National Guidelines For PPTCT PDF

Updated Guidelines for
Prevention of Parent to Child

Transmission (PPTCT) of HIV using
Multi Drug Anti-retroviral Regimen in India
December, 2013
Government of India
Ministry of Health & Family Welfare
Department of AIDS Control

Basic Services Division
Chandralok Building, Janpath
New Delhi - 110001

December, 2013
Government of India

New Delhi - 110001
Acknowledgement
We acknowledge the valuable contributions made by technical experts from the Department of AIDS Control/ GoI,
WHO, UNICEF, Clinton Health Access Initiative and CDC India.
Writing Group:
1.
2.
3.
4.
5.
6.
Dr
Dr
Dr
Dr
Dr
Dr
Geetanjali Kumari, (ex) National Programme Officer/ PPTCT, DAC

Avinash Kanchar, (ex) Programme Officer/ HIV-TB, DAC
Raghuram Rao, National Programme Officer/ ICTC, DAC
B B Rewari, WHO National Consultant & NPO/ ART, DAC
M. Naina Rani, National Consultant/ PPTCT, WHO, India
Srilatha Sivalenka, Scientific Affairs Specialist, CDC, India
Guidance Group:
1. Dr Suresh Mohammed, (ex) National Programme Officer/ ICTC, DAC
2. Dr Po-Lin Chan, (ex) Medical Officer, WHO/ SEARO
3. Dr Vimlesh Purohit, (ex) National Consultant/ PPTCT, WHO, India
4. Dr Ivonne Cameroni, (ex) Country Director, UNICEF, India
5. Ms Ameeta Chebbi, (ex) Country Director, CHAI, New Delhi
6. Dr Pauline Harvey, Director, CDC DGHA, India
7. Dr K Sudhakar, National Advisor, CDC, India
8. Dr Malalay Ahmadzai, Health Specialist, UNICEF, India
9. Dr Sudha Balakrishnan, Health Specialist, UNICEF, India
10. Dr Sandhya Kabra, (ex) Asstt. DG/ Lab Services, DAC
11. Dr Laxman Bharathi, Programme Officer/ ART, DAC
12. Dr Padmini Srikantiah, Consultant, CDC, India
13. Dr Subhashree Raghavan, Executive Director, SAATHII, India
14. Dr Reshu Agarwal, Programme Officer/ CST, DAC
15. Dr Debashish Dutta, (ex) Maternal & Child Health Specialist, UNICEF, India
16. Dr Amaya Maw Naing, Regional Advisor, HIV/AIDS, WHO/ SEARO
17. Dr Razia Pendse Narayanan, WHO/ SEARO
18. Dr Melita Vaz, (ex) Programme Officer/ Counseling, DAC
We also sincerely acknowledge the technical support extended by Members of the Technical Resource Groups
(TRGs) of PPTCT, ART, Paediatric & Laboratory Services; Project Directors & BSD Officers at all SACS, Regional
Coordinators/ CST, DAC, PPTCT Consultants and all others concerned with PPTCT.
Mentors:
1.
2.
3.
4.
5.
6.
7.
8.
Dr
Dr
Dr
Dr
Dr
Dr
Dr
Dr
Ashok Kumar, Dy. DG/ BSD, DAC

R S Gupta, (ex) Dy. DG/ BSD, DAC
Mohd Shaukat, (ex) Dy. DG/ CST, DAC
R S Rathore, Dy. DG/ CST, DAC
S Venkatesh, Dy. DG/ M&E, DAC
S Khaparde, Dy. DG/ STI, DAC
Neeraj Dhingra, Dy. DG/ TI, DAC
Naresh Goel, Dy. DG/ Lab Services, DAC
The assistance provided in preparing this document by Mr Stefen Tonsing (Technical Officer/ PPTCT, DAC),
Mr Rohit Mehta (M & E Officer, DAC), Ms Divya Taneja (Technical Officer/ Training, DAC), Mr Reneej K B (Technical
Officer/ ICTC, DAC), Ms Manali Jain (Office Assistant/ BSD, DAC) and Mr Vikas Gaur (Office Assistant/ BSD, DAC),
is appreciated
The technical support provided by WHO India Office in developing this document, as well as to UNAIDS India and
CDC India for facilitating its printing are acknowledged with thanks.
Contents
Chapter 1
Introduction
11
Chapter 2
PPTCT Policy, Essential Package and Guiding Principles
14
2.1
The Overall Goals of the PPTCT Programme
15
2.2
The Essential Package of Services under the PPTCT Programme
16
2.3
General Principles
18
2.3.1
Sexually Transmitted Infections and Reproductive Tract Infections
20
2.3.2
HIVTB Collaborative Activities
22
Guiding Principles for Use of ARV Drugs (ART) in PPTCT
24
PPTCT Services Under NACP
26
3.1
Existing Facilities
27
3.2.
Continuum of Care under PPTCT
28
Care and Assessment of HIV Infected Pregnant Women
30
4.1
Care during the Antenatal Period
31
4.2
Initial Assessment
32
4.3
Criteria for ART Initiation
34
4.4
Indications for Co-trimozaxole Prophylactic Therapy (CPT) in Pregnancy
34
HIV Infected Pregnant Women Requiring ART for her own Health
35
5.1
HIV Infected Pregnant Women being Newly Initiated on ART
36
5.2
Principles of Management
36
5.2.1
For HIV-infected Pregnant Women who Require ART for their Own Health
36
5.2.2
Choice of ART Regimen for HIV-infected Pregnant Women
36
5.2.2
Safety of Efavirenz (EFV) in Pregnant Women
38
ART Regimen for Pregnant Women having Prior Exposure to

NNRTI for PPTCT
38
2.4
Chapter 3
Chapter 4
Chapter 5
5.3
5.4
5.5
5.6
Chapter 6
Figure 2: Components of PPTCT Programme
Pregnant Women Already Receiving ART
38
Clinical and Laboratory Monitoring of Pregnant Women Receiving ART
39
Offer
HIV Counselling
Testing
Services
to allLifelong
Pregnant
ARV of
Prophylaxis
for Infantsand
Born
to Mothers
Receiving
ARTWomen
Interventions for Women Diagnosed with HIV Infection in
Labour and Postpartum
41
40
6.1
ART for Women Presenting in Active Labour
43
HIV Negative
HIV Infected Pregnant Women
6.2
ARV Prophylaxis for Infants Born to Women Presenting in Active Labour
44
Pregnant
Women
l
Antenatal Care (ensure at-least 4 visits)Monthly ART/ARV
Born toat
Women
who did not Receive any ART
44
l 6.3
Safe sex ARV Prophylaxis for Infants
prophylaxis
ART Centers.
counselling.
Chapter 7 Special Considerations
l
Counselling on choices of continuation or medical termination46
of
l
Couple
7.1
Pregnant Women with Active
TB (MTP)to undertake within the first 3 months47
pregnancy
of
counselling.
pregnancy only.
7.2
47
l
Linkages Pregnant
to familyWomen with HIV-2 Infection
l
Screening
for
TB
and
other
OIs.
7.3
48
planning Pregnant
services. Women with Hepatitis B or Hepatitis C Virus Co-infection
l
Screening
and
treatment
for
STIs.
l
Free
condoms.
Chapter 8 Labour and Delivery in the HIV Infected Pregnant Women
50
l
Behaviour change
l
WHO clinical staging and CD4 testing.
8.1
Intra Partum Management
51
communication
l
Counselling on positive living, safe delivery, birth-planning and
8.2
Anti Retroviral Treatment (ART)
51
(BCC) forIntra
highPartum
risk
infant feeding options.
women and
her Circumstances: Caesarean Section
8.3
Special
51
l
Couple and safe sex counselling and HIV testing of spouse and
partner.
8.4
False Labour
51
other living children.
l
Repeat HIV
8.5
Safer Delivery Techniques
52
testing,
l
Referral to ART Center.
Chapter
9 Care During the Postnatal Period
53
considering
l
Provide ART or ARV prophylactic regimen based on CD4 count
window,
period
if
9.1
The Postpartum Period and/or clinical staging.
54
spouse
is
positive
9.2
Screening for Postpartum
Depression
56
l
Nutrition
counselling and linkages to Government/other
or s/he have high
Nutrition
programmes.
9.3
Counsel and Follow-up of
Mother-baby
(m-b) Pairs after Discharge
57
risk behaviour.
l
Postpartum ARV prophylaxis for mother.
Chapter
10feeding
Infantand
Feeding Practice
59
l
Infant
l
Family
Planning
Services.
nutrition
10.1
Principles of Infant Feeding for HIV Infected Pregnant Women
60
counselling.
l
EBF
reinforcement/Infant
feeding
support
through
home
visits.
Chapter 11 Care and Follow-up of HIV Exposed Infants
66
l
Psycho-social
support
through
follow-up
counselling,
home
11.1
During the First Post-delivery Visit at 6 Weeks/ First Immunization Visit
67
visits
and
support
groups.
11.2
Confirmation of HIV Status in HIV Exposed Infants should be done at 18
69
Months, Regardless of Earlier Diagnosis
Chapter 12 Essential Gynaecologic Care for HIV Infected Pregnant Women
70
HIV
Exposed
Infant
(HEI)
12.1
Cervical Cancer Screening
71
Exclusive
breastfeeds
upto
6
months
(preferred
Option-I
WHO/NACO
Guidelines
2010-'11)
l
12.2
Family Planning and Birth-spacing
71
and continued breastfeeds in addition to complement feeds after 6 months upto 1 year for
Chapter 13 Monitoring and Evaluation
74
EID negative babies and upto 2 years for EID positive babies who receive Paediatric ART.
Chapter 14 PPTCT Programme: Roles and Responsibilities of Staff
93
l
Postpartum ARV prophylaxis for infant for 6 weeks.
l
Early infant diagnosis (EID) at 6 weeks of age; repeat testing at 6 months, 12 months & 6 weeks
after cessation of breastfeeds.
l
Co-trimoxazole prophylaxis from 6 weeks of age.
l
HIV care and Ped ART for infants and children diagnosed as HIV positive through EID.
l
Growth and nutrition monitoring.
National Guidelines for Prevention of Parent-to-Child Transmission of HIV
8
l
Immunizations and routine infant care.
l
Gradual weaning after 6 months and introduction of complementary feeds from 6 months
onwards along with continuation of BF for atleast 1 year for adequate growth & development of
the child.
emmargorP TCTPP fo stnenopmoC :2 erugiF
Annexures
Annex 1
Annex 2
ne:moGuidelines
W tnangerfor
P lRolling-out
la ot secivNACP
reS gnand
itseT
dna gConvergence
nillesnuoC VPlan
IH fin
o rthe
effO
NRHM
States
: Dosing Schedules ART for Pregnant Women
08
100
111
Annex 3
: ART for Pregnant Women

with no Prior ART
evitageN V111
IH
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tnangerP din
etcActive
efnI VLabour
IH
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m
o
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t
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rP
VRA/TRA ylhtnoM)stisiv 4 tsael-ta erusne( eraC latanetnA l
Annex 4
: Infant NVP Prophylaxis Dosing
111
xes efaS l
.sretneC TRA ta sixalyhporp
.gnillesnuoc
Annex
111
fo noi5
tanimre:t lacWHO
idem Clinical
ro noitauStaging
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Grading of Selected Clinical and.ylLaboratory
no ycnangerToxicities
p
Annex 6
:
y
l
i
m
a
f
ot segakniL 113
l
(Reference: WHO 2010 Guidelines for ART in Adults and Adolescents)
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emtaert dnToolthe
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.smodnoc eerF 116
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Annex 7
: Postpartum Depression
Scale
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noitacinummoc 119
Annex
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efas ,gnivil evofitiFamily
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.snoitpo gnideef tnafni
Flowchart on Counselling Mothers and their Families on Infant rFeeding
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Annex
120
dna9esuops: fo Options
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a gnillesofnuAge
oc xes efas dna elpuoC l
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Annex 10
: Testing Algorithm for HIV-1
Exposed
Infants
and
Children
<6
Months
,gnitset 121
.retneC TRA ot larrefeR l
g
n
i
r
e
tnuoc11
4DC no: deTesting
sab nem
iger citcafor
lyhpHIV-1
orp VR
A ro TRAInfants
edivorand
P lChildren >6 Months disnoc 122
Annex
Algorithm
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fi doirep ,wodniw
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evitisop si esuops
rehto/12
tnemnre: voICTC-ART
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dna gnForm
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Annex
hgih evah eh/s ro 123
.semmargorp noitirtuN
.ruoivaheb ksir
Annex 13
: OM for .rLaboratory
ehtom rof sInvestigations
ixalyhporp VRA mutraptsoP l
dna gnideef tnafnI 124
l
.seciv reS gninnalP ylimaF l
noitirtun
Annex 14
: List of Items that can be Procured under Universal Work Precautions
126
.gnillesnuoc
.stisiv emoh hguorht troppus gnideef tnafnI/tnemecrofnier FBE l
moh ,gn:illeCF-consent
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uoPatients
rht troppRegistering
us laicos-ohinto
cysPHIV
l Care & Starting ART
Annexe15
127
.spuorg troppus dna stisiv
Annex 16
: Transfer Out Form (Form for Transfer of PLHIV to Other ART Centre)
128
OM Regarding Provision of ART/ARV Prophylactic Drugs at ART Centre to

129
)IEH( tnafnI desopxE VIH
)11'-0102 senilediuG OCAN/OHW I-noitpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
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sdeef tfor
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noitiddServices
a ni sdeeIncluding
ftsaerb deCare
unitnof
oc dna 130
Annexro18
HIV Exposed Child
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.skeefor
w 6PPTCT-NRHM
rof tnafni rof sixIntegration
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Annex 19
: National Coordination Committee
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE l
OM from DDG (BSD) for Roll-out of PPTCT Multi-Drug
.sdeefRegimen
tsaerb fo nin
oitIndia
assec retfa 133
Annex 20
:
from 1st January 2014
.ega fo skeew 6 morf sixalyhporp elozaxomirt-oC l
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Annex 17
Abbreviations
ANC
AIDS
ALT
ART
ARV
ARSH
AZT
BCC
CPT
CDC
Antenatal Care
Acquired Immune Deficiency Syndrome
Alanine Aminotransferase
Antiretroviral Therapy
Antiretroviral
Adolescent Reproductive & Sexual Health
Zidovudine
Behaviour Change Communication
Cotrimoxazole Prophylactic Therapy
Centers for Disease Control and
Prevention
DBS
Dried Blood Spot
DIL
Direct-in-Labour
DNA
Deoxyribonucleic Acid
d4t
Stavudine
EBF
Exclusive Breast Feeding
EID
Early Infant Diagnosis
e-MTCT Elimination of Motherto-Child
Transmission
ERF
Exclusive Replacement Feeding
EFV
Efavirenz
EPI
Expanded Programme of Immunization
HBV
Hepatitis B Virus
HCT
HIV Counselling and Testing
HCV
Hepatitis C Virus
HEI
HIV Exposed Infant
HIV
Human Immunodeficiency Virus
ICF
Intensified case finding of TB
ICTC
Integrated counselling and Testing Centre
IMNCI
Integrated Management of Childhood
and Neonatal Illness
IUCD
LPV/r
3TC
MTCT
NACO
NNRTI
Intra-uterine contraceptive device

