counselling.
l Couple
counselling.
pregnancy only.
(BCC) for high risk
women and her
spouse is positive

the child.

.gnillesnuoc
elpuoC l
.gnillesnuoc
.ylno ycnangerp
ksir hgih rof )CCB(
reh dna nemow
evitisop si esuops

.dlihc eht

counselling.
l Couple
counselling.
pregnancy only.
(BCC) for high risk
women and her
spouse is positive

the child.
Annex 2: Dosing Schedules for ART for Pregnant Women
Clinical Scenario
nemoW tnARV
angProphylaxis
erP lla otand
secivreS gAntepartum
nitseT dna gnillesIntrapartum Postpartum
nuoC VIH fo reffO
dosing
Pregnant women TDF 300mg once daily Start ART as soon as Continue ART Continue ART life-long
requiring ART 3TC 300 mg once daily possible
EFV 600mg once daily (first trimester)
Annex 3: ART for Pregnant.srWomen Presenting
etneC TRA ta sixalyhporp
in Active Labour xes ewith
faS l
No. Prior ART
.gnillesnuoc
elpuoC l
Maternal Status Intrapartum .gnillesnuoc
Postpartum
.ylno ycnangerp
Presenting in active labour, .sTDF
IO r300mg
ehto dnonce a BTdaily
rof gnineercS l TDF 300mg once daily
No Prior ARV prophylaxis 3TC 300 mg once daily .se300
3TC civ rmg
es gonceninndaily
alp
.sITEFV
S ro600mg
f tnemtonceaert daily
dna gnineercS l .smodonce
EFV 600mg nocdaily
eerF l
noitacinummoc
Annex dna gn4: innaInfant
lp-htrib ,yNVP
reviledProphylaxis
efas ,gnivil evitisop dosing
no gnillesnuoC l
ksir hgih rof )CCB(
reh dna nemow
dna eBirth
suopWeight
s fo gnitset VIH dnNVP
a gndaily
illesndose
uoc (in
xesmg)
efas dnNVP a elpdaily
uoCdose
l (in ml)** Duration
.rentrap
Birth to 6 weeks: * .nerdlihc gnivil rehto VIH taepeR l
.retneC TRA o0.2 t laml/kg
rrefeR l ,gnitset
Infants with birth weight 2 mg/kg once daily. once daily Up to 6 weeks irrespective of
< t2000
nuoc gm4DC no desab nemigeInr cconsultation
itcalyhporwithp VRaA ro TRA edivorP l g n i r
whether exclusively e disnobreastfed
c
pediatrician trained
.gniginatHIV
s lacinilc ro/dna orfiexclusive
doirep ,replacement
wodniw fed.
care. evitisop si esuops
Birth weight 2000 – 2500 gm 10 mg once daily .semmargorp1nml oitonce
irtuNa day .ruoivaheb ksir
Birth weight more than 2500 .gm rehto15
mmg rofonce
sixaldaily
yhporp VRA m1.5 utraml ptonce
soP a lday dna gnideef tnafnI l
* * considering the content of 10 mg Nevirapine.sin ec1ml.
iv reSsuspension
gninnalPbased ylimaonF WHO
l Guidelines. noitirtun
.stiswith
* Infants iv em oh hweight
birth guorh<t t2000
roppugms gshould
nideefreceive
tnafnIdose
/tnem ofe2crmg/kg
ofnieronce l Consult expert HIV .paediatrician
FBEdaily. gnillesnuocin these
cases.
Source: WHO Guidelines
Annex 5: WHO Clinical Staging for Adults and Adolescents

