Elimination of Mother-to-Child Transmission of HIV (EMTCT)

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The four prongs of EMTCT:

  • Prong 1 – Primary prevention of HIV among women of childbearing age
  • Prong 2 – Prevention of unintended pregnancies among women living with HIV
  • Prong 3 – Prevention of HIV from mother to her infant
  • Prong 4 – Provision of appropriate treatment, care and support to women and children living with HIV and their families.

Prevention of Mother-to-Child Transmission

  • There are better clinical and laboratory outcomes if HIV treatment is initiated early.
  • Initiate cART immediately among all pregnant or breastfeeding women who test positive within Maternal Newborn Child Health (MNCH) services.
  • Treatment preparation and adherence counselling should be accelerated so that it is completed on the same day where feasible.
  • Initiation may be done by ART trained nurses/midwives within MNCH.
  • Where there is no capacity within MNCH to initiate cART the pregnant woman should be fast-tracked through the ART clinic.
  • Start Cotrimoxazole among all HIV infected pregnant women regardless of gestational age, CD4 count or WHO clinical staging.
  • Viral load should be performed within 4 weeks before labour and delivery to estimate the risk of transmission for all pregnant women on cART.
  • At 6 weeks postnatal, check CD4 count and if >350cells/ul on two results, Cotrimoxazole may be discontinued.

Combination antiretroviral therapy (cART) for eMTCT

First-line cART

  • For ARV naïve or sure of tail coverage 1st line cART is TDF + XTC + DTG - alternative regimen is TDF + XTC + or EFV400 or TDF + XTC + ATV-r (or LPV-r) or ABC +3TC +ATV-r (or LPV-r) or ABC + 3TC + DTG
  • For previous single dose Nevirapine (sdNVP) exposure; or Nevirapine (NVP) monotherapy exposure, or unsure of tail coverage 1st line cART is TDF + XTC + DTG
  • Alternative regimen is TDF + XTC + ATV-r (or LPV-r) or ABC + 3TC + ATV-r (or LPV-r).

Second- line cART

  • DTG and NNRTI –based first-line regimens can be substituted by AZT +3TC + LPV-r (or ATV-r)

Refer to tables under Elimination of Mother to Child transmission of HIV (in HIV section)