Lopinavir/ritonavir
Lamivudine
Mother-to-Child Transmission of HIV
National AIDS Control Organisation
Non-Nucleoside Reverse Transcriptase
Inhibitor
NRTI
Nucleoside Reverse Transcriptase
Inhibitor
NRHM National Rural Health Mission
NVP
Nevirapine
OIs
Opportunistic Infections
PEP
Post-Exposure Prophylaxis
PCP
Pneumocystis Jiroveci Pneumonia
PCR
Polymerase Chain Reaction
PPTCT
Prevention-of-Parent-to-ChildTransmission of HIV
RCH
Reproductive & Child Health
RPR
Rapid Plasma Reagin
NVP
Single-Dose Nevirapine
SRH
Sexual and Reproductive Health
TB
Tuberculosis
TDF
Tenofovir Disoproxil Fumarate
ULN
Upper limit of normal
UNAIDS United Nations Programme on HIV/AIDS
UNICEF United Nation International Childrens
Emergency Fund
VCT
Voluntary Counselling and Testing
WBS
Whole Blood Specimen
WHO
World Health Organisation
WBFPT Whole Blood Finger Prick Test
1
Introduction
Figure
2: Components
of PPTCT
There are an estimated 2.1 million
(2011)
People Living
withProgramme
HIV (PLHIV) in India, with National adult
HIV prevalence of 0.27% (2011). Of these, women constitute 39% of all PLHIV while children less than
15 years of age constitute 7% of all infections. As on March 2013, 0.1 million HIV positive children
Offer of HIV Counselling and Testing Services to all Pregnant Women
had been registered under the antiretroviral therapy (ART) programme and 38,579 are receiving free
ART. There has been a significant scale-up of HIV counselling & testing, Prevention of Parent-to-Child
Transmission (PPTCT) and ART services across the country over last five years. Between 2004 and 2013,
the number of pregnant women tested annually under the Prevention of Parent-To-Child -Transmission
HIV Negative
(PPTCT) programme increased from 0.8 million to 8.83 million and reach of the services has expanded
Pregnant Women
l
Antenatal Care
at-least
ART/ARV and
to the rural areas to a large extent. Concurrently,
there(ensure
has also
been 4a visits)Monthly
significant decentralisation
l
Safe sex
at ART
Centers.
scale-up of the ART services, with 7.34prophylaxis
Lakhs PLHIV
receiving
free ART across the country through 409
counselling.
l
Counselling
on choices of continuation or medical termination of
ART centres and 860 Link-ART centres
(LAC).
l
Couple
pregnancy (MTP)to undertake within the first 3 months of
counselling.
Mother-to-child-transmission
of HIV ispregnancy
a major only.
route of HIV infection in children. However, out of
l
Linkages27tomillion
family pregnancies in a year, only about 52.7% attend health services for skilled
an estimated
l
Screening for TB and other OIs.
planning
services.
care during
child
birth in India. Of those who availed health services, 8.83 million ANCs received
Screening
treatment
forpregnant
STIs.
Free condoms.
HIVlcounselling
and testing (March l2013)
out ofand
which
12,551
women were detected to be
l
Behaviour
change
l
WHO
clinical
staging
and
CD4
testing.
HIV positive. To enhance this coverage, a joint directive from the National AIDS Control Programme
l
Counselling
on positive
living,convergence
safe delivery,ofbirth-planning
and
(NACP)communication
and the National Rural Health
Mission (NRHM)
regarding
the two programme
(BCC)
for
high
risk
components was issued in July 2010, explicitly
stating
that universal HIV screening should be included
infant feeding
options.
women and her
as an integral component of routine lANC
check-up.
The
wasand
to ensure
thatofpregnant
women
Couple and safe sexobjective
counselling
HIV testing
spouse and
partner.
who are diagnosed with HIV would be linked to HIV services for their own health as well as to ensure
l
Repeat HIV
prevention of HIV transmission to newborn babies under the PPTCT programme.
testing,
l
considering
In the absence o f any intervention,
a substantial
proportion
of children
toonwomen
living
l
Provide
ART or ARV
prophylactic
regimenborn
based
CD4 count
window,
period
acquire
HIV ifinfection from their
mothers
either
during
pregnancy
,
labour/delivery
or
during
with HIV,
and/or clinical staging.
spouse isWithout
positive any inter vention, the risk of transmission o f HIV from infected pregnant
breastfeeding.
l
Nutrition counselling and linkages to Government/other
or s/he
have
high is estimated
to be around
20-45%. Use of ART and sd NVP/Sy NVP to
women
to her
children
Nutrition
programmes.
risk
behaviour.
effectiveARV
in reducing
thisfor
transmission
a s l o w a s 10 per
mother-baby pairs has shown to bel quite
Postpartum
prophylaxis
mother.
l
Infant feeding and
cent. Use of single dose Nevirapine (sd-NVP) at the onset of labour significantly reduces pre-partum
l
Family Planning Services.
nutrition
HIV transmission. However, it is less effective than other available ARV prophylaxis and it does not cover
counselling.
l
EBF
feeding
support
through
home
visits.
antenatal
or breastfeeding
periods.
Further
, it also
adds
to the
the risk of HIV transmission during the
l
Psycho-social
support
through
follow-up
counselling,
home
risk of acquiring drug resistance to nevirapine (NVP) as well as cross resistance to Efavirenz (NNRTIs). WHO
in 2010 had recommended two more efficacious
regimen,
option
A & option B, to further reduce the chances of
visits and
support
groups.
HIV transmission from mother-to-child.
Further in 2013, consolidated ART guideline, WHO has recommended moving away from the previous
HIV
Exposed
terms
Options
A, Infant
B and (HEI)
B+. Instead, the WHO new guidelines (June 2013) 1 recommend two options:
Exclusive breastfeeds upto 6 months (preferred Option-I WHO/NACO Guidelines 2010-'11)
l
1. Providing lifelong ART to all the pregnant and breastfeeding women living with HIV regardless of CD4
count or clinical stage OR
2. Providing
ART ARV
(ARVprophylaxis
drugs) forfor
pregnant
breastfeeding women with HIV during the motherl
Postpartum
infant forand
6 weeks.
to-child
transmission
risk(EID)
period
then
continuing
life-longat ART
for those
women&eligible
l
Early infant
diagnosis
at 6and
weeks
of age;
repeat testing
6 months,
12 months
6 weeksfor
treatment
for
their
own
health.
1
l Health
Co-trimoxazole
6 weeks
age.
World
Organization,prophylaxis
Consolidated from
guidelines
on theofuse
of Antiretroviral drugs for treating and preventing HIV infection,
Recommendations for a public health approach, June 2013.
l
l
12
l
l
the child.
emm
gorP Ttowards
CTPP fo stachievement
nenopmoC :2 eof
rugthe
iF global target of elimination of
Government of India is committed
toarwork
new HIV infections among children by 2015. Based on the new guidelines from WHO (June 2013),
Department of
for all pregnant
neAIDS
moWControl
tnangehas
rP ldecided
la ot sectoivprovide
reS gnitlife-long
seT dnaART
gnil(triple
lesnuodrug
C VIregimen)
H fo reffO
and breast feeding women living with HIV, in which all pregnant women living with HIV receive a tripledrug ART regimen regardless of CD4 count or WHO clinical stage, both for their own health and to
prevent vertical HIV transmission from mother-to-child. This would also help in maximising coverage for
evitagand
eN starting
VIH
nemoalive
W tnaand
ngefor
rP dtheir
etcefown
nI VIhealth,
H
those needing treatment for keeping them
avoiding stopping
n
e
m
o
W
t
n
a
n
g
efuture
rP
drugs with
repeat
pregnancies,
provide
early
protection
against
mother-to-child
transmission
in
xes efaS l
pregnancies and avoiding drug resistance.
.gnillesnuoc
fo norecommendations
itanimret lacidem rhave
o noitathe
unipotential
tnoc fo secto
iohreduce
c no gnithe
llesnrisk
uoCof lmother-to-child-transmission to less
These
elpuoC l
.gnillesthe
nuoccountry
than 5 per cent in breastfeeding populations. These guidelines shall be implemented across
.ylno ycnangerp
ylimaf ot segakniL l
from 1st January 2014.
.seciv res gninnalp
.sITS rof tnemtaert dna gnineercS l
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
dna gninnalp-htrib ,y reviled efas ,gnivil evitisop no gnillesnuoC l
ksir hgih rof )CCB(
reh dna nemow
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC l
.rentrap
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g
n
i
r
e
disnoc
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l
fi doirep ,wodniw
evitisop si esuops
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuN l
hgih evah eh/s ro
.ruoivaheb ksir
.rehtom rof sixalyhporp VRA mutraptsoP l
dna gnideef tnafnI l
noitirtun
.gnillesnuoc
emoh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP


rof raey 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
.skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP l
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2
PPTCT-Policy, Essential Package and Guiding Princi ples
mmargorP TCTPP fo stnenopmoC :2 erugiF

2.1 The Goals of the ePPTCT
Programme
In line with WHO standards for a comprehensive strategy, the National PPTCT programme recognises
nemoW tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO
the four elements integral to preventing HIV transmission among women and children. These are:
Prong 1: Primary prevention of HIV, especially among women of child bearing age.
Prong 2: Preventing unintended pregnancies
evitageN VIH
nemoW among
tnangerwomen
P detcefliving
nI VIHwith HIV.
n
e
m
oW tnangerP
A/TRA yHIV
lhtntransmission
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ael-tpregnant
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raC latainfected
netnA lwith HIV to their child.
Prong 3:VRPrevent
xes efaS l
.
g
n
i
esnufamily
oc
Prong
HIV, her children lland
in
fo no4:
itanProvide
imret laccare,
idemsupport
ro noitauand
nitnotreatment
c fo seciohto
c nwomen
o gnillesnliving
uoC with
l
e
l
p
u
o
C l
women
in
child
bearing
age.
.gnillesnuoc
.ylno ycnangerp
.sIO r4ehprongs
to dna BTfor
rof gPPTCT
nineercS l
.seciv res gninnalp
.smodnoc eerF l
e
g
n
ahc ruoivaheB l
Prong 4:
Prong 2:
Prong 1:
Care,
Prong
3:
noitacinummoc
dna gninnalp-htrib ,y reviledPrimary
efas ,gnivil eunintended
vPrevent
itisop no gnillePrevention
snuoC l
support
prevention
and
of MTCT
k
s
i
r
hgih rof )CCB(
pregnancies
of HIV
treatment
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
g
n
i
r
e
disnoc
fi doirep ,wodniw
evitisop si esuops
rehto/tnemnrevoG ot segaknil dna HIVg+ve
nillesnuoc HIV
no+ve
itirtuN l
hgih evah eh/s ro
HIV +ve Mother
HIV Negative i.e.
& Pregnant
Not Pregnant
.
s
e
m
m
a
r
g
o
r
p
n
o
i
t
i
r
t
u
N
& Child
general
Family Planning
.ruoivaheb ksir
population,
counselling in
.reARSH
htom rof sixICTC
a
lybut
hpmore
orp VRA mutraptsoP l
e.g.
importantly at
.ART
secentres
civ reS gninnalP ylimaF l
noitirtun
.gnillesnuoc
The National
PPTCT
programme
adopts
a
public
health
approach
to
provide
these
services
to pregnant
emoh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP l
women and their children. This approach seeks to ensure equitable access to high-quality PPTCT
services at the grass-root level while taking into account what is feasible on a large-scale within
available health infrastructure, human and financial resources.
Goals of National PPTCT Programme in India are:
1. Primary prevention of HIV, especially among women in child-bearing age.
2. Integration
.TRA cirtaidof
eaPPPTCT
evieceinterventions
r ohw seibab ewith
vitisogeneral
p DIE rohealth
f sraeyservices
2 otpu dsuch
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ibabasic
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(ANC), Natal and Post Natal Services,.sSexual
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ixalyhpoand
rp VFamily
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raptsoP lEID,
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skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraservices.
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3. Strengthening post-natal care of the HIV-infected mother and her exposed infant.
4. Provide.Dthe
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page).
IE hessential
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2.2 The Essential Package
of Services under the PPTCT Programme
The PPTCT services provide access to all pregnant women for HIV diagnostic, prevention, care and
treatment services. As such, the key goal is to ensure the integrated PPTCT services delivery within
existing Reproductive & Child Health (RCH) programme.
The Essential Package of PPTCT Services includes:
HIV Negative
Pregnant
RoutineWomen
offer of HIV counsellingl (Group/Individual
counselling)
and
testing to all pregnant
women
Antenatal Care (ensure
at-least
4 visits)Monthly
ART/ARV
out option.
l attending
Safe sex ante-natal care, with opt
prophylaxis
at ART Centers.
counselling.
l
Counselling on choices of continuation or medical termination of
l Ensure
Couple involvement of spouse & other family members and move from an ANC centric to a
Family
centric approach.
counselling.
pregnancy only.
l
Linkages to family
Provide ART to all HIV infected
pregnant women
regardless
l
Screening
for TB and
other OIs.of WHO staging and CD4 count
planning services.
results. Preferred regimen is TDF+3TC+
EFV.
l
Screening
and treatment for STIs.
l
Free condoms.
Behaviour
change delivery lfor WHO
clinical
staging
and CD4
testing.
l Promote
institutional
all HIV
infected
pregnant
women
(ANMs/ASHAs, Community
communication
l
Counselling
on positive
living,
delivery, birth-planning
and
workers to accompany to institutions;
reduction
of stigma
andsafe
discrimination
amongst health
(BCC) for high risk
infant
options.
care providers through sensitisation
andfeeding
capacity
building).
women and her
partner. of care for associatedl conditions
Provision
(STI/RTI, TB & other Opportunistic Infections (OIs).
l
Repeat HIV
Provide
psychosocial
support for HIV infected pregnant women
testing, nutrition counselling land
Referral
to ART Center.
considering
(Linkages
with ANM, ASHAs, lCommunity
outreach
DLNsregimen
to advise
themononCD4
thecount
right
Provide ART or ARVworkers,
prophylactic
based
window,
period
if
foods to take and to go to Anganwadi
for nutritional support and to the district level
and/or Centres
clinical staging.
spouse
is
positive
network of Positive People for lpeer
counselling
and psycho-social
support).
Nutrition
counselling
and linkages
to Government/other
or s/he have high
Nutrition
programmes.
risk behaviour.
Provide
counselling and support for initiation of exclusive breastfeeds within an hour of delivery
l
l as
Infant
and
the feeding
preferred
Option and continue for 6 months. After 6 months, complementary feeding
l
Family A
Planning
Services.
nutrition
should
be given along with breastfeeds.
small number
of babies born to HIV infected mothers
counselling.
l
EBF
feeding (who
support
through
visits.
who have serious illness or have died and a few reluctant mothers
at their
ownhome
risk despite
Psycho-social
support
throughreplacement
follow-up counselling,
home
counselling) may decide not tol breastfeed
but adopt
exclusive
feeding (ERF).
visits and support groups.
Provide antiretroviral prophylaxis to infants from birth up to a minimum period of 6 weeks.
Integrate follow-up of HIV-exposed infants (HEIs) into routine healthcare services including
immunization.
HIV
Exposed Infant (HEI)

l
Ensure initiation of Co-trimoxazole Prophylactic Therapy (CPT) and Early Infant Diagnosis (EID)
and continued
breastfeeds
in addition
to complement
feeds
6 months upto 1 year for
HIV DNA PCR
at 6 weeks
of age onwards
as per the
EIDafter
guidelines.
using
l Strengthen
and outreach
through
ANMs, ASHAs and District level networks and other
Postpartumfollow-up
ARV prophylaxis
for infant
for 6 weeks.
infected
women
family.
outreach
workers
to support
l
Early infant
diagnosis
(EID) atHIV
6 weeks
of pregnant
age; repeat
testingand
at 6their
months,
12 months & 6 weeks
Figurefrom
1: Essential
l
Co-trimoxazole prophylaxis
6 weeks Package
of age. of PPTCT Services
l
l
16
l
l
the child.
emmargorPand
TCTPTesting
P fo stneServices
nopmoC :2toerall
ugiPregnant
F
Offer of HIV Counselling
Women