CLINICAL STAGE 1 )IEH( tnafnI desopxE VIH
Asymptomatic
rof generalized
Persistent raey 1 otplymphadenopathy
u shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
CLINICAL STAGE 2
Moderate unexplaineda weight loss (under 10% presumed or measured body weight)b Recurrent respiratory tract infection
(sinusitis, tonsillitis, otitis media, pharyngitis)
Herpes zoster Angular cheilitis Recurrent oral ulceration .sdeeftsaerb fo noitassec retfa
.dlihc eht
Papular pruitic eruptions Seborrhoeic dermatitis Fungal nail infections
CLINICAL STAGE 3
Unexplaineda severe weight loss (over 10% of presumed or measured body weight)b
Unexplaineda chronic diarrhoea for longer than one month
Unexplaineda persistent fever (intermittent or constant for longer than one month) Persistent oral candidiasis
Oral hairy leukoplakia
Pulmonary tuberculosis
Pregnant Women Antenatal
Severe bacterial infections (e.g. pneumonia,l empyema, Care (ensure
pyomyositis, at-least
bone or 4 visits)–Monthly
joint infection, ART/ARV Acute
meningitis, bacteraemia)
necrotizing ulcerative stomatitis, gingivitis or periodontitis
counselling.
Unexplaineda anaemia (below 8 g/dl ), neutropenia (below 0.5
l Counselling onxchoices
100/1) and/or chronic thrombocytopenia
of continuation or medical termination of
(below
l Couple
50 x 100 /1) pregnancy (MTP)–to undertake within the first 3 months of
counselling.
CLINICAL STAGE 4C pregnancy only.
HIV wasting syndrome
Pneumocystis
l jeroveci pneumonia (PCP) l Screening and treatment for STIs.
Free condoms.
l Behaviour
Recurrent change
severe bacterial pneumonia l WHO clinical staging and CD4 testing.
Chroniccommunication
herpes simplex infection (orolabial,lgenital or anorectal
Counselling onofpositive
more than one month’s
living, durationbirth-planning
safe delivery, or visceral at anyand
site)
(BCC)candidiasis
Oesophageal for high risk
(or candidiasis of trachea, bronchi or lungs)
women tuberculosis
Extrapulmonary and her
Kaposipartner.
sarcoma l Couple and safe sex counselling and HIV testing of spouse and
Repeat HIV
Cytomegalovirus
l infection (retinitis or infection other living
of other children.
organs) Central nervous system toxoplasmosis
testing,
HIV encephalopathy l Referral to ART Center.
Extrapulmonary
considering cryptococcosis including meningitis Disseminated non-tuberculous mycobacteria infection Progressive
multifocal leukoencephalopthy
Chronicspouse
cryptosporidiosis
is positive
Chronicorisosporiasis
s/he have high l Nutrition counselling and linkages to Government/other
Disseminated Nutrition programmes.Recurrent septicaemia (including non-typhoidal
mycosis (extrapulmonary histoplasmosis, coccidiomycosis)
risk behaviour.
Salmonella)
Lymphoma (cerebral
nutrition or B cell non-Hodgkin) l
Invasive
Familycervical carcinoma
Planning Services.
Atypical disseminated
counselling. leishmaniasis
Symptomatic HIV-associated nephropathy or HIV-associated cardiomyopathy
a Unexplained refers to where the condition is not explained by other conditions.
b Assessment of body weight among pregnant women visits and support
needs groups.
to consider the expected weight gain of pregnancy.
c Some additional specific conditions can also be included in regional classifications, such as the reactivation of American
trypanosomiasis
(meningoencephalitis and/or myocarditis) in the WHO Region of the Americas and penicilliosis in Asia.
Source: Revised WHO clinical staging and immunological classification of HIV for surveillance. 2006 (in press).
the child.
Annex 6: Grading of Selected Clinical and Laboratory Toxicities
(Reference: WHO 2010 Guidelines for ART in Adults and
Adolescents)
Mild Moderate Severe Potentially life-
Grade 1 Grade 2 Grade 3 threatening Grade 4
Estimating severity grade nemoW tnangerP detcefnI VIH evitageN VIH
VRA/TRA ylhSymptoms
tnoM–)sticausing
siv 4 tsno
ael-ta Symptoms
erusne( ercausing
aC latanetnASymptoms
l n e m oW tnangerP
Clinical adverse causing Symptoms causing
event Not identified or minimal interference .sretngreater
eC TRthan
A taminimal
sixalyhporp inability to perform xestoeperform
inability faS l
elsewhere in the with usual social and interference with usual usual social and .gnilself–care
basic lesnuocor
table functional activities social and functional functional activities medicalelorpuoperative
oC l
fo shtnom 3 tsrif eht nihtiw ekatrednuactivities ot–)PTM( ycnangerp intervention
.gnillesnuindicated
oc
.ylno ycnangerp to prevent permanent
ylimaf impairment,
ot segakniL l
.sIO rehto dna BT rof gnineercS l .secivpersistent
res gninndisability
alp or
.sITS rof tnemtaert dna gnineercS l .sm odnoc eerF l
death
Haemoglobin 8.0–9.4 g/dl OR 7.0–7.9 g/dl OR 6.5–6.9 g/dl OR < 6.5 g/dl OR
dna gninnalp-htr80–94
ib ,y reg/l
vileOR
d efas ,gnivil e70–79
vitisog/l
p nOR
o gnillesnuoC65–69l g/l OR noi< tac65
ing/l
umOR moc
4.93–5.83 mmol/l 4.31–4.92 mmol/l 4.03–4.30 mm0l/lksir hg<ih4.03 rof )mmol/l
CCB(
reh dna nemow
dnaneutrophil
Absolute esuops fo gn1000–1500/mm
itset VIH dna g3 nillesnu750–999/mm
oc xes efas d3 nOR
a elpuoC500–749/mm
l
3
OR <500/mm.rentrOR
3
ap
count or 1.0–1.5/g/I* 0.75–0.99/g/I* 0.5 -0.749/g/I* <0.5/g/I*
Platelets 75000-99000/mm3 50000–74999/mm
3
20000–49999/mm 3
,gnitse3tOR
<20000/mm
OR 75-99/g/I* OR 50–74.9/g/I* OR 20–49.9/g/I* <20/g/I*
gniredisnoc
Chemistries .gnigats lacinilc ro/dna fi doirep ,wodniw
evitisop si esuops
rehto/tnemnrevoG>1.0–1.5
Hyperbilirubinaemia ot segxaULN knil dna >1.5–2.5
gnillesnuxocULNnoitirtuN>2.5–5l x ULN hgih >5 evaxhULNeh/s ro
.semmargorp noitirtuN .ru>oi500
vahemg/dl
b ksir
Glucose (fasting) 110–125 mg/dl 126–250 mg/dl 251–500 mg/dl
Hypoglycaemia 55–64 mg/dl OR .se40–54
civ reSmg/dl
gninnORalP ylimaF30–39l mg/dl OR <30 n mg/dl
oitirtOR
un
3.01–3.55 mmol/l 2.19–3.00 mmol/l 1.67–2.18 mmol/l <1.67 mmol/l
Hyperglycaemia
emoh ,gnilles116–160
nuoc pu-mg/dl
wolloOR
f hguorht161–250
troppus mg/dl
laicosOR
-ohcysP251–500
l
mg/dl OR >500 mg/dl OR
(nonfasting and no 6.44–8.90 mmol/l 8.91–13.88 mmol/l 13.89–27.76 mmol/l >27.76 mmol/l
prior diabetes) .spuorg troppus dna stisiv
Triglycerides - 400–750 mg/dl OR 751–1200 mg/dl or >1200 mg/dl or
4.52–8.47 mmol/l 8.48–13.55 mmol/l >13.55 mmol/l
Creatinine >1.0–1.5 x ULN >1.5–3.0 x ULN >3.0-6.0 x ULN )IEH( tnafn>6.0 I desXoULN
pxE VIH
AST (SGOT) 1.25–2.5 x ULN >2.5–5.0 x ULN >5.0–10.0 x ULN >10.0 x ULN
ALT (SGPT)
.TRA cirtaide1.25–2.5
aP eviecxerULN
ohw seibab>2.5–5.0
evitisop xDULN IE rof srae>5.0-10.0
y 2 otpu dxnULN a seibab e>10.0
vitagexnULNDIE
GGT 1.25–2.5 x ULN .skexew
>2.5–5.0 ULN6 rof tnaf>5.0–10.0
ni rof sixalyxhULNporp VRA>10.0mutraxpULNtsoP l
Alkaline 1.25–2.5 x ULN >2.5–5.0 x ULN >5.0–10.0 x ULN >10.0 x ULN
phosphatase .sdeeftsaerb fo noitassec retfa
.dlihc eht
Chemistries Offer of HIV Counselling and Testing Services to all Pregnant Women
Bilirubin 1.1–1.5 x ULN 1.6–2.5 x ULN 2.6–5.0 x ULN > 5 x ULN
Amylase >1.0–1.5 x ULN >1.5–2.0 x ULN >2.0–5.0 x ULN > 5.0 x ULN
HIV Negative
Pancreatic amylase >1.0–1.5 x ULN HIV Infected
>1.5–2.0 Pregnant
x ULN Women >2.0–5.0 x ULN > 5.0 x ULN
Pregnant Women
Lipase >1.0–1.5 x ULN l Antenatal >1.5–2.0 Care (ensure at-least
x ULN >2.0–5.0 4 visits)–Monthly
x ULN > ART/ARV
5.0 x ULN
Lactatecounselling. <2.0 x ULN without >2.0 x ULN without Increased lactate with Increased
acidosis l Counselling
acidosis on choices of pH continuation
<7.3 without or medical termination
lactate with pH of
l Couple
life- threatening <7.3 3 without
months of
counselling. consequences life- threatening
pregnancy only.
l Linkages to family consequences
Gastrointestinal Screening and treatment for STIs.
l Free condoms. l
Nausea
l Behaviour change
Mild OR transient; l WHO clinicaldiscomfort
Moderate staging and Severe
CD4 testing.
discomfort OR Hospitalisation
communication reasonable intake OR intake decreased minimal intake for³ 3 required
(BCC) for highmaintained
risk for <3 days days
women and her
Vomiting Mild OR transient; 2-3 Moderate OR Severe vomiting of Hypotensive shock
partner. episodes per day ORl Couple and safe sex counselling
persistent; and HIV
all foods/fluids testingOR
in 24 of spouse and
hospitalisation
l Repeat HIV mild vomiting <1 weekother living
4-5 children.
episodes per day hours OR orthostatic for intravenous
OR hypotension OR treatment required
vomiting lasting ³1 intravenous treatment
considering l Provide
week ART or ARV prophylactic
required regimen based on CD4 count
window, period if and/or clinical staging. Bloody diarrhoea OR
Mild OR transient;
spouse is positive Moderate OR Hypotensive shock
Diarrhoea 3-4 loose stools perl Nutrition counselling
persistent; and linkages
orthostatic to
hypotension Government/other
OR
or s/he have high
5-7 loose
day OR mild diarrhoeaNutrition stools per
programmes. OR ³ 7 loose stools/ hospitalisation
risk behaviour.lasting<1 week day OR diarrhoea day OR intravenous Rx required
l Infant feeding and l Postpartum
lasting ³1 ARV
week prophylaxis for mother.
required
Respiratory
Dyspnoea Dyspnoea on exertion Dyspnoea with normal Dyspnoea at rest Dyspnoea requiring
activity O2
visits and support groups. therapy
Urinalysis
Proteinuria
Spotl urine
Exclusive 1+
breastfeeds upto 6 months2+ or 3+
(preferred 4+
Option-I WHO/NACO Nephrotic
Guidelines syndrome
2010-'11)
24-hourand continued200
urine breastfeeds in addition
mg to 1 g loss/day 1 gtoto complement
2 g loss/day ORfeeds
2 g after
to 3.56g months
loss/day upto 1 yearsyndrome
Nephrotic for
OR <0.3% OR <3 g/l 0.3% to 1.0% OR 3 g OR > 1.0%
EID negative babies and upto 2 years for EID positive babies who receive Paediatric ART. OR >10 OR
to 10 g/l g/l >3.5 g loss/day
Gross haematuria Microscopic only Gross, no clots Gross plus clots Obstructive
the child.
Miscellaneous nemoW tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO
Fever 37.7-38.50C OR 38.6-39.50C OR 39.6- 40.50C OR > 40.50C OR
(Oral, >12 hours) 100.0 -101.50F 101.6 -102.90F 103 -1050F > 1050F for ³ 12
continuous hours
Headache Mild; no treatment nemoW tnangeOR

Moderate rPnon-
detcefnI VSevere
IH OR responds evitageN VIH
Intractable
VRA/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA initial
required narcotic analgesia Rx to l narcotic nemoW tnangerP
treatment xes efaS l
Allergic . g n i llesnuoc
fo noireaction
tanimret lacidPruritus
em ro nwithout
oitaunrash
itnoc fo sLocalized
eciohc nurticaria
o gnillesnuoCGeneralized
l urticaria, Anaphylaxis
elpuoC l
fo shtnom 3 tsrif eht nihtiw ekatrednu ot–)PTM( ycnangerpangioedema
.gnillesnuoc
Rash hypersensitivity Erythema, pruritus .ylno ycnangerpVesiculation OR moist ANY ONE OF:
Diffuse maculopapular
y l i m a f ot segakniL l
.sIO rehtorash
dnaORBT dryrof gnineercSdesquamation
l
OR
. s e c i v
mucous membrane
r es gninnalp
desquamation ulceration involvement,
.sITS rof tnemtaert dna gnineercS l .sm odnoc eerF l
suspected
.gnitset 4DC dna gnigats lacinilc OHW l egnahStevens-
c ruoivaJohnsonheB l
(TEN),
noitacinummoc erythema
dna gninnalp-htrib ,y reviled efas ,gnivil evitisop no gnillesnuoC l multiforme,
ksir hgexfoliative
ih rof )CCdermatitis
B(
reh dna nemow
dna esuops fo gnNormal
Fatigue itset VIactivity
H dna reduced
gnillesnuoNormal
c xes eactivity
fas dna elpuoCNormal l activity Unable .reto
ntcare
rap for
by < 25% reduced by 25-50%
.nerdlihc gnivil rehto reduced by > 50%; self
VIH taepeR l
cannot work
Source: Division of AIDS, National Institute of Allergy and Infectious Diseases, version 1.0 December g n2004,
i r e disnclarification
oc
tnuo2009
August c 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l
.gni5gatoxicity,
NOTE: This clarification includes the addition of Grade ts lacinwhich
ilc rois
/ddeath.
For abnormalities not found elsewhere in the toxicity table, use the information on estimatingviseveritye tisop sigrade esuoinpsthe first
column. hgih evah eh/s ro

