Comprehensive Prevention of Mother to

Child HIV Transmission

Presenter: Dr. Kayondo Musa

Lecturer of Obstetrics & Gynecology
MUST/MRRH
Objectives
By the end of this topic, you should be able to:
• Describe the components of PMTCT
• State the HIV vertical transmission statistics for
Uganda
• Outline the packages given to the mother during
pregnancy, labor/ delivery and postpartum
• Describe the care given to HIV exposed infants
with emphasis on testing algorithm,
breastfeeding and ARV prophylaxis
Guidelines
• Information adapted from the Uganda Ministry
of Health Consolidated guidelines for prevention
and treatment of HIV in Uganda 2018

• Currently referred to as elimination of mother-

to-child HIV transmission (eMTCT)

• Between 2010 to 2016: Attained 86% reduction

of new infections among children
Vertical transmission
• Is transmission from mother to child

• Vertical transmission accounts for vast majority

of infections

• Without PMTCT risk is 15 to 45 %

• These interventions reduce risk to below 5%

Components of the comprehensive
approach to PMTCT
1. Preventing new HIV infections among women
of reproductive age

2. preventing HIV transmission from HIV

positive mother to her baby

3. Providing HIV care ( treatment and support) to

HIV+ mothers, their children and families
Preventing new HIV infections
among women of reproductive age
• Routine HIV testing
• Safer sex practices (use of condoms)
• Use of Pre Exposure Prophylaxis (PrEP)
• Safe male circumcision (for male partners)
• Screening and treatment of Sexually transmitted
infections
Preventing HIV transmission from
HIV positive mother to her baby
1. During pregnancy (Antepartum/ Antenatal)

2. During labor (Intrapartum)

3. Postpartum/ Postnatal
Antenatal/ Antepartum care
• Routine screening for HIV and Syphilis
including the partners
• Link all HIV positive women to ART clinics
• Offer PrEP for discordant couples
• Re-test HIV negative women in a discordant
relationship test every 3 months
• Provide risk reduction counseling to HIV
negative women
HIV positive pregnant women
• Start ART immediately if not on ART or is
newly diagnosed
• Do a baseline CD4 count
• For those already on ART do viral load (VL)
testing at first ANC then every 6 months
throughout pregnancy and breastfeeding
period (till baby is 18 months)
HIV positive pregnant women
• Provide cotrimoxazole preventive therapy (CPT)
• Don’t provide fansidar for malaria prophylaxis
once already on CPT
• ART adherence counseling
• Screening and treatment for other STIs
especially syphilis
• Other Routine Antenatal Care packages and
Visits should be provided
Intrapartum Care
• Labor and delivery; highest risk period of
transmission to baby

• This is the time for mixing of body fluids of

mother and baby

• Birth related injuries occur during labor

increasing risk of infection.
 Don’ts of intrapartum care in
PMTCT
• Avoid prolonged labor- use a partograph, may
need to augment labor with oxytocin

• Avoid: frequent vaginal examinations, artificial

rupture of membranes, instrument delivery,
routine episiotomy and milking of the cord
Postpartum care
• Testing the infant for HIV using Polymerase
Chain Reaction (PCR)

• Feeding options with emphasis on breastfeeding

• ARV prophylaxis for the exposed infant

• ART to the mother

Handling the HIV exposed infant
(HEI)
Key points from the algorithm
• Breastfeeding still recommended for at least 1
year
• 3 PCR tests for those breastfeeding: 1st at 6
weeks, 2nd at 9 months and 3rd at 6 weeks after
breastfeeding
• CPT should be started at 6 weeks and stopped
when final HIV negative status is made at 18
months
• Those HIV positive ART and CPT for life.
ARV prophylaxis
• Initiate Nevirapine (NVP) prophylaxis to baby
immediately after delivery; low risk – 6 weeks,
High risk- 12 weeks
• High-risk infants are breastfeeding infants whose
mothers:
 Have received ART for four weeks or less before delivery.

 Tested HIV positive for the first time during 3rd trimester, labor
or postpartum
Nevirapine syrup
ARV prophylaxis
• PCR at 6 weeks
• If positive start ART - AZT/3TC/NVP then
change to ABC/3TC/LPVr pellets at 3 months
• Continued NVP in breastfeeding for mothers not
on ART/ not adhering/not virally suppressed
while breastfeeding
• Mother continues with ART
• CPT from 6 weeks to 18 months
ART for eMTCT
• TDF/3TC/EFV - Recommended
• TDF/3TC/ATVr- alternative 1
• TDF/3TC/DTG- alternative 2
20

Dosing schedule for infant NVP

prophylaxis

Infant Age and Weight NVP Daily Dose

(10 mg/ml formulation)

Birth to 6 Birth weight 1 ml once daily

weeks 2.0 to 2.5 kg
Birth weight > 2.5 1.5 ml once daily
kg
>6 weeks to 3 months (12 2 ml once daily
weeks)