Care for HIV Positive Women (eMTCT)

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ICD10 CODE: 098.719

All HIV services for pregnant mothers are offered in the MCH clinic. After delivery, mother and baby will remain in the MCH postnatal clinic until HIV status of the child is confirmed, then they will be transferred to the general ART clinic.

All pregnant mothers and partners should receive routine counselling and testing for HIV.

If mother tests negative:

  • Counsel on HIV prevention
  • Repeat test in third trimester/during labour and delivery

If mother tests positive or is already known positive but not yet on ART

  • Enroll on HIV care (eMTCT).

If mother is already positive and already on ART:

  • Continue on their existing regimen; may not be switched to Option B+ regimens
  • Perform viral load at first contact
  • For more information on HIV, including clinical diagnosis, management, and psychosocial support, refer to specific HIV/AIDS guidelines

Care for HIV Positive Women (eMTCT)

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

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

During labour: safe obstetric practices

  • Avoid episiotomy
  • Avoid artificial rupture of membranes
  • Avoid instrumental delivery (vacuum)
  • Avoid frequent vaginal examination
  • Do not milk umbilical cord before cutting
  • Actively manage third stage of labour
 HC3

Baby (see section 3.1.9.3)

  • Give infants daily Nevirapine (NVP) for for 6 weeks (12 weeks for high risk infants)
  • Give Cotrimoxazole beginning at 6 weeks, continue until final HIV status is confirmed negative
  • Offer DNA PCR test at 6 weeks, and again 6 weeks after cessation of breastfeeding
  

Notes

  • TDF and EFV are now considered safe in pregnancy
  • Those newly diagnosed during labour will receive sdNVP tablet and begin HAART for life after delivery

Caution

  • In case of low body weight, high creatinine, diabetes, hypertension, chronic renal disease, and concomitant nephrotoxic medications: perform renal investigation before giving TDF
  • TDF is contraindicated in advanced chronic renal disease

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

Counselling for HIV Positive Mothers

  • Give psychosocial support
  • Encourage mothers to enroll in Family Support Groups (FSG) for peer support
  • Advise on the importance of good nutrition
    • Talk to family members to encourage the woman to eat enough and help her avoid hard physical work
    • Micronutrient supplementation during pregnancy and
    • breastfeeding; iron + folic acid and multivitamins
  • Advise her that she is more liable to infections, and to seek medical help as soon as possible
  • Review the birth plan
    • Advise her to continue attending ANC
    • Advise her to deliver in a health facility where appropriate care can be provided for her and the baby
    • Advise her to go to the health facility as soon as labour starts or membranes rupture
During postpartum period
  • Advise on the infectiousness of lochia and blood-stained sanitary pads, and how to dispose them off safely according to local facilities
  • If not breastfeeding exclusively, advise her to use a family planning method immediately to prevent unwanted pregnancy
  • Linkage of mother-baby pair and her family, for on-going care beyond puerperium

Breast care: If not breastfeeding, advise that:

  • The breasts may be uncomfortable for a while
  • She should avoid expressing the breast to remove milk (the more you remove the more it forms)
  • She should support her breasts with a firm, well-fitting bra or cloth, and give her paracetamol for painful breasts
  • Advise her to seek care if breasts become painful, swollen, red; if she feels ill; or has fever
Counselling on infant feeding choice
  • Begin infant feeding counselling before birth when the pregnant mother has been identified to be HIV positive.
  • The decision on how she will feed the baby should be made before delivery. The mother should then be supported to implement the feeding option she has chosen
  • All mothers are encouraged to breastfeed their babies exclusively for 6 months and then introduce complementary feeding until 1 year
  • The mother has to continue her ARVs all through breast-feeding
  • The child should continue cotrimoxazole prophylaxis, until status confirmed negative with a PCR at 6 weeks after stopping breastfeeding
  • If a mother chooses to feed the newborn on replacement feeding from the beginning, the choice of replacement feeds should fulfil the AFASS Criteria (Affordable, Feasible, Available, Sustainable and Safe).