.dlihc eht
Annex 7: Postpartum Depression Screening Tool—The Edinburgh Scale
Offer of HIV Edinburgh Postnatal
Counselling Depression
and Testing Scaleto1 (EPDS)
Services all Pregnant Women
Name: ___________________________Address: ______________________________________________
Your Date of Birth: _________________________________________________________________

Baby’s Date of
Pregnant Women Birth: _______________________Phone: ________________________________
l Antenatal Care (ensure at-least 4 visits)–Monthly ART/ARV
l
As you Safe
are sex
pregnant or have recently hadprophylaxis
a baby, at
weART Centers.
would like to know how you are feeling. Please
counselling.
check the answer that comes closestl toCounselling
how you have felt IN of
on choices THE PAST 7 DAYS,
continuation not just
or medical how you of
termination feel
l Couple
today. pregnancy (MTP)–to undertake within the first 3 months of
counselling.
Here is and example, pregnancy only.
already completed.
I have planning services. l
felt happy:
-- Yes, all the time
Yes, most of the time
þ communication
l This would mean:
Counselling “I haveliving,
on positive felt happy most ofbirth-planning
safe delivery, the time” during
and the
(BCC)
-- No, notfor high
very risk
often past week. Please complete the other questions in the same
women and her
-- No, not at all way.
partner. l
In the
l past 7 days:
1. testing,
I have been able to laugh land Referral to ART Center.
see the 4. I have been anxious or worried for no good
considering
funny side of the things l reason
window, period if
-- As much as I always could and/or clinical staging.-- No, Not at all
spouse is positive
or--s/he
Not have so much now l Nutrition counselling-- Hardly
quite high and linkages
ever to Government/other
-- Definitely not so much now -- Yes, sometimes
-- Not at all
nutrition l Family Planning Services. -- Yes, very often
2. counselling.
I have looked forward with lenjoyment to *5. I have
EBF reinforcement/Infant felt support
feeding scared through
or panicky forvisits.
home no very
things l Psycho-social supportgood throughreason
follow-up counselling, home
-- As much as I ever did visits and support groups. -- Yes, quite a lot
-- Rather less than I used to -- Yes, sometimes
-- Definitely less than I used to -- No, not much
HIV--Exposed
Hardly at Infant
all (HEI) -- No, not at all
l Exclusive
*3. I breastfeeds
have blamed myselfupto 6 months (preferred
unnecessarily when Option-I WHO/NACO
*6. Things have been Guidelines
getting on2010-'11)
top of me
and continued
things went wrongbreastfeeds in addition to complement -- feeds
Yes,after
most6ofmonths
the timeupto 1 yearbeen
I haven’t for able
EID negative babies and upto 2 years for EID positive babies to cope
who at receive
all Paediatric ART.
-- Yes, most of the time
l Postpartum ARV prophylaxis for infant for 6 weeks. -- Yes, sometimes I haven’t been coping as
-- Yes, some of the time
l Early infant diagnosis (EID) at 6 weeks of age; repeat testing wellatas6 usual
months, 12 months & 6 weeks
-- Not very often
after cessation of breastfeeds. -- No, most of the time I copied quite well
-- No, never
Co-trimoxazole prophylaxis from 6 weeks of age.
l
-- No, I have been coping as well as ever
the child.
emthat
*7. I have been so unhappy margIorhave
P TCTPhad
P fo stneno*9. I
pmoC have
:2 erugbeen
iF so unhappy that I have been
difficultly sleeping crying
-- Yes,nemost
moWoftthe
nantime
gerP lla ot secivreS gnitseT dna-- gYes,
nillemost
snuoofC the
VIHtime
fo reffO
-- Yes, sometimes -- Yes, quite often
-- Not very often -- Only occasionally
-- No, not at all nemoW tnangerP detcef--nINo, VIHnever evitageN VIH
*8. IVR have felt sad or miserable
A/TRA ylhtnoM–)stisiv 4 tsael-ta erusne( eraC latanetnA l *10. The thought of n e m
harming oW tn angerPhas
myself
-- Yes, most of the time .sretneC TRA ta sixalyhporoccurred p to me xes efaS l
. g n i llesnuoc
fo noi--
tan imrequite
Yes, em ro noitaunitnoc fo seciohc no gnillesnuo--
t lacidoften C Yes,
l quite often
elpuoC l
fo shtnom 3 tsrif eht nihtiw ekatrednu ot–)PTM( ycnanger-- p sometimes
-- Not very often .gnillesnuoc
.ylno ycnangerp
-- No, not at all -- Hardly ever y l i m a f ot segakniL l
-- Never
. g n i t s e t 4 D C d n a g
Administered/Reviewed by__________________________Date____________________________n i g a t s l a c i n i l c O H W l e g n ahc ruoivaheB l
ksir hgih rof )CCB(
1
Source: Cox, J.L. Holden, J.M. and Sagovsky, R.1987. Detection of postnatal depression: Development reh dna nof emthe ow10-item
d n a e s u
Edinburgh Postnatal
o p s f o g n i t s e t V I H d n a g n i l l e s n u o c x e s e f a s d n a e l p u o C l
.r e n t r ap
Depression Scale. British Jormal of Psychiatry 150:782-786. .nerdlihc gnivil rehto VIH taepeR l
2
Source: K.L. Wisner, B.L. Parry, C.M. Piontek, Postpartum Depression N Engl J Med Vol. 347, No 3, July 18, ,2002, gnitse194-199
t
Users may reproduce the scale without further permission providing they respect copyright by quoting the names of the
tnuocthe4D
authors, C nand
title o dtheesasource
b nemofigethe r cpaper
itcalyin hpallorreproduced
p VRA ro Tcopies. RA edivorP l g n i r e d i s n o c
evitisop si esuops

.dlihc eht
Figure Postnatal
Edinburgh 2: Components of PPTCT Scale
Depression Programme
1
(EPDS)
Postpartum depression is the most common complication of child bearing.2 The 10-question Edinburgh
Offer ofScale
Postnatal Depression HIV Counselling
(EPDS) is a and Testing
valuable and Services to allofPregnant
efficient way identifyingWomen
patients at risk for
“perinatal” depression. The EPDS is easy to administer and has proven to be an effective screening tool.
Mothers who score above 13 are likely to be suffering from a depressive illness of varying severity. The
EPDSHIVscore
Negative HIVjudgment.
should not override clinical Infected Pregnant
A careful Women
clinical assessment should be carried out to
Pregnant
confirm Women The scale indicates
the diagnosis. l how theCare
Antenatal mother has at-least
(ensure felt during the previous week.
4 visits)–Monthly In doubtful
ART/ARV
cases Safe
l it maysex be useful to repeat the tool after 2 weeks. The
prophylaxis at ART Centers. scale will not detect mothers with anxiety
counselling.
neuroses, phobias or personality disorders.
l Couple
Womencounselling.
with postpartum depression need not feel alone. They may find useful information on the web
pregnancy only.
sites Linkages
l of to family
the National Women’s Health information Centre <www.4women.gov> and from groups
such as Postpartum Support International <www.chss.iup.edu/postpartum> and Depression after
Free
Delivery condoms. l Screening and treatment for STIs.
l
<www.depressionafterdelivery.com>
communication
Questions 1, 2, & 4 (without an *) Scoring
(BCC) for high risk
Are scored 0, and
1, 2her infantas
or 3 with top box scored feeding
0 andoptions.
the bottom box scored as 3.
women
Questions 3, 5-10 (marked with an *)
Are reverse scored,
testing, with top box scored as 3 and the bottom box scored as 3.
considering
Maximum score: 30 l Provide ART or ARV prophylactic regimen based on CD4 count
Possible Depression:
spouse 10 or greater
is positive
Alwaysorlook
s/heathave
itemhigh
10 (suicidal thoughts)
risk behaviour.
Users
l
may reproduce
Infant feeding andthe scale without
l further ARV
Postpartum permission,
prophylaxisproviding they respect copyright by
for mother.
quoting the names
nutrition of the authors, the
l
title, and the source
Family Planning Services. of the paper in all reproduced copies.
Instructions for using the Edinburgh Postnatal Depression Scale:
1. The mother is asked to check the response
visits that groups.
and support comes closest to how she has been feeling in
the previous 7 days.
2. All the items must be completed.