HIV Negative
Pregnant Women
Ante-natal Care (ensure at least 4 visits)

Safe sex counselling
eviof
tagpregnancy
eN VIH
nemoW
tnangerP
detcefnI with
VIH in the first 3 months
pregnancy
(MTP)to
undertake
Couple counselling.
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e
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t
n
angerP
VRA/TRA ylhtnoM)stisivonly.
4 tsael-ta erusne( eraC latanetnA l
xes efshortly)
aS l
Linkages to family
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eCTB
TR(40
A taGene-Xpert
sixalyhporptesting sites is being launched
Screening
planning services.
.
g
n
i
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e
s
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oc
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o
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om 3 tsrif eht nih
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ekatrednuand
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erp
.gnillesnuoc
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ngerptesting.
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WHO clinical staging
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napositive
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ineercsafe
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nalpinfant
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feeding
.sITS rofoptions.
tnemtaert dna gnineercS l
.smodnoc eerF l
women and her

Couple
and
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counselling
and
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testing
of
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g
n
ahspouse
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heBother
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.
g
n
i
t
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e
t
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g
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t
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a
c
i
n
i
l
c
O
H
W
l
partner.
living
children.
noitacinummoc
na gninHIV
nalptesting,
-htrib ,y reviled efas ,gnivil evitisop no gnillesnuoC l
d
Repeat
ksir hgih rof )CCB(

Linkage
to
ART
services.
considering window
eh dna nemow

Provide
ART
and CD4 rcount
period
if
spouse
is
dna esuops fo gnitset VIH dna gnillesnuoc regardless
xes efas dnof
a eclinical
lpuoC stage
l
.rentrap
positive or s/he have
Nutrition counselling
and
linkages
to
Government/other
nutrition
VIH taepeR l
high risk behaviour.
programmes.
,gnitset
Infant feeding
g
n
i
r
e
disnoc
tnand
uoc nutrition
4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l
EBF reinforcement/Infant feeding support through
home
visits.
fi doirep ,wodniw
counselling.
evitisophome
si esuvisits
ops and
Psycho-social support through follow-up counselling,
hgih evah eh/s ro
support groups.
.ruoivaheb ksir
HIV Exposed Infant (HEI)
noitirtun
Exclusive breastfeeds up to 6 months (preferred Option-I WHO/NACO Guidelines 2010-11) and
.gnillesnuoc
.stcontinued
isiv emoh hbreastfeeds
guorht troppinusaddition
gnideef tto
nacomplementary
fnI/tnemecrofniefeeds
r FBE after
l
6 months up to 1 year for EID
negative
emoh ,gbabies
nillesnuand
oc pup
u-wto
oll2ofyears
hguorfor
ht tEID
ropppositive
us laicosbabies
-ohcysPwhol receive Paediatric ART.
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.spuofor
rg tminimum
roppus dna6sweeks.
tisiv
HIV
)11'-care
0102and
senPediatric
ilediuG OART
CANfor
/OHinfants
W I-noand
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( shtnom 6asotHIV
pu spositive
deeftsaethrough
rb evisulEID.
cxE l
Growth
and
nutrition
monitoring.
Immunizations
.TRA cirtaideaand
P evroutine
iecer ohinfant
w seibcare.
ab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIE
Gradual weaning after 6 months and introduction
from
.skeew 6 rof of
tnacomplementary
fni rof sixalyhporpfeeds
VRA m
utrap6tsmonths
oP l
onwards along with continuation of BF for at least 1 year for adequate growth & development of
the child..
Confirmation of HIV status of all babies at 18 months using all 3 Antibody (Rapid) Tests.
.DIE hguorht evFigure
itisop V2:
IHComponents
sa desongaidof
nePPTCT
rdlihc dnProgramme
a stnafni rof TRA deP dna erac VIH l
.dlihc eht
2: all
Components
PPTCT Programme
The first and foremost important Figure
step for
pregnantofwomen
attending health services is to know their
HIV status as part of the routine ante natal screening blood tests. This has been clearly stated a directive
1). Services to all Pregnant Women
jointly issued by
bothofNRHM
and NACO1 (Annexure
Offer
HIV Counselling
and Testing
Four typical scenarios where pregnant women may attend the counselling and testing services include:
Women attending ante natal clinics.
HIV
Negative spouse of HIV-positive
HIVmen,
Infected
Pregnant
Pregnant
or those
with Women
high risk behaviour.
Pregnant
Women
Antenatal
Care (ensure
at-least
4 visits)Monthly
ART/ARV
Pregnant
women screened alt the
Sub centre
level by
ANM/Nurse
(whole blood
finger prick
l
Safe
test)sex
& Confirmation at ICTC. prophylaxis at ART Centers.
counselling.
l
Counselling
on choices
of continuation
or medical
termination
of
screening
test before
Women presenting directly-in-labour
(un-booked
cases,
require a HIV
l
Couple
pregnancy
(MTP)to
undertake
within
the
first
3
months
of
delivery).
counselling.
pregnancy only.
l
Linkages to family
l
planning services.
2.3 General
Principles
l
Screening and treatment for STIs.
l
Free condoms.

Informed
consent
as
per
guidelines
toclinical
be taken
for alland
ANCs.
l
Behaviour change
l
WHO
staging
CD4 testing.
communication
Counselling to inform all pregnant
women about
the anteliving,
natal routine
screening
tests haemoglobin
l
Counselling
on positive
safe delivery,
birth-planning
and
(BCC)
for Urine
high risk
(Hb %),
albumin/sugar, VDRL/RPR,
blood
grouping
&
typing
and
the
benefits
of
testing
for
women
HIV. and her
l
partner.
Nurse/Counsellors to provide information on the ante natal screening comprehensive package
l
Repeat HIV
including HIV testing through both individual counselling and group counselling information
testing,
l
sessions.
considering
l
window,
Pregnantperiod
Women
of HIV testing should be offered repeat counselling to explore
if who opt-out and/or
clinical staging.
the
reasons
for
opting
out,
address
any misunderstandings and encourage her to reconsider her
spouse is positive
l be
Nutrition
counselling
and at
linkages
to Government/other
These
offered routine
HIV testing
each subsequent
clinic visit.
ordecision.
s/he have
highwomen should
Nutrition
programmes.
behaviour.
risk
Post-test
counselling for all pregnant women is very important so as to educate those with
l
Postpartum
prophylaxis
for mother.HIV positive tests-further
l
Infant
feeding
negative
testsand
to remain un-infected;
whileARV
for those
with confirmed
l
Family
Planning
Services.
nutrition
counselling, support and referrals
to care
& treatment
services.
counselling.
EBFreferred
feeding
support
hometests
visits.
Pregnant women who havel been
by ANMs after
whole
bloodthrough
screening
must
support
follow-upsimilar
counselling,
undergo pre-test counselling landPsycho-social
follow the usual
HIV through
testing protocol
to the home
regular ante
natal cases at the stand-alone ICTCs
for confirmatory
tests.
visits and
support groups.
Disclosure of HIV status is to be done only at stand-alone ICTCs after appropriate confirmatory
testing as per laboratory guidelines (post-test counselling) and only by trained health staff (MO,
Nurse or Counsellor).

All pregnant
women upto
referred
to other(preferred
HIV services
including
ART Centre,
should
be tracked to
Exclusive
breastfeeds
6 months
Option-I
WHO/NACO
Guidelines
2010-'11)
l
ensure that they actually reach the services, and have been registered at the respective centres.
EID
Partner/Spouse
and and
family
(other
children)
testing
for babies
HIV to who
be done
as per
ICTC guidelines.
negative babies
upto
2 years
for EID
positive
receive
Paediatric
ART.

Partner (Husband)
involvement
duringforthe
pregnancy and thereafter. PPTCT interventions and FP
l
Postpartum
ARV prophylaxis
for infant
6 weeks.
methods
to
be
encouraged
e.g.,
couple
counselling
mutual
support,
mother
l
Early infant diagnosis (EID) at 6 weeks of age; repeat for
testing
at 6psycho-social
months, 12 months
&6
weeksto
ART
and
baby
to
ARV,
Family
planning
counselling
etc.
1
l
Co-trimoxazole
6 weeks
of age.plan in the state. No X-19020/17/2009-NACP(IEC), 10
Guidelines
for rolling outprophylaxis
NACP and from
NRHM
Convergence
August 2010
l
l
18
l
l
the child.
5.2 Flow of HIV Infected Pregnant Women Detected during Ante-natal Care and PPTCT Services
Figure-3 summarizes the flow of pregnant women presenting in antenatal care and PPTCT services.
Figure 3: Services to Pregnant Women during Antenatal Period
Pregnant women visiting Sub center

ANC Registration by Sub center ANM/MPHW (F)
A
evitageN VIH
nemoW tnangerP detcefnI VIH
Sub
center:
Routine
ANC
&
PNC
Sub
center:
Screen
pregnant
women
n
e
m
oW tnangerP
Services
for HIV, Syphilis and TB
xes efaS l
.gnillesnuoc
fo noitanimret lacidem ro noitaunitnoc fo seciohc no gnillesnuoC l
elpuoC l
Screening test for Syphilis:
Screening Test for HIV:
for Tuberculosis: .gnillesnuoc
.ylnfor
o Syphilis
ycnangerp Screening
Does Finger prick Whole blood test
Screening for Tuberculosis:
-Provide
ylimafRefer
ot Pregnant
segakniL l
screening.
forr-more
to designated microscopic center at
.sAsk
IOpregnant
rehto dwomen
na BT
of gnthan
ineercS women
l
Group/Individual
.
s
e
c
i
v
r
e
s
gninnalp
one syndrome or condition, check for
PHC if there is persistent cough of any
counselling session
Vaginal/Cervical
Discharge,
Genital
ora gnineercS duration,
usually with expectoration.
.
s
I
T
S
r
o
f
t
n
e
m
t
a
e
r
t
d
n
l
.smodnoItcmay
eerF l
-Offer HIV test
ano-rectal ulcer/blisters, Lower Abdominal Pain
be accompanied by one or more of the
e
g
n
a
h
c
r
u
o
i
v
a
.gorntenderness,
itset 4DCAno-rectal
dna gnDischarge,
igats laInguinal
cinilc OHW following
l
symptoms such as weight loss, heB l
Bubo, Genital or anal warts, Individuals with
chest pain, tiredness, shortness
noitacofinbreath,
ummoc
dna gninnalp-htrib ,y revileanal
d eorfagenitalwarts,
s ,gnivil eGenital
vitisoscabies,
p no Genital
gnillesnuoC fever,particularly
l
with rise of temperature in
k
s
i
r
h
g
i
h
r
o
f )CCB(
Pediculosis, Genital lesions
.snoover
itpogenitalia
gnideef tnafni the evening, in some cases there willbe
blood in the sputum, loss
reofhappetite
dna nand
emow
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC night
l sweats
.rentrap
VIH taepeR l
-Refer to PHC with Designated
Opt out/Refuse
Agree for test
Microscopic center (DMC) ,ifganitset
If Syphilis reactive refer to PHC/STI
test
woman hasany of the
Collection of
gnabove
iredisnoc
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C nsample
o desab nemiger citcalyhporp VClinic
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ro symptomatic
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orP l
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rehto/tneWholeblood
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segaCounseling
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sixtest
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n
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subsequent visit
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.seciv reS gninadvise
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ause
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r FBE l
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information, support
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confirmation of HIV
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(if RPR is not done earlier)
If)IHIV
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Start treatment
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tnafnand
i roare
f sixstarted
alyhpon
orARTwithout
p VRA mudelay
traportsoP l
Ensure allreferred pregnant women actually.sreach
waiting
for
CD4
and
other
laboratory
reports**
ga fo skeduring
ew 6 mAntenatal
orf sixalyhpPeriod
orp elozaxomirt-oC l
Figure 3: Services to Pregnant.eWomen
National Strategic Plan Multi-Drug ARV for Prevention of Parent to Child Transmission of HIV
27
.dlihc eht
IfHIV Negative
provide post -test
counseling
Figure and
2: Components
of PPTCT
Programme
2.3.1 Sexually Transmitted Infections
Reproductive
Tract
Infections
Sexually transmitted infections and reproductive tract infections (STIs/RTIs) are important public health
OfferStudies
of HIV suggest
Counselling
and Testing
Services
all Pregnant
problems in India.
that around
6 per cent
of thetoadult
populationWomen
in India is infected
with one or more STIs/RTIs. Individuals with STIs/RTIs have a significantly higher chance of acquiring
and transmitting HIV. Moreover, STIs/RTIs are also known to cause infertility and reproductive morbidity.
Controlling STIs/RTIs helps decrease HIV infection rates and provides a window of opportunity for
HIV Negative
counselling about HIV prevention and reproductive health.
Pregnant Women
l
Safe sex
Thel implementation
framework of National
Rural at
Health
Mission (NRHM) provides the directions for
prophylaxis
ART Centers.
counselling.
synergizing the strategies for prevention,
control andon
management
for STI/ RTIorservices
Phase II
l
Counselling
choices of continuation
medicalunder
termination
of of
l
Couple
Reproductive and Child Health Programme
(RCH II)
and Phase
III of National
Control
Programme
pregnancy
(MTP)to
undertake
within AIDS
the first
3 months
of
counselling.
(NACP III). While the RCH programmepregnancy
advocatesonly.
a strong reference to include STI/RTI and HIV/AIDS
l
Linkages to family
preventions, screening and management
in
maternal
child OIs.
health services, the NACP includes
l
Screening for TBand
and other
planning services.
services
forcondoms.
management of STIs andl ART
as a major
programme
Screening
and treatment
forstrategy
STIs. for prevention of HIV.
l
Free
l
Behaviour
change
clinical staging
and CD4
testing.
Syndromic
Case Management
(SCM)l is WHO
the cornerstone
of STI/RTI
management,
being a comprehensive
communication
l
Counselling
on
positive
living,
safe
delivery,
birth-planning
and
approach for STI/RTI control endorsed by the World Health Organization (WHO). This
approach classifies
(BCC) for high risk
STI/RTIwomen
into syndromes,
and her which are easily identifiable group of symptoms and signs and provides treatment
l
Couple
and safe sexTreatment
counselling
andbeen
HIV standardized
testing of spouse
and in
for thepartner.
most common organisms causing
the syndrome.
has
as given
Table
SCM achieves
high cure rates because
it provides
other living
children.immediate treatment on the first visit at little
l 1.
Repeat
HIV
or no laboratory
other important components like counselling,
testing, cost. However, it goes
l hand-in-hand
Referral to ARTwith
Center.
partnerconsidering
treatment, condom promotion
and
referral
for
HIV
testing.
l
window, period if
and/or clinical
staging. of STI/ RTIs
Table 1: Syndromic
Management
spouse is positive
l
or s/heSyndrome
have high
Treatment
Colour-coded Kits for STI Treatment
Nutrition
programmes.
risk
behaviour.
Urethral Discharge (UD),
Tab. Azithromycin 1 G (1) and
Grey
l
Postpartum
ARV
l
Infant
Cervicitis
(CD) feeding
Ano-rectaland
discharge
Tab.
Cefixime
400 mg
(1)prophylaxis for mother.
(ARD)Painful
Scrotal Swelling (PSS)
l
nutrition
Presumptive Treatment (PT)
counselling.
l
EBF reinforcement/Infant feeding support through home visits.
Vaginitis (VD)
Tab. Secnidazole 2 g (1) and
Green
l Fluconazole
Psycho-social
Tab.
150 support
mg (1) through follow-up counselling, home
Genital Ulcer Disease- Non Herpetic
Inj. Benzathine
MU (1) and White
visits andpenicillin
support2.4
groups.
(GUD-NH)
Tab. Azithromycin 1 G (1) and Disposable

syringe 10 ml with 21 gauge needle (1)
and
Sterile water 10 ml (1)
Genital Ulcer Disease- Non Herpetic

