Care for HIV Positive Women (eMTCT)

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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.

Key Interventions for eMTCT

  • Routine HIV Counseling and Testing during ANC
  • ART in pregnancy, labour and post-partum, and for life – Option B+

ManagementTreatment

Recommended ARV for option B+

  • One Fixed Dose Combination (FDC) pill daily, containing TDF + 3TC + EFV started early in pregnancy irrespective of the CD4 cell count, and continued during labour and delivery, and for life

Alternative regimens for women who may not tolerate the recommended option are:

  • If TDF contraindicated: AZT+3TC+EFV
  • If EFV contraindicated: TDF + 3TC + LPV/r

Prophylaxis for opportunistic infections

  • Cotrimoxazole 960 mg 1 tablet daily during pregnancy and postpartum
    • Mothers on cotrimoxazole DO NOT NEED IPTp with SP for malaria

During labour: safe obstetric practices

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

Baby (refer to specific HIV/AIDS guidelines)

 

Notes

  • TDF and EFV are safe to use in pregnancy
  • Those newly diagnosed during labour will 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 function investigations before starting TDF
  • TDF is contraindicated in advanced chronic renal disease