3. Care should be taken to avoid the possibility of the mother discussing her answers with others.
(Answers come from the mother or pregnant woman.)
4. EID
Thenegative
mother should complete
babies and upto 2the scale
years forherself, unlessbabies
EID positive she has limited
who English
receive or has
Paediatric difficultly
ART.
l with reading.
Postpartum ARV prophylaxis for infant for 6 weeks.
1
Source:
l Early infant
Cox; J.L. diagnosis
Holden, (EID)
J.M. and at 6 weeks
Sagovsky, of age;
R. 1987. repeat
Detection of testing atdepression:
postnatal 6 months,Development
12 monthsof& the
6 weeks
10-item
Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782-786.
2
Source: K.L. Wisner, B.L. Parry, C. M. Piontek, Postpartum Depression N Engl J Med vol 347, No 3, July 18, 2002, 194-199
the child.
Annex 8: Comparinng effectivveness of faamily plannning methods
Annex 8: Comparing Effectiveness of Family Planning Methods
Comp paring Effective
nemoW tnangerP lComparing
EeS gnitseTeness
la ot secivrEffectivenessdof
of Method
naMethods
ds
gnillesnuoC VIH fo reffO
More Effeective
How to m make your
Less than 1 pregnancyy per
100 women in one yea ar method most
nemoW tnangerP detcefnI VIH effectivee evitageN VIH
.sretneC TRA ta sixalyhporp After proceedure, little orr xnothing es efaS l
to do or reemember.gnillesnuoc
Vasectomyy: Use anotheer elpuoC l
method foor first 3 mon .gniths llesnuoc
.ylno ycnangerp
Implants Vasecto
omy Female
Female IUD y l i m a f o t s egakniL l
Implants .sIO rehto dSnterilization
Vasectomy a BT rof gnineerIUD cS l .seciv res gninnalp
Injections: Get repeat in njections
on time
LAM (for 6 months):
ksir hgih rof )CCB(
.snoitpo gnideef tnafni Breastfeed d often,rehday dnand
aa nemow
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC l night .rentrap
Injectablees LAM .nerdlihc gnivil rehto Pills Pills: Takee a pill each VIday
H taepeR l
d
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l Condoms, diaphragm: Use g n U disnoc
i r e
.gnigats lacinilc ro/dna fi time
correctly eevery doireyou pu,w odniw
have
e v i t i s o p s i e suops
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuN l sex hgih evah eh/s ro
.semmargorp noitirtuN Fertility-awwareness bassed
.ruoivaheb ksir
methods: Abstain or use
condoms when fertile.
Male Female
. s e c
Diaphragm
i v rm
e S g n i n n a l P y l i m
Fertilityy-Awareness
aF l
Newest methods (Standard noitiDays
rtun
.stisiv emoCondoms
C h hguorht trCondoms
oppus gnideef tnafnI/tnemecBase rofed niMethods
er FBE l Method annd Two Day .gnMethod)
Millesnuoc
emoh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP l may be eaasier to use.
.spuorg troppus dna stisiv Withdrawaal, Spermicidee: Use
correctly eevery time you
u have
sex

)11'-0102 senilediuGWithdrawa OCAN/al OHW I-noiSpermicide
StpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
Less effe ective
About 30 pregnancies
p p
per .skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP l
ske100ew 6wome
& senhtninom one21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE l
yeear
Reference: Reproductive Choicees and Family Plaanning for Peoplee Living.ewith
gaHIV
fo Counselling
skeew 6Tool mlorf sixalyhporp elozaxomirt-oC l
(http://www.whoo.int/hiv/pub/toolkkits/rhr/en/index.hhtml )
National Guidellines for Prevention of Parent-to-Chhild Transmissionn of HIV 116
.dlihc eht
Annex 9: Flowchart on Counselling Mothers and their Families on Infant Feeding Options
120
l
l
l
l
l
l
l
l
l
l
l
l
l
l
l
Annex
A 0-6
9: Flowc Months
chart of Age
on Counsselling MothersCounselling
s and their Fam milies
theonHIV
Infanttinfected mothers
Feeding option
ns 0-6 monthsand
o ageher family for
of
infant
Coounselling the HIV infected
i
feeding
mothers an
options: 0-6 months
nd her family for inffant feeding optionss: 0-6 months
Couple
testing,
partner.
Safe sex
nutrition
1. Ask
A about the mother HIV/ART stattus, home & Discuss Excluslve Replacement Feeding
3. D F (ERF) as a feeding optioon if 6. Explain the chosen feeding option 7. Provide follow- u
up conunselling and support at eevery visit
the child.
moth her cannot breastfeed and only if
i the 6 criterla for RF are fulfilleed as
HIV Negative
faamily situation
Exculve breeastfeeding for 6 months: About Baby:
considering
Repeat HIV
beloow
counselling.
counselling.
counselling.
l Does
D her family know her HIV statu
us? l EBF meaans giving only breast milk and no l Ask about the progress on infant feeding
Does
D she know her husband's HIV V Advan
ntages:
other liqquids or solids, not even water withh the
Free condoms.
risk behaviour.
l ASk about baby's immunization: cotrimoxazole dossing. EID status: infant NVP
Pregnant Women
status?
s l No rrisk of HIV transmission
communication
exceptioon of medicines
women and her

prophylaxis adherrence and monthly refill
l Is
I her husband/family l ERFF milks can be given by other persons
window, period if
or s/he have high

l NO "mixxed" feeding (ie. breastfeeding and d
spouse is positive
l
planning services.
Ask about baby's growth & health, look for signs of iillness and malnutrition
Behaviour change
Infant feeding and

supportive
s and willing to help babyy
(BCC) for high risk

giving other
o feeds) - animal or formula miilk
Linkages to family
Disadvvantages: l Asscess if further action or doctor's check is requireed and advise
care?
c can irrittate the lining of the infant's stomacch,
l Anim
mal milk is not a complete food for baby
l Family
F income per month causing g inflammation and making it easieer for l Discus ss about complemeentary feeding at 6 months of age
l Form
mula milk is a complete food but is expensive (about 8,000 to 10,000
0 Rupees for 6 the HIV virus in breast milk to get into the and whether to coontinue or stop breastfeeding
l Source of

monnths) baby's body
b
drinnking water l Type of For HIV-infected Children <2 years old: check that baaby is initiated on ART; encouragee
l Baby has more risk of infections -diarrrhoea, respiratory and ear infectio
ons and l Breastfe
feeding : Discuss and demonstratee breastfeeding to con
ntinue till 2 years of age
latriine/toiler used malnutrritions correct attachment to nipple and position
ning
l Can
C she prepare each feed with boiiled water and of baby For breastfeeding inffants still on infant NVP daily propphylaxis or mothers on ART or
l Careeful and hygienic preparation requuired each time: Sterilize feeding cups, using
PPTCT option B: cheeck baby's adherence to daily NV VP; encourage mother to continuee

clean
c utensils eg. up to 12-15 timees per day in the boiled water and fresh preparation of all
a feeds 12-15 times in the first 4 months of l Dis scuss prevention and breastfeeding till 12 months. Infants should start com mplementary feeding at 6 monthss
l
l
l
l
l
l
l
l
l
l
l
l
l
l
first
f 4 months of baby's life babyy's life treatmeent of cracked nipples: expressed of age
Growth and nutrition monitoring.

l Can
C she prepare feeds at night? some brreast milk after baby has finished and
a
rub overr nipple Follow IMNCI guidelines for complementary feeding. see National Guidelines for
l What
W is her latest CD4 count and iss she taking ART
4 Explaain the risks of parent-to-child trransmission nutrition for HIV affeected and infected infants and chiildren, NACO 2011.
or PPTCT regimen? l Discuss prevention and
l Does
D she plan to deliver in the heaalth facility or go If motheer or baby is taking ART or PPTC
CT regimen drug schedules, exp
plain: treatmeent of mastitis: breastfeed frequently About mother
Immunizations and routine infant care.

back
b to parent's house somewherre else? (need to l Thatt the risk of HIV transmission from
m mother-to-child is very low becau
use the ART A
and feeed until the breast is empty. Avoid l Ask how mother & family is coping with the baby
plan
p referral to other ICTCs) druggs will reduce the numbers of HIV virus
v in the breast milk breast eengorgement.
l Ask for mother's mood
m changes (screen for postparrtum depression)
l Dis scuss prevention and
l wheen mother or baby is taking ARV dru
ugs, less than 5 babies out of 100 babies
b may be l Family planning/ contraception
c and birth spacing
HIV infected treatmeent of oral ulcers and oral thrush
in infant l Give condoms and
d reinforce consistent condom usee
2. Counsel
C for breastfeeding l It is important to take the ART drugs ass prescribed -reinforce adherence of ART or
l Dis scuss breast and hand l Ask status and pro
ogress for pre-ART or ART care
l Exclusive
E breastfeeding is recommended during PPT TCT regimen.