Tab. Doxycycline 100 mg (30) and
Blue
Exclusive
breastfeeds
months
(preferred
Option-I WHO/NACO
l
(GUD-NH)for
patients
allergic to upto 6Tab.
Azithromycin
1 G (1)
penicillin.
Guidelines 2010-'11)
Genital Ulcer Disease- Herpetic
Tab. Acyclovir 400 mg (21)
EID negative babies and upto
2 years for EID positive babies whoRed
receive Paediatric ART.
(GUD-H)
l
Postpartum ARV prophylaxisTab.
for infant
for 6 weeks.
Lower Abdominal Pain (LAP/PID)
Cefixime 400 mg (1) and
Yellow
Tab.
Metronidazole
mg (28)
and at 6 months, 12 months & 6 weeks
l
Early infant diagnosis (EID) at
6 weeks
of age;400
repeat
testing
Cap. Doxycycline 100 mg (28)
Inguinal Bubo (IB)
Tab. Doxycycline 100 mg (42) and
Black
l
Co-trimoxazole prophylaxis from
weeks of age.
Tab. 6
Azithromycin
1G
l
l
20
l
l
the child.
STI/ RTI Service Package
The syndromic approach is the foundation of STI/RTI services at all facilities. Laboratory tests can be
neavailable.
moW tnaThe
ngerminimum
P lla ot spackage
ecivreS of
gnSTI/RTI
itseT dnservices
a gnille(Table
snuoC2)Vto
IHbe
foprovided
reffO at different
used wherever
facilities are tabulated below:
Table 2: Level of Care Service Provider Modalities Package of Services
Level of Care
VIH
n
e
m
o
W
t
n
a
n
g
erP
l
Information
xespromotion
efaS l
Condom provision and
.gnillesnuoc
Screening for STI/RTI
l
Referral for treatmentelpuoC l
.gnillesnuoc
l
In addition to .above,
seciv res gninnalp
Provide counselling
l
.smodnoc eerF l
Referral to
egICTC
nahc ruoivaheB l
l
noitacinummoc
l
ksir hgih rof )CCB(
In addition to above,
reh dna nemow
STI/RTI treatment through
l
.rentrap
syndromic approach and partner
VIH taepeR l
management
,gn(including
itset
l
Simple diagnostic tests
g
n
i
r
e
d
i
s
noc
Syphilis screening)
l
fi doirep ,wodniw
ARSH services
itisop si esuops
Referral toevICTC
l
Reporting htogidistrict
h evah RCH
eh/sOfficer
ro
.ruomanagement
ivaheb ksir of
Syndromic case
l
STI/ RTI d
(provision
na gnideof
ef directly
tnafnI l
observed treatment nfor
l
oitsingle
irtun
dose regimen) .gnillesnuoc
l
nemoW tnanModalities
gerP detcefnI VIH
Service Provider
VRA/TRA ylhtnoMASHA/Link
)stisiv 4 tworker/
sael-ta eruThrough
sne( eratheir
C latanetnA
outreach
Health worker .sretneC
TRA ta sixalyhporp
meetings and
(M/F)
fo noitanimret lacidem ro noitaunitnoc fo seciohc no gnillesnuoC
observance of village
health and
.ylno ycnangerp
nutrition days
.sworker
IO rehto dThrough
na BT roANC
f gnineercS
Sub-centre
ANM/Health
.sITS rof tnemclinics,
taert dgroup
na gnineercS
meetings and
.gnitset 4DC dna gnigats lacinilc OHW
household
dna gninnalp-htrib ,y reviled efas ,gnivil evicontacts
tisop no gnillesnuoC
.sRoutine
noitpo gOPDs,
nideef tnafni
Medical Officer/
PHC/Mobile Medical
Unit/Dispensary/CHC/
dna esuops fo gnitseStaff
t VIHNurse/
dna gnillesnuocANC
xes eClinics/
fas dna elpuoC
Camps
LHV/Laboratory
Urban Health post/
Technician
Rural Hospital/Sub
.retneC TRA ot larrefeR
divisional
Hospital
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuN
STI/RTI clinic
Medical Officer
District hospital,
.rehtnurse
om rof sixalyhpGynaecology/
orp VRA mutraptsoP
Staff
Medical College
Counsellor,
hospitals, select Rural
.secivObstetrics
reS gninnaclinics
lP ylimaF
ANC Clinics
Hospital/Sub divisional Laboratory
.stisiv emoh hguorht troppus gnideef tnafnI/tnemecrofnier FBE

General OPD
Technician
Hospital).
emoh CLINIC
,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP l
SURAKSHA
Village
evitageN
Package of Services
Minimal laboratory testing

Counselling
Condom Promotion
Partner treatment
Syphilis screening
Referral to ICTC
Linkage
)IEHwith
( tnaother
fnI deservices
sopxE VIH
)11'Women
-0102 seand
niled
iuG RTI
OCAServices
N/OHW I-noitpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
Pregnant
STI/
All pregnant
should
.TRA cwomen
irtaideaP
eviecebe
r ohscreened
w seibabfor
evitsyphilis.
isop DIE Syphilis
rof sraeyis2 one
otpuofdnthe
a seeasily
ibab evtreatable
itagen DISexually
E
Transmitted Infection (STI/RTI) caused by Treponema
pallidum,
which
can
be
transmitted
to
.skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP sexual
l
partners
new
skeew 6as& well
shtnoas
m 2from
1 ,shtinfected
nom 6 tapregnant
gnitset taewoman
per ;egato
fo sher
keew
6 taborn
)DIE(child.
sisongUntreated
aid tnafni ylsyphilis
raE l is
.
s
d
e
e
f
t
s
a
e
r
b
f
o
n
o
i
t
a
s
s
e
c
r
e
tfa cause
responsible for multisystem complications and other sickness among infected patients and may
.ega in
fo the
skeepregnant
w 6 morf woman.
sixalyhpoMany
rp elozpatients
axomirt-of
oCsyphilis
l
miscarriages, low birth weight and premature delivery
.dlihc eht
Figure 2:any
Components
of PPTCT
are asymptomatic and do not manifest
symptoms
of the Programme
disease. The National STI/RTI prevention
and control programme mandates a screening test to detect hidden syphilis among all pregnant women
attending Antenatal
Clinics.
The Rapid Plasma
Reagin test
(RPR to
Test)
Venereal Women
Diseases Laboratory
Offer of
HIV Counselling
and Testing
Services
all or
Pregnant
Test (VDRL Test) are the most commonly used screening tests to detect syphilis. The programme
recommends treatment of all RPR reactive patients.
HIV Negative
Process
of Screening ANC Women HIV Infected Pregnant Women
Pregnant Women
l
l at
Safe
ANM
thesex
village/subcentre level will prophylaxis
do screening
HIV and Syphilis using whole blood finger
at test
ART for
Centers.
counselling.
prick test.
l
l
Couple
counselling.
If the Syphilis
test is reactive then the pregnant woman would be referred to designated STI/RTI clinics
pregnancy only.
l
Linkages
familyavailability for Syphilis confirmation.
or PHC
with RPRtotesting
l
planning services.
l
Screening
and
treatment
for STIs.
l HIV
Freetest
condoms.
If the
is reactive then the pregnant
woman
will
be referred
to stand alone ICTC for confirmation
l
Behaviour
change
l undergoes
WHO clinical
staging
and CD4 at
testing.
of HIV
by rapid tests.
The patient then
pre-test
counselling
the ICTC by the ICTC counsellor.
communication
l
Counselling
on
positive
living,
safe
delivery, birth-planning and
The ICTC collects 5 ml blood for HIV rapid tests and RPR test.
(BCC) for high risk
women
After HIV
and and
RPRher
testing, the patient returns to the ICTC counsellor for post test counselling. During
l
partner.
post-test counselling the ICTC counsellor provides the HIV and syphilis test report and counsels the
l
Repeat HIV
patienttesting,
to go to the STI/RTI clinic for further follow-up and advice from the STI/RTI counsellor and
l
Medical
officer for treatment if required.
considering
l
window, period if
spouse is
positive
2.3.2 HIV-TB
Collaborative
Activities
l
or s/he have high
Nutrition
programmes.
risk behaviour.
Tuberculosis
(TB) is responsible for about 25% of all deaths among HIV infected individuals. The risk of
l
l
Infant
feeding and 10 times higher
active
TB
is approximately
in HIV-infected pregnant women compared to HIV uninfected
l
nutrition
women. Active TB in HIV-infected pregnant women can contribute to increased risk of maternal mortality,
counselling.
l
and is also associated with prematurity, low birth weight, and perinatal tuberculosis among infants. A
l
Psycho-social support through follow-up counselling, home
recent study in India found that maternal TB increases the risk of HIV transmission from mother -to child
by 2.5 times. The key TB prevention interventions recommended by World Health Organization at HIV
care settings include airborne infection control at HIV care settings and Isoniazid Preventive Therapy
(IPT). NACP is currently implementing airborne infection control measures like fast tracking of cough
symptomatic patients, promotion of cough hygiene etc. at ART centres. Further, the National Technical
l
Working Group (NTWG) on TB-HIV collaboration, at NACO endorsed IPT as a strategy and recommended
its implementation at all ART centres in the country. This activity is planned for roll-out in 2014-15.
l with
Postpartum
ARV prophylaxis
for infant and
for 6 treatment
weeks. of HIV-TB are also important for reducing
Along
TB prevention,
early detection
l
Early
infant
diagnosis
(EID)National
at 6 weeks
age; repeat
testing(RNTCP)
at 6 months,
12 months
& 6activities
weeks
mortality.
The
NACP
and Revised
TBof
Control
Programme
implement
various
after
cessation
breastfeeds.
jointly to
ensure
early of
detection
and treatment. These include:
l
l
l
22
l
l
the child.
mmaAssociated
rgorP TCTPPTB
fo stnenopmoC :2 erugiF
Activities for Early Detection of eHIV
HIV testing of presumptive TB cases
HIV testing of diagnosed TB patients

Intensified TB case finding (ICF) at ICTC
evitageN VIH
ICF at ART centres
n
e
m
oW tnangerP
xes efaS l
Activities to Ensure Early Treatment of
.srHIV
etneC TRA ta sixalyhporp
.gnillesnuoc
elpuoC l
Linkage of HIV-TB cases to ART
.gnillesnuoc
.ylno ycnangerp
Initiation of HIV-TB cases on ART
.seciv res gninnalp
HIV testing of presumptive TB cases:
tests to diagnosed
.sITS rDetection
of tnemtaeofrt HIV
dna gby
ninoffering
eercS HIV
l
.smodnTB
oc epatients
erF l is
being implemented by NACP
egnahc ruoivaheB l
.gnand
itseRNTCP
t 4DC dnjointly
a gnigasince
ts lacinilc OHW l
noitacinummoc
2007-08. NACP and RNTCP decided to offer HIV test upstream during evaluation
ksir hgiof
h rpatients
of )CCB( for TB
reh dnaofneHIV
mowby 2-4
when they present with TB symptoms. This activity is expected to expedite detection
.
r
e
n
trap
weeks, leading to early linkage to treatment and hence reduction in mortality.
VIH taepeR l
,gand
nitsitetis now
Intensified TB case finding at ART centres: .ICF
at
ART
centres
is
implemented
since
2010
retneC TRA ot larrefeR l
g
n
i
r
e
d
isnoc
implemented
tnuoc 4DC at
noall
deART
sab ncentres,
emiger cLink
itcalART
yhpocentres
rp VRA and
ro TRLink
A edART
ivorPplus
l centres. Gene-Xpert testing is being
fi doirep ,wodniw
nigatfor
s laearly
cinilcscreening
ro/dna and testing for
proposed by the TB programme in 40 sites.gsoon
evitTB.
isop si esuops
hgih evah eh/s ro
Process of Screening ANC Women
.ruoivaheb ksir
Women registered for ANC care would be
HIV and Syphilis bynoANMs
.sescreened
civ reS gnifor
nnaTB
lP yalong
limaF with
l
itirtun at sub
centre
.gnillesnuoc
.stilevel.
siv emoh hguorht troppus gnideef tnafnI/tnemecrofnier FBE l
emoh ,for
gniTB
llesnsymptoms
uoc pu-wo(Refer
llof hguPregnant
orht troppwomen
us laicoto
s-odesignated
hcysP l microscopic centre (DMC) at PHC
ANM checks
if there is a persistent cough of any duration. It may be accompanied by one or more of the following
symptoms such as weight loss, chest pain, tiredness, shortness of breath, fever, particularly rise of
temperature in the evening, in some cases there can be blood in the sputum, loss of appetite and night
sweats).
rofHIV
raeypositive
1 otpu pregnant
shtnom 6women
retfa sdtoeeRNTCP
f tnemelfor
pmTB
oc odiagnosis
t noitiddaand
ni streatment
deeftsaerbatdethe
uniearliest.
tnoc dna
Refer all
.dlihc eht

Stand Alone ICTC
Stand Alone ICTC
Sub-centre level Whole Blood Finger
Prick TestWomen
(WBFPT centre)
Offer of HIV Counselling and Testing Services to all Pregnant
Three Rapid test for

Confirmation of HIV
Syphilis confirmation using
Screening of Ante-natal cases

for HIV and syphilis/STI/TB
Screening of Ante-natal
cases for HIV using WBFPT,
Screening women for Syphilis
using WBFPT/STI and Screen
women for TB by history taking
HIV RPR
Negative
test and
Pregnant Women
l
TB screening
Referral linkage with
l
Safe sex
prophylaxis
at ICTC
ART for
Centers.
Stand-alone
counselling.
confirmation
HIV status.
l
Counselling
onofchoices
of continuation
medical
termination
of
or
Referral
linkage
with
Couple
Provides confirmation of
l
Stand-alone
ICTC
for
HIV status for Women
pregnancy
(MTP)to
undertake
within
the
first
3
months
of
Refer to STI clinic/PHC/
counselling.
confirmation
of
HIV
status
screened positive with
ICTC
with
RPR
testing
pregnancy only.
Whole Blood
l
Linkages
to Finger
familyPrick
facility for confirmation of
Refer to STI clinic/PHC/
Test (WBFPT)
l
Screening
Syphilis for TB and other OIs.
planning
services.
ICTC with RPR testing
l
Screening
for STIs.
facility for confirmation of
Provides
confirmation of
l Free
condoms.

