PMTCT

Prevention of Mother-to-Child Transmission

I’m ending AIDS by preventing mother-to-child transmission of HIV

PMTCT stands for, Prevention of Mother-to-Child Transmission. PMTCT programmes offer a range of services for women of reproductive age, living with or at risk of HIV, to maintain their health and stop their infants from acquiring HIV.

HIV can be transmitted from an HIV-positive woman to her child during pregnancy, childbirth and breastfeeding. Mother-to-child transmission (MTCT), or ‘vertical transmission’ as it is also known, accounts for the vast majority of infections in children between the ages of 0-14 years.

Without treatment, if a pregnant woman is living with HIV, the likelihood of the virus passing from mother-to-child is 15% – 45%. However, Antiretroviral Treatment (ART) and other interventions can reduce this risk to below 5%.

Guidelines for pregnant women living with HIV

It is stated that all pregnant women living with HIV should be provided with ART, regardless of their CD4 count – this is a blood test that measures how many CD4 cells you have in your blood.

WHO guidelines on infant feeding for mothers living with HIV

The World Health Organisation (WHO) bases its recommendations on infant feeding for mothers living with HIV on the comparative risk of infants acquiring HIV through breastfeeding, with the increased risk of infants dying from illnesses such as malnutrition, diarrhoea and pneumonia, which increases if they are not breastfed.

  • Mothers living with HIV on ART should exclusively breastfeed their infants for the first six months of life.
  • Then introduce appropriate complementary foods while continuing to breastfeed for at least 12 months and up to 24 months or longer (similar to the general population).
  • When ARV drugs are not immediately available, the WHO still recommends mothers exclusively breastfeed for the first six months of an infant’s life and continue, unless environmental and social circumstances are safe for, and supportive of, replacement feeding. Based on consideration of:
    • the socioeconomic and cultural contexts of the population groups served by maternal and child health services.
    • the availability and quality of health services.
    • the local epidemiology (which diseases are common and who they affect), including HIV prevalence amongst pregnant women.
    • the main causes of under-nutrition among mothers and children, and infant and child mortality.

When ARV drugs are unlikely to be available, such as in acute emergencies, mothers living with HIV are still recommended to breastfeed their infants to increase their chances of survival.

WHO guidelines for HIV-exposed infants

  • Infants born to mothers living with HIV are tested between four and six weeks old, known as ‘early infant diagnosis’.
  • HIV test will be carried out again at 18 months and/or when breastfeeding ends to provide the final infant diagnosis. This is important because proportionally more infant infections occur during breastfeeding.
  • All infants who test positive for HIV should be immediately started on ART.
  • The treatment should be linked to the mother’s course of ARV drugs and would vary according to the infant feeding method as follows:
    • Breastfeeding: the infant should receive once-daily Nevirapine from birth for six weeks.

Replacement feeding: the infant should receive once-daily Nevirapine (or twice-daily Zidovudine) from birth for four to six weeks.