hygienee for mother, and oral hygiene for l Reinforce adheren
nce to ART or PPTCT regimen
pregnancy only.
the
t first 6 months of life, as if has more
m benefits to
If motheer is not on ART or mother/infant not receiving new PPTCT regim men (eg. In baby
baby
b and mother l Refer to ART centrre as appropriate

the disttricts which are still using sd-NV
VP during the scale up of new PPTCT
guldelllnes), explain: Exclusive Replacement
R Feeding for 6 mon
nths:
Exp
plain: Breastfeeding is recommen
nded
l Dis scuss and

Advvantages: l During the first 6 months of life, it is im
mportant to keep the child healthy by
b good
feedding practices demonsstrate the amount to be fed 8. Counselling for sttopping breastfeeding

l Complete
C nutrition for baby for 6 months
m

l Tell motther to prepare according to
l EBF is recommended because breast milk
m contained antibodies which protect the l For mother on AR
RT for her own health: continue ARTT
l Antibodies
A in breast milk protects against infections instructtions with scoop (if formula feedin
ng)
babiies from infetions-unless ERF can be safely done according to the 6 criteria
c

Family Planning Services.
l For infants still on
n infant NVP prophylaxis or motherrs
l Babies
B on breastfeeding do not usually have health l Dis scuss hygienic preparatiion
l ERFF must be correctly done otherwisee child will not grow well or may dev
velop
problems
p like diarrhoea, pneumonnia, ear infections of feeds: l Do not stop breasttfeeding abruptly: gradually cut doown the number of breastfeeding
mallnutrition
}
sessions a day acccording to comfort of mother and iinfant over one month
l Always
A available, free of cost Handd washing with soap
l Althhough there is a small risk of transm
mission of HIV through breast milkk this must be
l Ensure complemeentary feeding is nutritionally adeqquate and safe
l Most
M convenient, no need to prepaare or get out of balaanced with the risks of other health problems (diarrhoea, respiratory infections) } Cleann utensils and surface
bed
b at night due to replacement feeding. l Check for growth and nutritional status of baby
} Boileed water
l Once brestfeedingg is stopped completely, DO NOT pput baby back to breast for any
Disaadvantages: } Preppare enough for one feed
sucking
Breast milk contains HIV virus, howevver ART or PPTCT 5. Helpp mother and family declde on feeeding choice } Throw
w away leftover feed if baby doess
regiimen will significantly prevent thee transmission of not finish
f
WHO clinical staging and CD4 testing.
HIV virus during breastfeeding Clarify qquestions

} Do not re-use leftover feeds as it may
y

Go throough points 2-4 again, if necessarry
lead
d to food poisoning
Sup
pport the decision for infannt feeding ment feeding
Box § : Six Criteria for replacem
Breeastfeeding is recommendeed as it is Mothhers known to be HIV- infectedd should give replacement feeeding to their infants only wheen All of the following conditioons are met:

l Affordable,
l Sa
afe water and sanitation aree assured at the household l The mother, or carregiver can prepare it frequen
ntly enough in a l The family
fa is supportive of this praactice, and
HIV care and Ped ART for infants and children diagnosed as HIV positive through EID.
l Safer with ART drugs, levvel and in the community, an nd t it is safe and carries a low
clean manner so that w risk of l The mother,
m or caregiver can access health care that offers
l Feasible and l Thhe mother, or other caregiver can reliably afford to providee diarrhoea and mallnutrition, and compprehensive child health servicces
l Convenient. suufficient RF (milk) , to supportt normal growth and l The mother, or carregiver can, in the first six mon
nths exclusively
deevelopment of the infant, and give replacementt feeding, and
117
Counselling on positive living, safe delivery, birth-planning and

Counselling on choices of continuation or medical termination of
Gradual weaning after 6 months and introduction of complementary feeds from 6 months
Annex 10: Testing Algorithm for HIV-1 Exposed Infants and Children <18 Months
Less than 6 months old and born to HIV positive mother A <6 months
Follow Advisory 1
HIV- 1 DNA detected Collect & send Dried Blood Spot (DBS) of babies between 6 weeks to <6 months of age HIV- 1 DNA detected
for HIV-1 DNA PCR (At ICTC)
Refer to ART Centre
Collect and send whole Blood HIV-1 DNA not Guidance 1-Lab will request HIV- 1 DNA l If child develops signs and symptoms of HIV infection
specimen for HIV-1 DNA PCR. detected by for fresh whole blood sample not detected at <6 months of age, repeat HIV DNA PCR by DBS
Follow Advisory 1 whole Blood from ART centre if result is
l In asymptiomatic child, repeat HIV DNA PCR at 6
( At ART Centre) discordant and rely on the
months of age
final whole blood test result
Follow Advisory 3
Infant is
HIV- 1 DNA detected HIV-1 HIV- 1 DNA detected
infected HIV- 1 DNA detected HIV- 1 DNA not detected
Follow Advisory 2 Follow Advisory 1 Breastfed in the Not breastfed in

6 weeks before the 6 weeks
Advisory 1 Advisory 3 Confirm with repeat HIV-1 test before test
Advisory 2 DNA PCR test using
l Start l Infant is probably not infected, but is at Whole Blood specimen
l Continue risk Follow Advisory 3
cotrimoxazole
if not already cotrimoxazole.
l Repeat HIV-1 DNA PCR by DBS test at
started l Mange OI, if any 6 months, 6 weeks after last breast HIV-1 DNA detected HIV-1 DNA not detected Infant is
.ylno ycnangerp
.semmargorp noitirtuN
HIV-1

l Start Paed ART milk feeding or if the child develops
l Assess and symptoms of HIV infection uninfected

.seciv reS gninnalP ylimaF l
.rehtom rof sixalyhporp VRA mutraptsoP l
.sITS rof tnemtaert dna gnineercS l
.sIO rehto dna BT rof gnineercS l
nemoW tnangerP detcefnI VIH
encourage therapy as per

national protocol If Follow all steps
l Continue cotrimoxazole until definitely
breast feeding Infant is in owchart

if replacement breast feed, continue negative HIV-1
breast feeding for 2 from Guidance 1
feeding not l Discourage weaning too early - use infected Stop cotrimoxazole
started yrs. Avoid mixied Avoid putting baby
local guidelines and ensure AFASS
feeding to breast
criteria are met before weaning. 6
months is often a good time to discuss Continue Advisory 2
possibility of weaning
l Rapid antibody test not
Establish definitive recommended
In children (< 18 months) with signs and symptoms of HIV whose exposure status is unknown
diagnosis
perform rapid test for HIV antibodies. If negative, label child as uninfected, if positive follow algorithm l If baby is < 6 weeks- HIV-1
at 18 months, DNA PCR not recommended
A or B, depending on age of child. Attempt to determine the HIV infection status of the parents to

by HIV l 6 weeks and above is the
determine if the child is HIV-exposed; thereafter follow the algorithms to determine the infection status
3 antibody optimal age for a routine first
in the child.
.dlihc eht
.gnillesnuoc
noitirtun
fi doirep ,wodniw
gniredisnoc
,gnitset
.rentrap
reh dna nemow
ksir hgih rof )CCB(
noitacinummoc
.seciv res gninnalp
.gnillesnuoc
.gnillesnuoc
.ruoivaheb ksir
hgih evah eh/s ro
evitisop si esuops
tests (rapid) HIV-1 DNA/PCR test

For more information, contact NACO at labservices.naco@gmail.com
dna gnideef tnafnI l
VIH taepeR l
egnahc ruoivaheB l
.smodnoc eerF l
elpuoC l
xes efaS l
nemoW tnangerP
evitageN VIH

Rapid test negative - does not need HIV-1 DNA PCR
Establish definitive diagnosis at

A £months
l Stop cotrimoxazole
6 months
l Discontinue ART, if
l Avoid putting baby
18 months, by HIV antibody

Infant is HIV-1
Not breastfed in the
6 weeks before test
uninfected
Collect blood and test for HIV antibodies using rapid test. Also prepare a Dried Blood Spot (DBS) for HIV-1 DNA PCR (Level ICTC)
Annex 11: Testing Algorithm for HIV-1 Exposed Infants and Children <18 Months
B>6
to breast
started
Pregnant Women Antenatal Care (ensure at-least 4 visits)–Monthly ART/ARV
onwards. If negative repeat rapid test

l
l Infant is probably not infected, but is at risk
test
If rapid test positive, follow ow chart from
Safe sex
breast milk feeding or if the child develops

l
l Repeat rapid HIV test 6 weeks after last

counselling.
l Continue cotrimoxazole until definitely
antibodies. If negative, label child as uninfected, if positive follow algorithm A or B, depending on age of child. Attempt to determine
l Couple
6 weeks before test
the HIV infection status of the parents to determine if the child is HIV-exposed; thereafter follow the algorithms to determine the
Breastfeed in the
counselling.
pregnancy only.
Linkages to family
symptoms of HIV infection
In children (< 18 months) with signs and symptoms of HIV whose exposure status is unknown, perform rapid test for HIV
l

at 12 months
Child of 6-18 months age born to HIV positive mother
l l
negative
l
(BCC) for high risk
step
women and her
Guidance 1 - Lab will request for fresh whole blood sample
l
Send Dried Blood Spot (DBS) of child for HIV-1 DNA PCR

from ART centre if result is discordant and rely on the
considering
HIV- 1 DNA not detected

l
spouse is positive
more information contact NACO at labservies.naco@gmail.com


Rapid test positive

final whole blood test result

HIV- 1 DNA detected
specimen for HIV-1 DNA PCR
Collect and send whole Blood

Follow Advisory 1
HIV- 1 DNA detected

l start ARV therapy as per national protocol
Follow Advisory 1.