Refer to and
DMCtreatment
for TB
Syphilis
Syphilis status for women
confirmation
l
Behaviour
change
l
screened reactive with
Referbirth-planning
to DMC for TB and
communication
WBFPT
l
Counselling on positive living, safe delivery,
confirmation
(BCC) for high risk
women and her
Referral Linkage with ART
Tracking
of infected
l
Couple referral
and safe
sex counselling and HIV testing of spouse and
partner.
centre
pregnant women to ART centre
Tracking referral of infected
l
Repeat HIV
pregnant women to ART centre
Coordination
testing, for institutional
Through MO-PHC
l
delivery,
EID, provision of ART
considering
l
for direct-in-labor cases etc.
window, period if
spouse
positive
Liaison
with is
outreach
workers,
Liaison with outreach workers,
Follow-up visits to infected
l
Nutrition counselling and linkages
to Government/other
ANM
follow-up
ANM etc. for follow-up of HIV
women for EID, visits to ART
or etc.
s/heforhave
highof HIV
Nutrition
programmes.
infected
Women
infected
women
centre,
regular treatment
risk behaviour.
l
l
Infant feeding and
l
nutrition
for Pregnant Women at Different Levels
counselling.Figure 4: PPTCT Services
l
l
2.4 Guiding Principles for Use

of ART in PPTCT
The guiding principles for the use of ART to prevent HIV transmission from mother-to-child are:
HIV infected pregnant women, in need of ART for their own health should receive life-long ART.

Postpartum
ART initiation
mother (preferred
and ARV Prophylaxis
to child are
aimed at2010-'11)
improving HIVExclusive
breastfeeds
upto 6tomonths
Option-I WHO/NACO
Guidelines
l
child
survival
by
reducing
HIV
transmission
through
breastfeeding.
free
babies and
upto
years for EID
babies
who
Paediatric
ART.
EID
HIV negative
exposed infants
should
be2followed-up
andpositive
managed
as per
thereceive
National
Guidelines
on Care
l
Postpartum
ARVinfants
prophylaxis
for infant for 6 weeks.
of HIV exposed
and children.
l
In India, the PPTCT programme has been in place for many years, and recommended ARV prophylaxis
was sd of Tab Nevirapine (200mg) to mother during labour and single dose of Sy Nevirapine to the
l
infant at birth.
l
l
24
l
l
the child.
emmthe
argorNational
P TCTPP fotechnical
stnenopmoC
:2 erugiF have been revised and, it is
However, with evolving evidence,
guidelines
recommended that:
neinfected
moW tnpregnant
angerP llwomen
a ot secshould
ivreS be
gniinitiated
tseT dnaongnlife-long
illesnuoART
C VI(on
H ftriple
o reffART)
O regardless
1. All HIV
of WHO clinical stage or CD4 cell count.
ART Centre: Initiate ART to HIV positive pregnant mother
results
emoh ,gnillesnuoc pu-wregardless
ollof hguof
orWHO
ht troclinical
ppus lstage
aicosand
-ohCD
cys4Pcount
l
Preferred
.spuorregimen:
g troppuTDF+3TC+EFV
s dna stisiv
ART centre will collect sample for baseline and other
investigations
Labour & Delivery
Antenatal
2. HIV infected pregnant women should preferably be initiated on ART at ART centre and should
not be delayed for want of CD4 cell count report.
evitageN VIH
The summary of the technical guidelines Multi Drug Anti-retroviral Regimen for PPTCT
n
e
m
oWistnprovided
angerP in
Figure 5.
xes efaS l
.
g
n
i
llesnduring
uoc the
Care
with health services
fo nfor
oitathe
nimHIV-infected
ret lacidem ropregnant
noitaunitwomen
noc fo sebegins
ciohc non
o gnthe
illesfirst
nuoCcontact
l
e
l
p
u
oC l
ante
period.
fo natal
shtnom
3 tsriEstablishing
f eht nihtiw aekrelationship
atrednu ot)or
PTaMrapport
( ycnangwith
erp the HIV infected pregnant woman is
.gnillesnuoc
fundamental in providing a continuum of care involving
care, support, and treatment for
.ylno ycnaprevention,
ngerp
the mother and child. This requires.sthe
team at the health
IO reinvolvement
hto dna BT rof
of gthe
ninclinical
eercS land para-medical
.seciv res gninnalp
facility the Obstetricians, Paediatricians,
Physicians,
Medical
Officers,
Nurses,
ANMs,
ASHAs, Lab
.smodnoc eerF l
Technicians, Counsellors and Outreach Workers. District Level Positive Networks, Local Community
egnahc ruoivaheB l
Based Organizations and Self-Help Groups (SHGs) should help support the HIVninfected
oitacinummother
moc and
her family.
ksir hgih rof )CCB(
reh dna nemow
dna esuops fo gnitset VIH dna gnEstablish
illesnuoHIV
c xestatus
s efasofdPregnant
na elpuWomen
oC l
.rentrap
VIH taepeR l
,gnitset
g
n
i
r
e
disnoc
HIV test Negative
tnKnown
uoc 4HIV
DC infected
no descase
ab nand
emialready
ger citreceiving
calyhpoART
rp VRA Newly
ro TRdetected
A edivoHIV
rP infection
l
fi doirep ,wodniw
evitisop si esuops
hgi(as
h eper
vah eh/s ro
From ICTC Collect the blood
Repeat HIV test
.sfor
emCD4
marand
gorsend
p noitititortuN guidelines
Continue ART
sample
for window
period
.ruoivah&eb ksir
(as per guidelines)
refer women to
H/o risk factor)
.rehtom rof sART
ixalycentre
hpoART
rand
p Vcentre
R
A mutraptsoP l
noitirtun
.gnillesnuoc
Postpartum

Mother: Continue ART during Labour,
)11'-0102 senilediuG OCAN/OHWDelivery
I-noitpand
O dthereafter
erreferplifelong
( shtnom 6 otpu sdeeftsaerb evisulcxE l
Mother: Continue ART life long
Infant: Daily NVP from birth until minimum 6 weeks of age,
.skeofechoice
w 6 rooff tinfant
nafnifeeding)
rof sixalyhporp VRA mutraptsoP l
then stop (irrespective
skeew 6 & shtnom 21 ,shtnom
6 ta gn
itset taeporerExclusive
;ega fo Replacement
skeew 6 taFeed
)DIE( sisongaid tnafni ylraE l
Exclusive
Breastfeeds
.ega fo Guidelines
skeew 6 moand
rf sixOptions
alyhporpfor
elozthe
axomirt-oC l
Figure 5: The Summary of the Technical
.DIE hguorht evitisopMore
VIH sEfficacious
a desongaidPPTCT
nerdlihcRegimen
dna stnafni rof TRA deP dna erac VIH l
.dlihc eht
3
PPTCT Services under NACP
3.1 Existing FacilitiesemmargorP TCTPP fo stnenopmoC :2 erugiF

Under the National AIDS Control Programme, various HIV related services are provided through public
and private health care providers depending on the programme need and the availability of health
infrastructure, human resource and their expertise.
The PPTCT services are provided through the Integrated Counselling and Testing Centres (ICTCs)
evitageN VIH
which are of the following types:
n
e
m
oW tnangerP
1. Stand-Alone ICTCs: These are HIV counselling and testing facilities supported byxeNACP
s efaS inl the
.
s
r
e
t
n
e
C
T
R
A
t
a
s
i
x
a
l
y
h
p
o
r
p
form of staff (Counsellor & Lab Tech) and necessary logistic support. These
.gncentres
illesnuoperform
c
fo noiconfirmatory
tanimret lacidtests
em ro for
noitaHIV.
unitnTypically
oc fo seciothese
hc no centres
gnillesnuare
oC located
l
in Medical Colleges,
elpuoCDistrict
l
fo shHospitals,
tnom 3 tsrTaluk
if ehtHospitals
nihtiw ekand
atreCommunity
dnu ot)PTM
( ycnaCentres.
ngerp
Health
.gnillesnuoc
.ylno ycnangerp
y
l
i
m
a
f
ot Nurses
segakniand
L lLab
2. Facility-Integrated ICTCs (F-ICTCs):
the staff (Staff
.sIO rehto dThese
na BTare
rof gfacilities
nineercSwhere
l
.seciv res gninnalp
Technicians) from existing health facilities are trained in counselling and testing, and service
.smodnoc eerF l
delivery is ensured with provision of HIV test kits from the NACP. though it would be best to be
egnahc ruoivaheB l
purchased from NRHM budget. The centres perform only screening tests for HIV using Whole
noitacinummoc
dnaBlood
gninnaFinger
lp-htriPrick
b ,y revtest
iledkits
efasand
,gniany
vil eclient
vitisopfound
no gnipositive
llesnuoCon lscreening is referred
to a stand-alone
ksir hgih rof )CCB(
.
s
n
o
i
t
p
o
g
n
i
d
e
e
f
t
n
a
f
n
i
ICTC for confirmation. Typically, these centres are located at PHCs. The rprivate/NGO
eh dna nemofacilities
w
also
function
under
this
model.
.rentrap
nerdlihc gwhere
nivil rethe
hto Auxillary Nurse Midwives
VIH ta(ANMs;
epeR lnow
3. Screening Centres: These are health .facilities
,
g
n
set
.retneChealth
TRA ofacilities
t larrefeRarel trained in counselling anditscreening
called Jr. Health Assistant (F)) at existing
g
n
i
r
e
d
i
s
n
c
tnuocfor
4DHIV
C nby
o dwhole
esab nblood
emigefinger
r citcaprick
lyhpotest.
rp VRThese
A ro Tcentres
RA edivperform
orP l only screening test for HIVothrough
fi doirep ,wodniw
.gnigand
ats lany
aciniclient
lc ro/dfound
na
whole blood finger prick test (WBFPT)
reactive through this screening test
evitisop si esuops
are located at PHCs
rehtois
/tnreferred
emnrevoto
G Stand-Alone
ot segaknilICTCs
dna for
gnconfirmation.
illesnuoc noiTypically,
tirtuN l these centres
hgih evah eh/s ro
and Sub Centres.
.ruoivaheb ksir
d
n
a
gnidiseedetailed
f tnafnI below
l
The 5 tier structure of public health system and HIV related services at different levels
noitirtun
in the Table 3:
.gnillesnuoc
Table 3: HIV Services at Different Level of Health Facilities

Level of Health Infrastructure
Available
.spuorg trHIV
oppFacilities
us dna stisiv
Medical College
Stand -Alone ICTC, ART Centre

Centre of Excellence (CoE) in HIV care
Paediatric Centre of Excellence (pCoE)
Available HIV Services

ICTC, PPTCT, HIV-TB, ART
including
Paed. ART, OI, STI, EID
)IEPPTCT,
H( tnaHIV-TB,
fnI desART,
opxEOI,
VISTI,
H
Stand- Alone ICTC, ART Centre
ICTC,
)11'-0102 senilediuG OCALink
N/OHART
W ICentre,
-noitpOBlood
derreBank
ferp( shtnom 6 EID
otpuservices,
sdeeftsLinkages
aerb evisto
ulcDLNs/
xE l
rof raey 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni DIC
sdeefor
ftspsycho-social
aerb deunitnosupport
c dna and
services
.TRA cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2 otpICTC
u dn/a HIV
seibScreening,
ab evitagePPTCT,
n DIE HIVSub-district/Community Health Stand- Alone ICTC, Facility-ICTC ART/
keewstorage
6 rof tnacentre
fni rof siTB,
xalyART,
hporOI,
p VSTI,
RA m
utraEID
ptsServices
oP l
Centre
Link -ART Centre.sBlood
DIC,
Primary
skeew Health
6 & shtCentres/
nom 21 ,shtnomStand-Alone
6 ta gnitsetICTCs
taeper ;ega fo skeew 6 ta )HIV
DIEScreening,
( sisongaidPPTCT,
tnafni HIV-TB,
ylraE STI
l
24x7 PHCs
Facility integrated ICTCs
Sub-Centres
Screening Centre (Whole
Finger
.ega foBlood
skeew
6 morf HIV
sixaScreening
lyhporp elTest
ozaxomirt-oC l
Prick Test)
.dlihc eht
District Hospital
2: Components of PPTCT Programme

3.2. Continuum of careFigure
under
PPTCT
With the revision of PPTCT guidelines that recommend use of the more efficacious Multi Drug ART regimen,
it is important to consider Prong-3 of National PPTCT programme as a continuum of interventions
rather than a one-time activity (Fig 6). This requires close coordination between various implementing
components for PPTCT-ART linkage, Early Infant Diagnosis (EID), Paediatric ART services etc.
Negativeof care involves the HIV

Infected
Pregnant Women
TheHIV
continuum
following
steps:
Pregnant Women
l
1. Safe
Increasing
uptake of PPTCT services by pregnant women.
l
sex
prophylaxis at ART Centers.
counselling.
l
Counselling
of continuation
or Comprehensive
medical termination
of
2. Counselling and Testing of pregnant
womenon
aschoices
an integral
part of ANC
Services
l
Couple
pregnancy
(MTP)to
undertake
within
the
first
3
months
of
package.
counselling.
pregnancy only.
l
3. Linkages
Detectiontooffamily
HIV infected pregnant
women.
l
Screening
for TB and other OIs.
planning services.
l women
Screening
and treatment
for STIs.
4. Free
Linking
HIV infected pregnant
to Care,
Support and
Treatment services.
l
condoms.
l
Behaviour change
l
5. Initiating ART for all HIV infected pregnant women regardless of CD4 count, starting it as soon as
communication
Counselling
positive
safesamples
delivery,for
birth-planning
andand
diagnosed
andrisk
continued for llife.
However, on
make
sure living,
to obtain
CD4 cell count
(BCC)
for high
baseline
tests
women
and
herat the time of initiating ART or soon after initiating ART.
l
partner.
6. Counselling on birth-planning and institutional deliveries of identified HIV infected pregnant
l
Repeat HIV
women.
testing,
l
considering
7. Screening emergency labour lroom
deliveries
cases) forregimen
HIV. If HIV
positive,
Provide
ART (un-booked
or ARV prophylactic
based
on CD4providing
count
window,
if sample for CD4
ART andperiod
obtaining
cell
count
as
soon
as
possible.
spouse is positive
l
Nutrition
counselling
andemergency
linkages labour-room
to Government/other
8. orLinking
of HIV
infected pregnant
women identified
through
care services
s/he have
high
Nutrition
programmes.
risk
behaviour.
to Care,
Support and Treatment services.
l
l
Infant feeding and
9. nutrition
Provision of Syrup Nevirapinel for
the new
born infant
from birth till 6 weeks of age (minimum).
Family
Planning
Services.
At the end of 6 weeks, CPT should be initiated and baby to be linked to the EID programme.
counselling.
l
CPT continued to baby from 6 weeks up to 18 months or until the confirmatory test of the baby
l
is done using all three Rapid Antibody Tests. If baby is confirmed positive, then CPT will be
continued.
10. If the infant is detected positive in EID programme (DBS+WBS tests are positive), then ensure
initiation of Pediatric ART for the baby through ART centre as per ART guidelines as soon as
possible.
l
11. Follow-up
of HIV
infected mother
and to
baby
until breastfeeding
is over.
and continued
breastfeeds
in addition
complement
feeds afterperiod
6 months
upto 1 year for
12. At six weeks of age of baby, do DBS test and confirm with WBS test. If the age of baby is more
l
Postpartum
ARV prophylaxis
for infant
for 6test
weeks.
than 6 months,
then do antibody
(rapid)
first, if found positive then only DBS sample should
l
Early
infant
diagnosis
(EID)
at
6
weeks
of
age;
repeat
months, 12
months
& 6 weeks
be sent. If DBS comes positive then do a WBS
testtesting
If WBSatis6 positive,
start
Paediatric
ART as
after
of breastfeeds.
sooncessation
as possible.
l
13. Confirmation of diagnosis of child using 3 anti-body tests (Rapid) at ICTCs at 18 months of age.
l
l
28
l
l
the child.