infection status in the child.

l Continue cotrimoxazole.
HIV- 1 DNA detected
l Assess and encourage
Start contrimoxazole
Refer to ART Centre

if not already started
infant is
infected
l Manage OI, if any

replacement feeding
HIV-1
breast feeding if

Advisory 2
l
not started
Advisory 1

l
the child.
Annex 12: ICTC- ART eCentre
mmargorP TCTPP fo stnenopmoC :2 erugiF
An
nnex 12:Referral
IC form
CTC- ART centr
re referral forrm
neAIDS
State AmoW tnaSoociety
Control ngerP lla ot secState
ivreAIDS
S gControl
nitseT dna gnillesnuoState
Society C VAIDS
IH fControl
o refSociety
SfO
Referral Form
m Referral Form
m Referral Form
m
Name & Addreess of Name & Addrress of Name & Addrress of

ICTC: ICTC: ICTC:
Copy-1 (too be retained att the ICTC) Copy-2 (to bee carried by the client to the Copy-3 (to be sent to ART centre
c through
VRA/TRA ylhtnoM–)stisiv 4 tsaeART l-tacentre
erusandane(retained
eraC latattART anecentre)
tnA l e-mail or posto
n e m t)W tnangerP
Part-1 to
t be filled by th he ICTC .sretPart-1
neC to tTRbeAfilled
ta sbyixthahelyICTC
hporp Part-1 to be filled by th
xes efaS l
he ICTC
Couunsellor/Staff Nurse
N Cou unsellor/Staff Nurse
N Counsellor/Staff .gNurse
Nnillesnuoc
elpuoC l
fo sName
htn&om 3uretsofriCounsellor
signatu f eht r/Staff
nihtinurse:
w ekatNameredn&usignatu
ot–ure
)PofTCounsello
M( ycnr/Staff angnurse:
erp Name & signatture of Counselloor/Staff nurse:
.gnillesnuoc
.ylno ycnangerp
PID No. Date of
o .sIO PID
rehNo.
to dna BT roDate f gnofo ineercS l PID No. .secivDate
resofgninnalp
referraal referraal referrral
Name of the cllient (optional): Name of the cllient (optional):: Name of the client (optional)::
dnAge:
a gninnalp-htribSex: ,y reviled efas ,gAge: nivil evitisop no gSex: nillesnuoC l Age: noitSex
acx:inummoc
ksir hgih rof )CCB(
Ph. No.: Ph. No.: Ph. No.: reh dna nemow
Category of the client (Tiick Mark): Category of the client (Tiick Mark): Categoryy of the client (T
Tick Mark):
ANC/G General/Exposedd infant
.nGeneral/Exposed
ANC/G
erdlihc gndivinfant il rehto ANC/G VIdHinfant
General/Exposed taepeR l
.retneC TRA ot larrefeR l , gnitset
Name and adddress of the ARTT centre Name and adddress of the ART T centre Name and adddress of the ART T centre
tnureferred
oc 4DtoC no desab nemiger citcalreferred yhportop VRA ro TRA edivorP l referred to g n i r e disnoc
evitisop si esuops
Counsellor's siignature: Counsellor's signature: Counsellor's ssignature:
Part-2 to be filled
f by the ICT .restaff
TC htoafter
m rof sPart-2
ixalyto
hpbeorfilled
fp VR byAthemAR uRTtracentre
ptsostaff
P l Part-2 to bbe filleddna bygnthe
idARTeef centre
tnafnI l
feedback from ARTcentre staff@
H the patient rreached ART.gce nentre:
illesYes/No
nuoc
.sHas
tisithe
v epatien
month reached
hguorh ART centre:
t trcoppuYes/No
s gnidHas
eefthe
tnpatient
afnI/ttreached
nemeART crofcnentre:ier FYes/No
BE lHas
emoh ,gnillesnuoc pu-wollof hgIfuYes
If Yes orht troppus laicos-ohcysP l If Yes
Pre ART Baseline ART Innitiated (Yes/No)

.spuorgBaseline
Pre ART
troppus dART
na stisiv
A Initiated Pre ART Baseline ART Initiated
Regn No. CD4 Regn No. CD4 (Yes/No) Regn No. CD4 (Yes/No)
Count Count Count

Ifro f rnot
ART aey 1 otpu shtnom 6 retfa sIfdART eenot
f tnemelpmoc ot noitidda nIfi ART sdenot eftsaerb deunitnoc dna
initiate initiated initiated
.TRA cirtaideaP eviecer ohw seireason
reason bab evitisop DIE rof sraey 2 otpreason u dna seibab evitagen DIE
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeName
ART Counsello r Name & Sign
nature ART Counsello
or per ;&egSign
a nature
fo skeew 6 tART a )D IE( siorsoName
Counsello ngai&dSign tnnature
afni ylraE l
f all patients detected ppositive at ICTC and sent tos
To be filled for. s d e e f t s a e r b f o n o i t a s eccentre/LAC
ART retfaplus.
.eCopy
@ ga3ftoobe
bssent
keeback
wto6them orf sICTC
refferring ixabylART
yhp orp eplus
ccentre/LAC lozthrou
axghoemail/post/patient
mirt-oC l
.dlihc eht
Annex 13: OM for Laboratory Investigations

T-11020/36/2005-NACO (ART)
Goverment of India
National AIDS Control Organisation
HIV Negative (Care, Support &Pregnant
HIV Infected Treatment Divison)
Women
l Safe sex prophylaxis at ART Centers. 6th Floor, Chanderlok Building
counselling. 36 Janpath, New Delhi- 110001
l Couple
pregnancy (MTP)–to undertake within theDate-January,first 3 months 2012
of
counselling.
pregnancy only.
l Linkages to family OFFICE MEMORANDUM
Subject:
l FreeRevised Technical Guidelines
condoms. l on Laboratory
Screening andMonitoring
treatment forforSTIs.
patients at ART centres/LAC/LAC plus
l
centres change
Behaviour l WHO clinical staging and CD4 testing.
communication
1. Essential/Mandatory Tests for all lPatientsCounselling on positive
Registering in HIVliving,
Care safe delivery,
at Art Centre/birth-planning
LAC Plus and
(BCC) for high risk
• women
Haemogram/CBC,
and her Urine for routine and microscopic examination, fasting blood sugar, blood
urea, ALT (SGPT), VDRL, CD4
partner. l Couple Gene-xpert
count, and safe sexincounselling
institutionsand HIV testing
where locatedof X-ray
spouseChest
and PA
l view. Pregnancy
Repeat HIV test if required.other living children.
• Symptoms and signs directed investigations for ruling out Ols.
window,Tests
2. Additional period
forifall Patients to be Started
and/or on ART
clinical staging.
spouse is positive
• orOther
s/he investigation
have high like USG labdomen, Nutritionsputum
counselling
for AFB, and linkagesetc.toasGovernment/other
CSF analysis per the physician’s
decision
risk Nutrition programmes.
depending on clinical presentation. Efforts to be made to fast track these investigations
behaviour.
l Infant feedinginitiation
so that ART and Postpartum ARV prophylaxis for mother.
is not delayed.
l