Ante-natal PPTCT
nemoW
services:
InitiateART
tnangerP lla ot sIntra

ecivnatal
reS PPTCT
gnitseT dna gnillesnuoC VIPost
H fonatal
refPPTCT
fO
services:
ContinueART
services:
Continue ART life long
evitageN VIH
n
e
m
oW tnangerP
xes efaS l
Counselling and testing in all phases; encourage institutional deliveries
.gnillesnuoc
elpuoC l
.gnillesnuoc
.ylno ycnangerp
.seciv res gninnalp
Link with ART services and CD4
Link with ART services, CD4 testing,
.sITS Link
rof twith
nemART
taetesting
rservices
t dna gnand
ineeCD4
rcS l
.smodART
nocInitiation
eerF l
EID & paediatric
testing
egnahc ruoivaheB l
noitacinummoc
Pregnant Women
dna gninnaFigure
lp-htrib6:,yPRONG
reviled e3:
fasContinuum
,gnivil evitisof
opCare
no gnfor
illeHIV
snuoInfected
C l
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
g
n
i
r
e
disnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
4
Care and Assessment of HIV Infected Pregnant Women

4.1 Care during the Antenatal
Period
HIV infected pregnant women may present to ICTCs and ART centres at various stages of pregnancy
(Refer to Table 4).
Pregnant Women who are detected to be HIV infected during ante natal care should be initiated
on ART (TDF+3TC+EFV) regardless of clinical stage or CD4 count. However, it is important to
evitaThe
geNinitiation
VIH
nem
oW tnand
angfor
erPbaseline
detcefnItests
VIH before initiating ART.
obtain sample of blood for CD4
count
n
e
m
o
W
t
n
a
n
g
erP
V
A/TRshould
A ylhtnonot
Mbe
)stidelayed
siv 4 tsaefor
l-tawant
erusnofe(CD4
eraCtest
latan
etnA l
ofRART
results.
xes efaS l
.gnitest
llesnkit)
uoc during

Pregnant
women
who
are
detected
to
be
HIV
infected
by
screening
test
(by
one
e
l
p
u
C l at
labour
for confirmation of HIV ostatus
fo shactive
tnom 3
tsrif should
eht nihbe
tiwinitiated
ekatrednon
u ART
ot)Pbut
TM(should
ycnanbe
gerreferred
p
.gnillesnuoc
the earliest and linked to ART centre, if confirmed
.ylno ycnapositive.
ngerp
.sIO rehsummary
to dna BTof
romaternal
f gnineercART
S l(life long) and
.seinfant
civ resARV
gninprophylaxis
nalp
The table below (Table 4) provides
.
s
I
T
S
r
o
f
t
n
e
m
t
a
e
r
t
d
n
a
g
n
i
n
e
e
r
c
S
l
.smodnoc eerF l
for different clinical scenarios.
egnahc ruoivaheB l
Table 4: Summary of Maternal ART (Life Long) and Infant ARV Prophylaxis for
noitacinummoc
dna gninnalp-htrib ,y reviled efas ,gn
ivil evitisClinical
op no gnScenarios
illesnuoC l
Different
ksir hgih rof )CCB(
reDuration
h dna nofemow
Scenarios
Different Clinical Scenarios
Maternal ART
Infant ARV
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpprophylaxis
uoC l
Infant ARV prophylaxis
.rentrap
.nmaternal
erdlihc gART
nivil rNVP
ehto
VIH taepeR l
Scenario 1
Mother diagnosed with HIV
Initiate
6 weeks
during pregnancy
,gnitset
g
n
i
r
e
disntooc12
maternal
Extending NVP prophylaxis
Scenario
tnuoc 24DCMother
no dediagnosed
sab nemwith
iger HIV
citcalyhpInitiate
orp VR
A ro TRART
A ediNVP
vorP l
weeks
during labour or immediately
fi doirep ,wodniw
postpartum and plans to
evitisop si esuops
rehto/tnembreastfeed
nrevoG ot segaknil dna gnillesnuoc noitirtuN l
hgih evah eh/s ro
.semother
mmargfor
orHIV
p noitirNVP
tuN
Refer
6 weeks
Scenario 3
Mother diagnosed with HIV
.ruoivaheb ksir
during labour or.rimmediately
ehtom rof sixacare
lyhpand
orpevaluation
VRA mutraptsoP l
d
n
a
gnideef tnafnI l
for treatment
postpartum and plans
.
s
e
c
i
v
r
e
S
g
n
i
n
n
a
l
P
y
l
i
m
a
F
l
noitirtun
Exclusive Replacement
.gnillesnuoc
.stisiv emfeeding(ERF)
oh hguorht troppus gnideef tnafnI/tnemecrofnier FBE l
Scenario
4 ohInfant
em
,gnilleidentified
snuoc pas
u-HIV
wollof hguorInitiate
ht tropmaternal
pus laicART
os-ohcNVP
ysP
exposed after birth (through
infant (at 6 weeks or after) or
maternal HIV antibody testing))
and is breastfeeding
No NVP
Refer mother to ART
Infant identified as HIV
Centre after CD4 tests (No drugs)
exposed after birth (through
)11'-01infant
02 sor
enmaternal
ilediuG HIV
OCAN/OHWand
I-nobaseline
itpO detest
rreand
ferp( shtnom 6
treatment
antibody testing) and is not
rof raebreastfeeding
y 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni
Scenario 5
Perform infant DNA/PCR test if child

is 6 weeks old or older Immediately
initiate 6 weeks or longer of NVP
strongly consider extending this to 12
weeks
Do HIV DNA/PCR test in accordance
)IEnational
H( tnarecommendations
fnI desopxE VIon
H
with
otearly
pu sinfant
deeftdiagnosis;
saerb evino
sulinfant
cxE ARV
l
prophylaxis; initiate treatment if the
sdinfant
eeftsisaeinfected
rb deunitnoc dna
.TRA Mother
cirtaidreceiving
eaP evieART
cer but
ohw seibDetermine
ab evitisoan
p DIE rof sNVP
raey 2 otpuUntil
dna6sweeks
eibab after
evitamaternal
gen DIEART
.sART
keew 6 rof tnafni rof sixaislyrestarted
hporp VorRA
mu1trweek
aptsafter
oP l
until
alternative
interrupts ART regimen
breastfeeding has ended
regimen
or
solution;
while
breastfeeding
(such
as
toxicity, stock-outs or refusal to counsel regarding
continuing ART
continue)
without interruption
.dlihc eht
Scenario 6
Figure 2:
Components
of PPTCT
Programme
HIV infected pregnant women require
joint
management
from
both the HIV care team (for her HIV
condition) and the Obstetric team (for successful outcomes of pregnancy). HIV infected pregnant
women requireOffer
all components
of good antenatal
care, Services
including to
iron-folate
supplementation,
of HIV Counselling
and Testing
all Pregnant
Women anaemia
management, baseline CD4 count, screening of TB, prevention and management of OIs, STI treatment,
special Obstetric practices especially during labour and delivery, ART initiation and its continuation,
counselling for infant feeding options, post natal care, follow-up, family planning and contraception.
Postpartum
care and follow-up for the
wellbeing Pregnant
of motherWomen
and infant, as well as adherence to ART and
HIV Negative
HIV
Infected
other
care,
to
prevent
HIV
transmission
during
breastfeeding
important.
Pregnant Women
l
Antenatal Care (ensureisat-least
4 visits)Monthly ART/ARV
l
Safe sex
prophylaxis
ARTpregnancy
Centers. and delivery:
Good antenatal care
ensuresatthat
counselling.
l
l
Couple
Is a safe experience
for the
mother.undertake within the first 3 months of
pregnancy
(MTP)to
counselling.
Box
1
pregnancy only.
Builds the foundation for the delivery of a healthy baby (minimal risk of HIV
l
Linkages to family
l
planning services. transmission
to the baby)
l
l
Free condoms.
l
Behaviour change
l
communication
l
4.2 Initial
assessment
(BCC) for high
risk
women and her
All HIV infected pregnant women should
haveand
routine
ante
natal care
forHIV
thetesting
well-being
of her
l
Couple
safe sex
counselling
and
of spouse
andbaby
partner.
including:
l
Repeat HIV
l
Referral
to ART
Center. and 1st check-up within 12 weeks, 2nd
testing,
At least 4 ANC check-ups during
pregnancy
(registration
considering
between 14-26 weeks, 3rd between
28-32
4th between
36-40
weeks)
as per
RCH/
l
Provide
ART weeks
or ARVand
prophylactic
regimen
based
on CD4
count
window,
period if
NACP guidelines.
spouse is positive
l
Nutrition
counselling and linkages to Government/other
orHistory,
physical
examination.
s/he have
high and abdominal
Nutrition
programmes.
risk behaviour.
Antenatal routine blood screening:
l
l
Infant feeding and
l
Family
Services.
nutrition
o Hb, blood group & Rh typing,
urinePlanning
routine at
1st visit; including tests for syphilis, Hepatitis
counselling.
B and HIV.
l
follow-upatcounselling,
home
o Urine routine to be donel atPsycho-social
all visits, andsupport
Hb% tothrough
be re-checked
the 3rd visit
at 28-32
weeks gestation.
2 Doses of Tetanus Toxoid (TT) to prevent maternal and newborn tetanus:

First dose:
ANC registration.
HIVoExposed
Infantat(HEI)
Exclusive
breastfeeds
6 after
months
WHO/NACO
2010-'11)
l
o Second
dose: 4-6upto
weeks
the(preferred
first dose, Option-I
preferably
at least oneGuidelines
month before
the expected
date of delivery
(EDD).in addition to complement feeds after 6 months upto 1 year for
and continued
breastfeeds
EID negative
babies and upto 2 years for EID positive babies who receive Paediatric ART.
Antenatal
drug supplementation:
l
o IFA
tablet
(100mg
ironat
+60.5
mg folic
acid)
dailytesting
for 100
after 12
1stmonths
trimester
prevent
l
Early
infant
diagnosis
(EID)
weeks
of age;
repeat
at days,
6 months,
& to
6 weeks
anaemia.
l
Co-trimoxazole
from 6persists.
weeks of age.
o Double theprophylaxis
dose if anaemia
l
l
32
l
l
the child.
emmargosigns,
rP TCTPART
P fo slinkages-CD4
tnenopmoC :2 etesting
rugiF if HIV positive and ART, birth
Counselling on nutrition, rest, warning
planning, institutional delivery, exclusive breastfeeding within an hour of delivery, safe sex, HIV-specific
advice and contraception.
From the HIV care aspect for pregnant women, the initial assessment follows standard adult ART
guidelines including:
evitageN VIH
WHO clinical staging.
n
e
m
oW tnangerP
Clinical screening for TB and STI symptoms: Screen for TB at each visit: Intensified Case Finding
xes efaS l
retn
eC TRA taTB
sixin
alyall
hpoHIV-infected
rp
(ICF) as per TB-HIV guidelines.sfor
screening
individuals..gnillesnuoc
puoC l
Clinical
with blood in sputum,elunexplained
fo sho
tnom
3 tsriscreeningask
f eht nihtiw ekfor
atrcough
ednu o(of
t)any
PTMduration),
( ycnangecough
rp
.gnilleglands/nodes
snuoc
fever or weight loss, fatigue, night sweats,
pleuritic chest pain;
.ylnoloss
ycnaofngappetite,
erp
y
l
i
m
a
f
o
t
s
e
g
akniL l
in neck, armpits/axilla or
.sIgroin.
O rehto dna BT rof gnineercS l
.seciv res gninnalp
.sITSinrofatnnormal
emtaertpregnancy
dna gnineeisrcSaround
l
o The normal weight gain
11 kg. Most
ofoditnoccurs
.sm
oc eerF inl the
second and third.gntrimester
each
gnahcthe
ruofirst
ivahetrimester
B l
itset 4DC(approximately
dna gnigats laci5nilkg
c Oin
HW
l trimester), ewhile
noitaand
cinum
mocfactors
clinically
other
dna gninisnausually
lp-htrib1-2
,y rekg.
viledThe
efaweight
s ,gnivilgain
evitispatterns
op no gnishould
llesnuobe
C co-related
l
ksir h
gih Arofailure
f )CCB(to gain
like twin pregnancy, hyperemesis
gravidarum
during
the
first
trimester
etc.
reh dduring
na nempregnancy
ow
weight should arouse the suspicion for further evaluation. Weight loss
.
r
e
n
t
r
ap
requires detailed assessment, because it can be a sign of underlying Opportunistic Infections
VIH taepeR l
(OIs) in HIV infected individuals. .nerdlihc gnivil rehto
,gnitset
Screen and treat any STIs: any concurrent STIs may increase the risk of HIV transmission
g
n
i
r
e
disnoc from
mother-to-child, and may adversely.gnaffect
national
fi doirep to
,wothe
dniw
igats lthe
acinpregnancy.
ilc ro/dna Treat STIs according
evitisop si esuops
guidelines. Baseline laboratory investigations as per national adult guidelines.
hgih evah eh/s ro
CD4 cell count (baseline):
.ruoivaheb ksir
d
n
a
nidebrought
ef tnafnI tol the
o Women who do not return for results should be actively traced back gand
noitirtun
continuum of care through the help of grass-root level health functionaries ANMs/ASHAs/
.gnillesnuoc
.stisiv em
oh hguorhthealth
troppuworkers.
s gnideef tnafnI/tnemecrofnier FBE l
Community
Initiate adherence counselling (antiretroviral treatment for mother and ARV prophylaxis for infant)
and it is re-emphasized that the initiation of ART for the pregnant women should not be withheld
for want of the above laboratory investigations and clinical staging. Initiate Co-trimozaxole
Prophylactic Therapy (CPT) if CD4 250 cells/mm3.
Nutritional counselling for the mother: good food, rest and exercise.
f raey 1 otp
shtnom 6 and
retfavitamin/mineral
sdeef tnemelpmsupplements.
oc ot noitidda ni sdeeftsaerb deunitnoc dna
roAdherence
tou iron-folate
Counsel for regular ante natal check-up and institutional delivery.

Counsel
for
exclusive
breastfeeding
within
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taepean
r ;ehour
ga fo of
skedelivery.
ew 6 ta )DIE( sisongaid tnafni ylraE l
.sdduring
eeftsaerthe
b fofirst
noita6ssmonths)
ec retfa under
No MIXED FEEDING (No breast feeding and other milk feeds
any circumstances.
.dlihc eht

4.3 Criteria for ART Initiation
Initiation of ART in pregnant women needs to be done at the earliest and after adequate treatment
preparedness for adherence to maintain her own health and also to prevent HIV virus transmission to
the unborn baby.
In HIV infected pregnant women the dictum should be do not delay ART initiation. The eligibility
HIV for
Negative
HIV Infected
Pregnant
criteria
initiating ART in HIV positive
pregnant
women Women
are as below:
Pregnant Women
l
ART eligibility inprophylaxis
pregnant women:
l
Safe sex
at ART Centers.
counselling.
l
Counselling
onpregnant
choices ofwomen
continuation
or medical HIV
termination
of
Initiate lifelong
ART in all
with confirmed
infection
l
Couple
pregnancy
(MTP)to
undertake
within
the
first
3
months
of
regardless of WHO clinical stage or CD4 cell count. TDF + 3TC + EFV
counselling.
pregnancy only.
as first-line ART in pregnant and breastfeeding women,
Box to2 family is recommended
l
Linkages
l
Screening
for TBinand
planning services. (including pregnant women
theother
first OIs.
trimester of pregnancy and women
l
Screening
and
treatment
for
STIs.
l
Free condoms.
of childbearing age)
l
Behaviour change
l
initiated only at ART centre
communication ART shall lbe Counselling
on positive living, safe delivery, birth-planning and
(BCC) for high risk
women and her
l
partner.
4.4 Indications
for Co-trimozaxole
Prophylactic Therapy (CPT) in
l
Repeat
HIV
Pregnancy
testing,
l
considering
The indications
for co-trimozaxole initiation
pregnant
are same
as those
othercount
adults
l
ProvideinART
or ARVwomen
prophylactic
regimen
based for
on CD4
window,
period
if
(CD4250 cells/cmm). Co-trimoxazoleand/or
prophylaxis
helpful in reducing morbidity and mortality as it
clinicalisstaging.
spouse
is
positive
prevents Opportunistic Infections (OIs)
as Pneumocystis
pneumonia
toxoplasmosis,
l such
Nutrition
counselling jiroveci
and linkages
to(PCP),
Government/other
or s/he have high
diarrhoea as well as other bacterial infections.
Nutrition programmes.
risk behaviour.
l
l
Infant feeding and
Starting Co-trimoxazole in pregnancy
l
nutrition
counselling.
Co-trimoxazole
should
be started if CD4
count
is through
250 cells/mm3
and
l
EBF
feeding
support
home visits.
continued lthrough
pregnancy,
delivery
and
breastfeeding
as
per
national
guidelines (Dose:
strength
tablet 1 tab daily).
Box 3
visitsDouble
and support
groups.
Ensure that pregnant women take their folate supplements regularly.

l
l
l
l
l
l
34
l
l
the child.
5
ART for HIV Infected Pregnant Women
2: Components
PPTCT Programme
All HIV infected pregnant women Figure
(irrespective
of CD4ofcount/Clinical
stage) should receive lifelong ART.
This treatment serves two key purposes:
1. Improves health and prolongs survival of the mother.
2. Reduces the risk of HIV transmission from mother-to-child during pregnancy, labour, delivery, and
throughout the breastfeeding period.
HIV Negative
Pregnant Women
l
5.1l Safe
HIVsexInfected Pregnant prophylaxis
Womenatbeing
Newly Initiated on ART
ART Centers.
counselling.
l
HIV-infected
l
Couplepregnant women who are initiated on ART should be referred for routine baseline clinical
pregnancy
within the
3 months
of of
and laboratory
evaluation as per national
guidelines(MTP)to
for adultsundertake
and adolescents.
The first
absence
or delay
counselling.
pregnancy only.
laboratory
investigations
l
Linkages
to familyshould not prevent the initiation of ART.
l
planning services.
l
l
Free condoms.
l
Behaviour change
l
All
HIV
infected
pregnant women
should
be safe
seendelivery,
on a priority
in the ART
communication
Box 4
l
Counselling
on positive
living,
birth-planning
and
(BCC) for high risk
Centre.
women and her
l
partner.
l
Repeat HIV
testing,
l
considering
5.2 Principles
of management
l
window, period if
is positive Pregnant Women should Start ART
5.2.1 spouse
All HIV-infected
l
or s/he have high
Nutrition
programmes.
behaviour.
risk
Start
ART as soon as possible and continue
ART throughout pregnancy, delivery, breast feeding
l
Postpartum
ARV
prophylaxis for mother.
l
Infant
and
periodfeeding
and thereafter
lifelong.
l
nutrition
counselling.
Even if the pregnant women lpresents
very late in pregnancy
(including
who
present
EBF reinforcement/Infant
feeding
supportthose
through
home
visits.after
36 weeks of gestation), ART should be initiated promptly.
l
5.2.2 Choice of ART Regimen for HIV-infected Pregnant Women
There are several regimens recommended for use as first-line ART regimen for adults in India.
HIV infected
However,
in case of
HIV Exposed
Infant
(HEI) pregnant women requiring ART, the recommended first-line regimen is
Tenofovir
(TDF) (300
mgs) +
Lamuvidine
(300 Option-I
mg) + Efavirenz
(EFV)
(600 mg).
Exclusive
breastfeeds
upto
6 months(3TC)
(preferred
WHO/NACO
Guidelines
2010-'11)
l
EID negative babies
and upto 2 years
for EIDregimen
positive babies
receivePregnant
PaediatricWomen
ART. is
The recommended
first-line
for HIVwho
infected
l
Postpartum ARV
prophylaxis
for infant
for 6+
weeks.
(TDF)
(300 mg)
Lamuvidine (3TC) (300 mg) + Efavirenz (EFV)
Box 5 Tenofovir
l
Early infant diagnosis
(EID)
at
6
weeks
of
age;
repeat testing
at 6 (NVP/EFV)
months, 12at
months
& 6 weeks
(600 mg) (if there is no prior exposure
to NNRTIs
any gestational
after cessation of
breastfeeds.
age
l
l
l
36
l
l
the child.
First line ART for pregnant and breastfeeding women and ARV drugs for their infants
A once-daily fixed-dose combination of TDF + 3TC + EFV is recommended as first-line ART in

pregnant and breastfeeding women, including pregnant women in the first trimester of pregnancy
and women of childbearing age.
CESSATION OF MTCT RISK
MTCT RISK PERIOD
vitageexclusive
N VIH
nemoWART
tnanand
gerPare
detcexclusively
efnI VIH breastfeeding or edoing
Infants of mothers who are receiving
n
e
m
o
W
t
n
a
ngerP
VRA/TRA yfeeding
lhtnoMshould
)stisiv 4
tsael-tatleast
a erusnsix
e( eweeks
raC laof
taninfant
etnA prophylaxis
l
replacement
receive
with daily Syp Nevirapine.
xes efaS l
.srbirth
etneCorTR
A ta sHIV
ixalyexposure
hporp is known.
Infant prophylaxis should begin at
when
.gnillesnuoc
elpuoC l
.gnillesnas
uoca fixed
The recommended first-line regimen for pregnant
women, is available
.ylnand
o ycnbreastfeeding
angerp
dose combination (FDC), is safe for
.sIboth
O rehtpregnant
o dna BT and
rof gnbreastfeeding
ineercS l women and
.sectheir
iv res ginfants,
ninnalpis well
.sITS rof tnem
ert dna gninwith
eercSother
l
tolerated, has low monitoring requirements,
istacompatible
drugs used in.sclinical
modnoccare,
eerF and
l is
namen.
hc ruoThe
ivahalgorithm
eB l
.gnitset 4DC dna gfor
nignon-pregnant
ats lacinilc OHwomen
W l as well asegfor
harmonised with the new recommendations
noitacinummoc
dna for
gninpregnant
nalp-htriwomen
b ,y revileand
d efatheir
s ,gninfants
ivil evitiis
sodescribed
p no gnillesinnuFigure
oC l 7 below
for ART
ksir hgih rof )CCB(
reh dna nemow
.rentrap
PREGNANT AND BREASTFEEDING
HIV EXPOSED INFANTS
WOMEN WITH HIV
VIH taepeR l
,gnitset
g
n
i
r
e
disnoc
fi doirep ,wodniw
evitisop si esuops
rehto/tnemnrevoG ot segaknil dna gnillesnuoc nExclusive
oitirtuN Breastfeeding
l
hgih evah eh/s ro
.semmargorp nfor
oitfirst
irtuN
6 months. Daily
.Exclusive
ruoivaheReplacement
b ksir
feeding for first 6 months
for minimum
.rehtom rof sixalyhporp VRA mutraNVP
ptsoP
l
d
n
a
g
n
i
d
e
e
f
t
nafnI l
6 weeks (or maximum
6 weeks
Initiate lifelong ART:
.seciv reS gninnalP yliifmmaternal
aF l ART
noitiof
rtuNVP
n
started late)
.gnillesnuoc
.stisiv emoh hguTDF
orh+
t t3TC
ropp+usEFV
gnideef tnafnI/tnemecrofnier FBE l
emoh ,(Assess
gnillesnCD4
uocbaseline
pu-wolbut
lof hdogunot
orht troppus laicos-ohcysP l
withhold ART while waiting for results)
.spuorg troppus dnEarly
a stiinfant
siv diagnosis (EID) at 6 weeks, 6 months; 12
(ART Initiation to be done only at ART centre)
months (or after 6 weeks of stopping

breast-feeds completely)

Final infant diagnosis at 18 months (3 rapid tests)
.skAND
eewCARE
6 rofFOR
tnafn
i rof sWOMAN
ixalyhpoAND
rp VINFANT
RA mutraptsoP l
LINKAGE TO ART TREATMENT
BOTH
Figure 7: Algorithms for the 2013 Recommendations for Pregnant
.sdeand
eftsaBreastfeeding
erb fo noitassecWomen
retfa
Lifelong ART for all Pregnant and Breastfeeding Women with HIV
.dlihc eht
Figurewomen
2: Components
of PPTCT
Programme
The alternate regimen if the pregnant
are unable
to tolerate
preferred first-line regimen are as
below:
Offer of HIV CounsellingPreferred

and Testing
Services to all Pregnant
Women
First-line Regimen
Alternate First-line Regimens
First-Line ART for
HIV positive pregnant women
TDF + 3TC+ EFV
AZT+ 3TC+EFV
AZT+3TC+NVP
TDF+ 3TC+NVP
HIV Negative
5.2.3
Safety
of
Efavirenz
(EFV)
in
Pregnant
Women
Pregnant Women
l
Antenatal
Care (ensure at-least 4 visits)Monthly ART/ARV
l
Safe sex
at ART
Centers.
Safety counselling.
is a critical issue for pregnant andprophylaxis
breastfeeding
women
and infants as well as women who might
l
Counselling
on
choices
of
or medical
of
become
pregnant. Although data on EFV and TDF use in pregnantcontinuation
women remain
limited, termination
more data have
l
Couple
counselling.
become
available since 2010 and provide
increased
pregnancy
only.assurance for recommending TDF+3TC+EFV as
l
Linkages
to
family
the first-line ART regimen for pregnant
and
breastfeeding
women
l
Screening
for TB and
other(Ford.
OIs. N et. al, 2011, Ekouevi DK et.al
planning services.
2011,
Use condoms.
of Efavirenz during pregnancy:
a public
perspective,
l
Screening
andhealth
treatment
for STIs. Technical update on treatment
l
Free
optimisation,
Geneva,
World Health lOrganization,
on testing.
evidence available, EFV has been
l
Behaviour
change
WHO clinical2012).
stagingBased
and CD4
communication
recommended
for use in pregnant women
in all trimesters
of pregnancy
first trimester. and
l
Counselling
on positive
living, safeincluding
delivery, birth-planning
(BCC) for high risk
women and her
l
Couple Women
and safe sexhaving
counsellingPrior
and HIV
testing of spouse
and
5.3 partner.
ART Regimen for Pregnant
Exposure
to
l
HIV for PPTCT
Repeat
NNRTIs
testing,
l
considering
HIV infected
pregnant women who have
had previous
to Sd NVPregimen
(or EFV) based
for PPTCT
prophylaxis
l
Provide
ART orexposure
ARV prophylactic
on CD4
count
window,
period
if
and/or
clinicalsuch
staging.
in prior pregnancies, an NNRTI-based ART
regimen
as TDF+3TC+EFV may not be fully effective
spouse is positive
l
Nutrition
linkages
to Government/other
due to or
persistence
archived mutation
to NNRTIs.counselling
Thus, theseand
women
will require
a protease-inhibitor
s/he haveofhigh
Nutrition
programmes.
based risk
ARTbehaviour.
regimen viz:
l
l
Infant feeding and
TDF +nutrition
3TC + LPV/r (Lopinavir/ritonavir)
l
counselling.
l
feeding
support
through home visits.
The dose will be TDF+3TC (1tabletdaily)+
LPV (200mg)/r (50mg)
(2 tablets
BD)
l
5.4 Pregnant Women Already Receiving ART
Pregnant women who are already receiving ART for their own health, should continue to receive the
HIV
Exposedthroughout
Infant (HEI)
same
regimen
pregnancy, labour, breast-feeding period and thereafter life-long. If a woman
Exclusive
breastfeeds
upto
6 months
(preferred
Option-I with
WHO/NACO
Guidelines
2010-'11)
l
is on an EFV based regimen,
there
is no need
to substitute
nevirapine
(this was
done as per
earlier guidelines). She must continue on whatever regimen she is stabilized on and is responding to
adequately.
l
l
l
l
l
38
l
l
the child.