• Serum creatinine is essential when considering TDF.
• PAP smear, fundus examination l
also to be done
Psycho-social but through
support ART initiation not counselling,
follow-up to be delayed for these
home
tests.
3. Tests for Special Situation
• HBs Ag-for all patients if facility is available but mandatorily for those with history of IDU, multiple
HIVblood
Exposed Infant
& blood (HEI) transfusion, ALT > 2 times of ULN, on strong clinical suspicion. But
products
l ART not tobreastfeeds
Exclusive be withheld if HBsAg
upto 6 monthstesting is not available.
(preferred Option-I WHO/NACO Guidelines 2010-'11)
• and continued
Anti-HCV breastfeeds
antibody in addition
only for those to complement
with history feeds after
of IDU, multiple blood6&months upto 1 year
blood products for
transfusion,
EID
ALT>negative
2 timesbabies
of ULN,andonupto 2 years
strong for EID
clinical positive babies who receive Paediatric ART.
suspicion.
• For patients with Hepatitis B or C co-infection, further tests may be required to assess for chronic
active hepatitis.
•
l
For patients to prophylaxis
Co-trimoxazole be switchedfrom to a6Pl basedofregimen,
weeks age. Blood Sugar, LFT and Lipid profile to be done
at baseline.
the child.
4. Tests for Monitoring Purpose emmargorP TCTPP fo stnenopmoC :2 erugiF
• Essential - CD4,Hb, TLC, DLC, ALT(SGPT)/creatinine clearance (if on TDF), every 6 months or
earlierneifm oW tnan
required. gepatients
For rP lla otstarted
secivreon S AZT
gnitBased
seT dnregimen,
a gnillesHb
nuoatC15
VIH fo rethen
days, ffO every, month
for initial 3 months, 6 months and then every 6 months/as & when indicated. For patients started
on EFV based regimen, lipid profile should also done yearly. For patients started on ATV, LFT to be
done at 15 days, 1 month, 3 months, 6 months and then every 6 months. Blood sugar and Lipid
profile every 6 months for patients on Pl based regimen. All the above tests can be done earlier
based on clinicians assessment/discretion. xes efaS l
. g n i llesnuoc
fo• noiOther
tanimrinvestigations
et lacidem ro nduring
oitaunifollow-
tnoc fo up
secasiohper
c norequirement/availability.
gnillesnuoC l
elpuoC l
All fabove
o shtninvestigations
om 3 tsrif ehothert nihtthan
iw ekCD4
atredand
nu oviral
t–)Pload
TM( estimations
ycnangerp (when required), shall be done from
.gnillesnuoc
the health facility where the centre is located with.ysupport lno ycnanfrom
gerpState Health Department.
.gnitset 4DC dna gnigats lacinilc OHW l egnahc ruYours oivahefaithfully
B l
ksir hgih rof )CCB(
reh dna nemow
.retneC TRA ot larrefeR l (Dr. Mohammad ,gnitShaukat)
set
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l g n i r e d i sADG
n oc (CST)
evitisop si esuops
Copy to: .semmargorp noitirtuN .ruoivaheb ksir
1. Project Director, All State AIDS control Society
2. Nodal Officers of all ART centres
3. ADGem oh ,Services),
(Lab gnillesnuocNACO
pu-wollof hguorht troppus laicos-ohcysP l

.dlihc eht
Annex 14: List of ItemsFigure
that2: can
Components of PPTCT Programme
be Procured under Universal Work
Precautions
1) Disposable latex Gloves–2 Boxes (100 per Box)
2) Disposable Laboratory gowns–As per Number of positive deliveries in years.
3)
HIV Disposable
Negative Plastic aprons–24 Number
Pregnant
4) Women
Disposable Face Mask–2 Boxesl Antenatal
(100 per Care
Box) (ensure at-least 4 visits)–Monthly ART/ARV
5) counselling.
Disposable Caps–4 Boxes (25 per box)
6)
l
Couple
Shoe covers–2 Boxes (25 pairs pregnancy
per box) (MTP)–to undertake within the first 3 months of
counselling.
pregnancy only.
7)
l Linkages
Rubber boots–2
to familypairs
8) Hand rubs/disinfectant solution for hand wash-
Screening 6 bottles.for STIs.
and treatment
l Free condoms. l
l Behaviour
9) change Number l WHO clinical staging and CD4 testing.
Needle destroyer–1
10) (BCC)
Sharpfor
disposal containers–2 Numbers
high risk
11)women and her
1% Sodium hypochlorite–24lcans per year
Couple (5 litres
and safe canister of and
sex counselling 4–5%)
HIV testing of spouse and
partner.
12)
l HIV hypochlorite–1canother
10% Sodium
Repeat living(5
per year children.
litres canister of 40% solution)
testing, Referral to ART Center.
13) Spirit/70% alcohol–6 bottlesl(500 ml/bottle)
14)window,
Cotton-6period if (large 500 gm/pack)
Bundles and/or clinical staging.
spouse is positive
15)or Tissue paperhigh
s/he have rolls–24 Numbers
16)risk behaviour.
Cloth Aprons/Laboratory coats–4 Numbers
17)nutrition
Colour coded waste disposallbags–4
FamilyDozen
Planning Services.
18) Colour coded waste disposallbins–8 Numbers
19) Biohazard labels–2 Dozen
20) Bandaids –100 Numbers
21) Needles/Syringes–3 Boxes (100 per box)
22)
l
Rubber gloves
Exclusive for dirty
breastfeeds washing
upto 6 monthsand waste handling-8
(preferred Option-INumbers
WHO/NACO Guidelines 2010-'11)
23) and continued
Measuring breastfeeds
cylinder glass 1inlitre
addition to complement feeds after 6 months upto 1 year for
–2 Number
24) Covered discard jars/discard buckets with lid–4 Number
25)
l
Hepatitis
Early infantBdiagnosis
vaccination andatantibody
(EID) 6 weeks titres
of age; forrepeat
staff employed
testing at 6under NACO–4
months, vials of& 6 weeks
12 months
6 doses each
26)
l Co-trimoxazole
Any other itemprophylaxis from 6 weeks
with prior approval of NACOof age.
the child.
Annex 15: CF- Consentemform
for Patients Registering into HIV Care &
Starting ART
I, (name)………………........................................, (address)………………………….........................
CONSENT to share all information pertaining to my health and HIV/AIDS status with the service providers
who will be part of the management of my condition.
And
I AGREE to receive Antiretroviral Therapy .sretprovided
neC TRA underta sixalthe yhpNational
orp programme. xes efaS l
.gnillesnuoc
fo nounderstand
I fully itanimret lathe
cideinformation
m ro noitaunthat itnochas fo sbeen
eciohprovided
c no gnilleby snu oChealth
the l
care staff in the following: elpuoC l
.gnillesnuoc
• That the ART is not an emergency and thus .ylnowill
ycnbe angstarted
erp as per theyldecision
imaf ot sofegthe aknidoctor.
L l I
. s I O r e h t o d n a B T r o f
shall attend the ART centre as per appointment for timely initiation of ARTg n i n e e r c S l
.seandciv rregular
es gninnfollow-
alp up.
• That receiving ART involves shared confidentiality with other service providers such as CBO/
NGO/CCC/positive network who may support my treatment and other welfare measures through
dnaoutreach
gninnalp-and
htribhome-based
,y reviled efascare ,gniactivities
vil evitisopatnhome.o gnillesnuoC l noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
• dnaThat
esuoART
ps forequires
gnitset V100%
IH dnaadherence
gnillesnuoctoxedrugs s efas and
dna Ielshall
puoCabide by the same.
l
.rentrap
• That I understand the side effects of ART. .nerdlihc gnivil rehto VIH taepeR l
• That I shall not stop the drugs on my own and will return to the centre if there is g nany
i r e diproblem.
snoc In
case I stop the drugs on my own accord/do .gnigats lnot acinadhere fi doinot
ilc ro/dntoa the regimen, I shall rep hold
,wodthe niw health
care staff of the ART Centre responsible for any complication arising out of the same. ops e v i t i s o p s i e s u
• In case, I am on ART from outside.son emamdifferent
argorp noregimen,
itirtuN I agree to receive .ruothe ivahdrugs/regimen
eb ksir
.r e h t o m r
provided under the national programme.o f s i x a l y h p o r p V R A m u t r a p t s oP l dna gnideef tnafnI l
• In case, I want to take ART from other centre or to go other city for livelihood .or gnillesnureasons,
other oc I
will inform my ART Centre and get a “transfer out” letter before leaving.
.......................................
Signature of patient with date )IEH( tnafnI desopxE VIH

......................................
Signature .TRofA witness
cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIE
(Doctor/nurse/counsellor) .skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP l
(This should be translated in local language &/or explained to patient.sbefore deeftsataking
erb fo npatients
oitassec rsignature)
etfa
.dlihc eht
Annex 16: Transfer outFigure
form2: Components
(Form for of PPTCT Programme
Transfer of PLHIV to Other ART
Centre)
Name and address of the transferring ART Centre ___________________________________________
Name and address of ART Centre where patient is being transferred ____________________________
NameHIVofNegative HIV Infected Pregnant Women

Patient: ________________________________________________________________________
HIV lCare
Safe(Pre-ART)
sex Registration No. _________________________________________________________
Addresscounselling.
and contact details: _____________________________________________________________
_ l Couple pregnancy (MTP)–to undertake within the first 3 months of
counselling.
pregnancy only.
Reason
l Linkages
for transferto family
(Specify) 1. Patient Choice 2. Provision of second line ART/ Alt First line
Datel of transfer:_____________________
Free condoms. l Screening and treatment for STIs.
ART regimen (pls. specify): _________________________________
Date of(BCC)
startingfor ART:___________/______________/
high risk (Date/Month/Year); Latest CD4________________
women and her
Next date Couple and safe sex counselling and HIV testing of spouse and
for dispensing drug is ___________/______________/
partner. l

Please testing,
find the following original documents handed over to the patient:
considering
1. Patient Treatment Record (White Card) l Provide ART or ARV prophylactic regimen based on CD4 count
spouse
2. Patient is positive
Booklet (Green Booklet)
3. Others, any (Mention)
risk ifbehaviour. Nutrition programmes.
Name and Signature of SMO/MO Phone no. and e-mail of SMO/MO:
counselling.
(To be filled by the receiving ART Centrel EBF
andreinforcement/Infant feeding
sent to the transferring ARTsupport
Centre through home visits.
by post/email)
(Name of Patient), referred by you on date ____________/_____/__________has reported and been
registered with us on_____________/______/_____________along with the documents sent by you. Her/
His HIV Care (Pre- ART) registration no. is ___________________ and ART registration no. (if applicable)
is _____________________________
Namel Exclusive
and breastfeeds
Signature of SMO/MO upto 6 months
Phone no (preferred
with e-mailOption-I WHO/NACO Guidelines 2010-'11)
of SMO/MO
Address of the
EID ART Centre,
negative babies and transferring
upto 2 yearsout the for patient: _____________________________________
EID positive babies who receive Paediatric ART.
the child.
Annex 17: OM Regarding Provision of ART/ ARV Prophylactic Drugs at
ART Centre to HIV Infected Pregnant Women
Government of India
Ministry of Health and Family Welfare
Department
nemoW tof naAIDS
ngerPControl
detcefnNational
I VIH evitageN VIH
AIDS Control Organization
(Care,.sreSupport
tneC TR&A Treatment
ta sixalyhpoDivison)
rp xes efaS l
.gnillesnuoc
6th Floor, Chanderlok elpuoBuilding
C l
.gnillesnuoc
.ylno ycnangerp 36 Janpath, New Delhi-110001
.sIO rehto dna BT rof gnineercS l Date
.sec- i28th
v res gAugust,
ninnalp 2012
OFFICE MEMORANDUM
dna gninnalp-htribSubject:
,y reviled eART/ARV
fas ,gnivProyhylaxis
il evitisop nofor
gnipregnant
llesnuoC positive
l
women noitacinummoc
ksir hgih rof )CCB(
It has been decided that ART/ARV prophylaxis .snoitpfor
o gnpregnant
ideef tnafpositive
ni women will rehbedninitiated
a nemowonly at
dna ecentres.
the ART suops foAfter
gnitse6t Vmonths
IH dna gof nillpregnancy,
esnuoc xes einfascasedna ethe
lpuopregnant
C l woman is not able .rentotracome p to
ART centre, the ARV drugs may be given to.nan erdauthorized
lihc gnivil remember
hto of her family. This VIHdrug taepsupply
eR l to
authorized member can continue till 2 months .retneafter
C TRAdelivery.
ot larrefeAfter
R l that drugs will be dispensed , g n i t s et to the
women
tnuoconly
4DConnoher
desattending
ab nemigethe r ci“ART
tcalyhcentre”.
porp VRA ro TRA edivorP l g n i r e d i s n o c
evitisop si esuops
.seciv reS gninnalP ylimaF l (Dr. Mohammed noitirtShaukat)
un
.stisiv emoh hguorht troppus gnideef tnafnI/tnemecrofnier FBE l .gnillesnuoc (CST)
ADG
Ph: 011- 23731805
To, .spuorg troppus dna stisiv
1. Project Director, State AIDS Control Society, Andhra Pradesh & Karnataka
2. Regional Coordinator (CST), Andhra Pradesh & Karnataka
3. )1Programme
1'-0102 senDirector,
ilediuG OCoE,
CAN/Gandhi
OHW I-Hospital,
noitpO deSecunderabad
rreferp( shtnom &6Bowring otpu sdeHospital,
eftsaerb eBangalore
visulcxE l
4. roNodal
f raey Officer,
1 otpu All
shtART
nomCentres
6 retfa in
sdAndhra
eef tnemPradesh
elpmoc &otKarnataka
noitidda n(To i sdebeeftcoordinated
saerb deunitby nocSACS)
dna
Copy to,
1. DDG (BSD), NACO
2. NPD (ICTC), NACO .sdeeftsaerb fo noitassec retfa
.dlihc eht
Annex 18: List of Reference Doctors for Advice on PPTCT Services
Including Care of HIV Exposed Child
S. No. Name of Centre Contact Person E-mail Mobile Other Contact No.

counselling.
l Couple
counselling.
pregnancy only.
(BCC) for high risk
women and her
spouse is positive

the child.
Annex 19: National Coordination Committee for PPTCT-NRHM
Integration Activities

.gnillesnuoc
elpuoC l
.gnillesnuoc
.ylno ycnangerp
ksir hgih rof )CCB(
reh dna nemow
evitisop si esuops

.dlihc eht

counselling.
l Couple
counselling.
pregnancy only.
(BCC) for high risk
women and her
spouse is positive

the child.
Annex 20: OM from DDG(BSD) for Roll-out of PPTCT Multi-Drug
Regimen in India from 1st January 2014

.gnillesnuoc
elpuoC l
.gnillesnuoc
.ylno ycnangerp
ksir hgih rof )CCB(
reh dna nemow
evitisop si esuops

.dlihc eht
Back Inner
State / UT wise Number of HIV Counseling and Tes ng Centers (ICTCs) In India (December, 2013)
SA –ICTC / F- ICTC/ PPP-ICTC

15539
State / UT wise Number of HIV / AIDS Treatment Centers In India (December, 2013)
ART/ LAC
1278
The HIV Counseling & Tes ng and Treatment Facli es are being rapidly further scaled up during NACP- IV (2012-17)

December, 2013
Government of India
New Delhi - 110001

National Guidelines For PPTCT 0 PDF

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National Guidelines For PPTCT 0 PDF

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Updated Guidelines for

Prevention of Parent to Child

Prevention of Parent to Child

1. Dr Geetanjali Kumari, (ex) National Programme Officer/ PPTCT, DAC

1. Dr Suresh Mohammed, (ex) National Programme Officer/ ICTC, DAC

Annex 2 : Dosing Schedules ART for Pregnant Women 111

Annex 3 : ART for Pregnant Women nemoWPresenting

.gnitset 4DC dna gnigats lacinilc OHW l egnahc ruoivaheB l

.seciv reS gninnalP ylimaF l noitirtun

OM Regarding Provision of ART/ARV Prophylactic Drugs at ART Centre to

ANC Antenatal Care IUCD Intra-uterine contraceptive device

.spuorg troppus dna stisiv

)IEH( tnafnI desopxE VIH

The Essential Package of PPTCT Services includes:

results. Preferred regimen is TDF+3TC+Screening EFV.

nemoW tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO

l Free condoms. l Screening and treatment for STIs.

nemoW tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO

ANC Registration by Sub center ANM/MPHW (F)

Level of Care nemoW tnanModalities

• HIV testing of presumptive TB cases

• Intensified TB case finding (ICF) at ICTC

• Three Rapid test for Screening of Ante-natal cases Screening of Ante-natal

Labour & Delivery

Mother: Continue ART during Labour, )IEH( tnafnI desopxE VIH

.seciv reS gninnalP ylimaF l noitirtun

Level of Health Infrastructure .spuorg trHIV

TheHIV Negativeof care involves the HIV

nemoW tnangerP detcefnI VIH evitageN VIH

.spuorg troppus dna stisiv

)IEH( tnafnI desopxE VIH

infant feeding options.

• WHO clinical staging. nemoW tnangerP detcefnI VIH evitageN VIH

testing, l Referral to ART Center.

HIV Exposed Infant (HEI)

This treatment serves two key purposes:

.gnitset 4DC dna gfor

HIV – EXPOSED INFANTS

withhold ART while waiting for results)

)IEH( tnafnI desopxE VIH

Key points to be noted in pregnant women nemoW in tmonitoring

the pregnancy and her potential weight k s i r hgih rof )CCB(

.sdeeftsaerb fo noitassec retfa

Assessment Baseline 2 Weeks 4 Weeks 8 Weeks 12 Weeks Every 6 Comment

Table 6: Dosage Schedule and Common Side-Effects with ART Drugs

Name of ARV Dose Major side-effects

.spuorg troppus dna stisiv

)IEH( tnafnI desopxE VIH

nemoW tnangerP detcefnI VIH evitageN VIH

HIV-screening Test should .sretneCbe:

.retneC TRA ot larrefeR l , g n i t s e t

rof raey 1 otpu Assessment

.sdeeftsaerb fo noitassec retfa

.gnirotinom noitirtun dna htworG l

Offer of HIV Counselling and Testing Services to all Pregnant Women

.spuorg troppus dna stisiv

)IEH( tnafnI desopxE VIH

l Free condoms. l Screening and treatment for STIs.

l Repeat HIV other living children.

• Those women on ART require careful clinical and laboratory monitoring.

.spuorg troppus dna stisiv

)IEH( tnafnI desopxE VIH

reported complication being post-partum.sfever. puorg troppus dna stisiv