5.5 Clinical and Laboratory
Monitoring of Pregnant Women
Receiving ART
Clinical and laboratory monitoring of HIV infected pregnant women on ART should be done as per
national ART guidelines for adults and adolescents.
Key points to be noted in pregnant women
in tmonitoring
women are: evitageN VIH
nemoW
nangerP deART
tcefnin
I Vpregnant
IH
nemoW tnangerP
Look for clinically significant anaemia among HIV-infected pregnant women, since anaemia
xes efaS l
during pregnancy is common (usually developing around 28-34 weeks of gestation).
.gnillesnuoc
elpuoC l
fo shWHO
tnom clinical
3 tsrif estaging
ht nihtwill
iw ehelp
katrein
dnmonitoring
u ot)PTM(the
ycnpatient
angerpclinically, potential disease progression
.gnillesnuoc
.ylno ycnangerp
or treatment failure.
.seciv res gninnalp
Weight loss is one of the .indicators
clinical stage,
be
sITS rof tneused
mtaeto
rt determine
dna gnineedeteriorating
rcS l
.smodbut
noc this
eerFcan
l
difficult to assess during
the
clinical
stage of eagn
pregnant
ahc ruoivwoman,
aheB lit is
.gnitspregnancy.
et 4DC dna When
gnigatsdefining
lacinilc O
HW
l
noitacinummoc
dnanecessary
gninnalp-htotritake
b ,y reinto
viledconsideration
efas ,gnivil evher
itisoexpected
p no gnillweight
esnuoCgain
l in relation to the gestational age of
k
s
i
r
hgih rof )CCB(
the pregnancy and her potential weight
.snoiloss
tpo gfrom
nideeHIV
f tna(see
fni section 5.1).
reh dna nemow
.rennausea
trap and
ART-related side-effects may overlap with that of common pregnancy conditions eg.
VIH taConsult
epeR l the
vomiting. Minor symptoms should be controlled symptomatically with medicines.
,
g
n
itset
Obstetrician for drugs that are safe for use in pregnancy.
g
n
i
r
e
d
i
s
noc
fi doirep ,wodniw
.gnigatsabsolute
lacinilc roCD4
/dnacell count decreases
Due to pregnancy-related haemo-dilution,
during pregnancy.
evitisop si esuops
rehtoAfter
/tnemdelivery,
nrevoG body
ot sefluid
gaknchanges
il dna normalise
gnillesnuoto
c the
noinon-pregnant
tirtuN l
state, and
hgihCD4
evahlevels
eh/s may
ro rise
.ruoiwoman
vaheb kreceiving
sir
by 50-100 cells/ul. Therefore, a decrease in absolute CD4 count in a pregnant
d
n
a
g
n
i
d
e
e
f
t
n
a
f
nI l
ART in comparison to CD4 values prior to pregnancy may not necessarily indicate immunologic
noitirtun
decline and should be interpreted with caution (ref to SACEP in case of any doubt).
.gnillesnuoc
The recommended
emoh ,gnillesclinical
nuoc pu-and
wollolaboratory
f hguorht trfollow-up
oppus laicschedule
os-ohcysPforl pregnant women is similar to that
recommended for non-pregnant adults, and
Table
.spuisordetailed
g troppusindn
a stis5.
iv Additional assessments of hemoglobin
or Liver Function Tests (LFT), Renal Function Tests (RFT) should be performed when warranted by
clinical signs & symptoms.
HIV care and follow-up of pregnant women should be scheduled to coincide with their antenatal visits,
as far as possible. Document all investigation results in the RCH/MCH card (Antenatal & Child) also, so
that the .TObstetric
RA cirtaiteam
deaP is
eviaware
ecer ohofwtest
seibresults.
ab evitiInform
sop DIEpatient
rof srato
ey ensure
2 otpu that
dna other
seibabhealth
evitagcare
en Dproviders
IE
in the team eg. Obstetricians & their support staff
are
updated
on
the
progress
of
their
HIV
care.
ske6ew
6 & shof
tnopregnancy,
m 21 ,shtnin
omcase
6 taagpregnant
nitset taewoman
per ;egaisfounable
skeew to
6 tgo
a )D
( siART
songacentre,
id tnafn
i ylART
raE drugs
l
After
months
toIEthe
the
can be given to an authorised member of her family. The drug dispensing to an authorised member can
continue for 2 more months after delivery. ( Refer Annexure-17)
.dlihc eht
Figure
2: Laboratory
Components Follow-up
of PPTCT Programme
Table 5: Recommended Clinical
and
of Pregnant Women Receiving ART
Assessment
Baseline
2 Weeks 4 Weeks 8 Weeks 12 Weeks
Offer of HIV Counselling and Testing Services to all
Every 6
Months
Pregnant
Comment
Women
Clinical evaluation
Every month
Adherence counselling
Every month
Weight
Every month
Infected
Pregnant
Women
Re-check at 28-32
HIV
weeks
Pregnant Women
l
X
X
X
As and when required

l
Safe sex
clinically
ALT (LFT)
counselling.
**
**Specifically
for
Urinalysis*
l
Counselling on choices of continuation
or medical
termination
of
l
Couple
regimen. of
pregnancy (MTP)to undertake within the TDF-based
first 3 months
counselling.
Urinalysis dipsticks is
pregnancy only.
routinely done in
l
Linkages to family
l
Screening
for
TB
and
other
OIs.
follow-up
planning services.
CD l4 count
Thereafter
every
6
months
as
per
guidelines
l
Free condoms.
Blood
Urea
/
Sr.
Creatinine
l
Behaviour change
l
Blood Grouping
and
Typing
communication
l
HBV, HCV
Screening should
(BCC) for high risk
be performed in
screening
women and her
States
where ANCs
l
Couple
and
safe
sex
counselling
and
HIV
testing
of spouse
and
partner.
are being tested
l
Repeat HIV
routinely or based on
the risk profile (e.g.
testing,
l
IDUs, through blood
considering
l
Provide ART or ARV prophylactic regimen based
on CD4 count
transfusion)
window, period if
RPR/ VDRL*
spouse is positive
l
Nutrition counselling and linkages to Repeat
Government/other
Blood Sugar*
every 6 months
or s/he have high
if
started
on LPV/r
Nutrition
programmes.
Lipid profile
risk behaviour.
based regimen
l
l
Infant feeding and
* Normally part of standard ante-natal routine screening.
l
nutrition
A baseline
Blood urea and serum creatinine should be undertaken before starting Tenofovir based regimen, wherever available
counselling.
l
(ART should not be withheld in pregnant women for want of these baseline investigations that could be carried out over time,
as soon as possible).
l
visitsand
andone
support
Lipid profile and Blood Sugar at baseline, 6 months
year, if groups.
started on LPV/r based regimen.
*Haemoglobin
HIV Negative
Table 6: Dosage Schedule and Common Side-Effects with ART Drugs

Name of ARV
Dose
Major side-effects

1
Tenofovir Disoproxil Fumarate (TDF) 300mg Once Daily
Nephrotoxicity, Hypophosphaetemia
l
Lamivudine (3TC)
300mg Once Daily
Very few side effects: Hypersensitivity,
2
and continued breastfeeds in addition to complement feeds after
6 months
upto 1 year for
rarely
Pancreatitis
negative
years
EIDDaily
positive babies who
receive Paediatric
ART.
Efavirenz
(EFV) babies and upto 2 600
mgfor
Once
Neuro-psychiatric
symptoms
like
3 EID
hallucinations,
suicidal
ideations,
l
nightmares, vivid dreams etc
l
Lopinavir/Ritonavir (LPV/r)
400/100 mg Twice Daily
Gastro-intestinal disturbances, glucose
4
after cessation of breastfeeds. (Dose of FDC tablet of LPV(200mg)/r intolerance, Lipo-dystrophy and
hyperlipidemia
(50mg)
l
Co-trimoxazole prophylaxis from 6
weeks 2oftabs
age.BD)
l
l
40
l
l
the child.

5.6 ARV Prophylaxis for
Infants Born to Mothers Receiving Life-long ART
Infant ARV prophylaxis is required for all infants born to HIV infected women receiving ART to further
reduce pre-partum and postpartum HIV transmission, in addition to the protection received from
the mothers ART regimen. Infant ARV prophylaxis provides added protection from early postpartum
transmission, particularly in situations where women started ART late in pregnancy, have less than
optimal adherence to ART and have not
evitageN VIH
nemachieved
oW tnangfull
erPHIV
detcviral
efnIsuppression.
VIH
nemoW tnangerP
VRA
/TRAprophylaxis
ylhtnoM)swhere
tisiv 4 tmothers
sael-ta eare
rusnreceiving
e( eraC laART
tanetis:
nA Daily
l
The infant
ARV
NVP for 6 weeks (i.e. till the first
xes efaS l
.sretneCof
TRwhether
A ta sixalthe
yhpoinfant
rp
immunization visit for the infant), regardless
is exclusively breastfed or receives
.gnillesnuoc
fo noitareplacement
nimret lacidem
ro noitaunitnoc fo seciohc no gnillesnuoC l
exclusive
feeding.
elpuoC l
.gnillesnuoc
Dose and duration of infant daily NVP prophylaxis.yis
lnogiven
ycnabelow
ngerp in Table 7.
IO reDuration
hto dna Bof
T rInfant
of gninDaily
eercS NVP
l
Table 7: Dose.sand
Prophylaxis
.seciv res gninnalp
.smon
odWHO
noc eeGuidelines)
rF l
(based
egnahc ruoivaheB l
Birth Weight
NVP daily dose (in mg)
NVP daily dose (in ml)*
Duration
noitacinummoc
Birth to 6 weeks:
ksir hgih rof )CCB(
0.2 ml./kg. once daily
2 mg/kg once daily.
Up
Infants with birth weight < 2000 gm
rehtod6nweeks
a nemow
dna esuops fo gnitset VIH dna gInnconsultation
illesnuoc xewith
s efaas dna elpuoC l
irrespective.rofenwhether
trap
exclusively breast fed or
paediatrician trained in HIV
VIH taepeR l
exclusively replacement
care.
nitset
fed. (may be,gextended
Birth weight 2000 2500 gm
10 mg. once daily
1 ml. once a day
g
n
i
r
e
d
noc
to 12 weeks, ifismother
has
not
received
fi doirep ,wodnART
iw for
adequate
duration
evitisop si esuops
Birth
a day
i.e atleast 24 weeks
rehweight
to/tnemore
mnrethan
voG2500
ot gm
segaknil15 dmg.
na once
gnidaily
llesnuoc noi1.5
tirtuml.
N once
l
hgih evah eh/s ro
.
s
e
m
m
a
r
g
o
r
p
n
o
i
t
i
r
t
u
N
*Considering the content of 10 mg Nevirapine in 1ml suspension
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
6
Interventions for Women Diagnosed with HIV
Infection in Labour and Postpartum
emmof
argpregnant
orP TCTPPwomen
fo stnenowith
pmoC unknown
:2 erugiF HIV status presenting directlyThere is a significant percentage
in-labour for delivery (un-booked cases). Any pregnant woman who presents in active labour with
nestatus
moW tshould
nangerPbellaoffered
ot secthe
ivreSroutine
gnitseTscreening
dna gnilof
lesHIV,
nuoCwith
VIHopt-out
fo reffOoption as per
unknown HIV
National Guidelines. Screening using Whole Blood Finger Prick Test in the delivery/labour ward should
be undertaken.
evitageN VIH
6.1 VPregnant
Positive innemoW tnangerP
RA/TRA ylhtnWomen
oM)stisiv 4intsaLabour
el-ta erusnWho
e( eraCare
latanFound
etnA
xes efaS
HIV-screening Test should
.sretneCbe:
TRA ta sixalyhporp
l
.gnillesnuoc
fo1.
noiInitiated
tanimret on
laciART
dem (TDF+3TC+EFV)
ro noitaunitnoc fo simmediately.
eciohc no gnillesnuoC l
elpuoC l
.gnillesnuoc
.ylnopost-natal
ycnangerpward offer pre-test Counselling, counsel
2. The next day the Counsellor should visit the
.sIOfeeding
rehto dnfor
a Bfirst
T ro6months,
f gnineercSif she
l
and advise for exclusive breast
has already
if
.sestarted
civ res gbreast
ninnalfeeds;
p
.
s
I
T
S
r
o
f
t
n
e
m
t
a
e
r
t
d
n
a
g
n
i
n
e
e
r
c
S
l
.smodadhere
noc eerto
F either
l
not she must be counselled on option for breast vs replacement feeding but must
e
g
n
a
h
c
r
u
o
i
v
a
h
e
B
.
g
n
i
t
s
e
t
4
D
C
d
n
a
g
n
i
g
a
t
s
l
a
c
i
n
i
l
c
O
H
W
l
exclusive breast feeding or exclusive replacement feeding the first six months. Thereafter, thelLab
noitacinummoc
dnatech
gninwill
nalpconfirm
-htrib ,y rthe
evilHIV
ed efstatus
as ,gniby
vil e3virapid
tisop anti-body
no gnillesntests.
uoC Blood
l
sampleksfor
be
ir hCD4
gih rtesting
of )CCBshall
(
.
s
n
o
i
t
p
o
g
n
i
d
e
e
f
t
n
a
f
n
i
drawn of all HIV confirmed cases by Lab tech and S/he will personally carry
rehthe
dnasample
nemowto CD4
.
ntrap along
lab and bring the report along with a months supply of ART taking her spouse orrebuddy
H taepeto
R reach
l
with her/him under extreme circumstances when the post-partum mother isVIunable
,
g
n
i
t
s
e
t
the ART Centre within the next 2 days for Pre-ART Registration and Adherence
gniredCounselling.
isnoc
However, she should be motivated and followed- up for ensuring she reports
to
the
fi doirep ,woART
dniwCentre
evitisher
op sstatus
i esuopthe
s next
within 30 days. The ICTC Counsellor and Lab Technician after confirming
h
g
i
h
e
v
a
h
e
h
/
s
r
o
day will ensure no interruption in the
continuation
given to the HIV
.sem
margorp noiART
tirtuNonce the first dose .was
ruoivaheb ksir
positive pregnant women
in the post-natal
.rehtom in
rofthe
sixalabour-room
lyhporp VRAand
mutrthe
aptnext
soP day
l
dna gnidward.
eef tnafnI l
noitirtun
The broad principle is as far as possible direct-in-labour women must be seen by ART Medical Officer
.gnillesnuoc
at the earliest opportunity but this should not lead to delaying in ART initiation. All efforts should be
made that at least she is seen by the facility Medical Officer.
Women who are screened and found HIV Infected during

)IEH( tnlabour
afnI deorsojust
pxE after
VIH
)11Box
'-01026seniledelivery
diuG OCshould
AN/OHW
oitpOadeTop
rrefePriority
rp( shtnfor
om Clinical
6 otpu sdManagement
eeftsaerb evisand
ulcxECD4
beI-n
given
l
rof raey 1 otpu Assessment

shtnom 6 rein
tfathe
sdeART
ef tneCentre.
melpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
.skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE
.ega fo skeew 6 morf sixalyhporp elozaxomirt-oC
.DIE hguorht evitisop VIH sa desongaid nerdlihc dna stnafni rof TRA deP dna erac VIH
.gnirotinom noitirtun dna htworG
.erac tnafni enituor dna snoitazinummI
shtnom 6 morf sdeef y ratnemelpmoc fo noitcudortni dna shtnom 6 retfa gninaew laudarG
.dlihc eht
.stseT )dipaR( ydobitnA 3 lla gnisu shtnom 81 ta seibab lla fo sutats VIH fo noitamrifnoC
l
l
l
l
l
l
l
43

Protocol for Women Presenting Directly-in-Labour (Unbooked Cases)
Intrapartum
Pregnant women coming directly-in-labour
Postpartum
HIV Negative
Found
HIV
positive
using
Whole
Blood
Finger Prick
testing
in labour
room/4delivery
ward
Pregnant Women
l
Antenatal
Care
(ensure
at-least
visits)Monthly
ART/ARV
l
Safe sex
counselling.
l
l
Couple Collect blood sample for CD4 and send the sample next day to ART centre
pregnancy
(MTP)to undertake within the first 3 months of
Initiate maternal
ART (TDF+3TC+EFV)
counselling.
pregnancy only.
l
Linkages to family
l
planning services.
Next morning:
l
Screening
and treatment
for STIs.
l
FreeCounselling
condoms.
and confirmation of HIV
status and blood
sample collection
for CD4 testing
l
Behaviour change
l
Mother:
Continue living,
ART after
delivery
communication
l
Counselling
on positive
safe
(BCC) for high risk
women and her
l
partner.
DailyHIV
Sy. Nevirapine from
Mother: Link with ART centre to
lInfant:
Repeat
birth
until
6
weeks
(minimum)
continue
testing,
l
Referral to ART Center. ART as soon as possible.
considering
l
window, period if
Figure
8: Protocol for Women Presenting Directly-in-Labour (Unbooked Cases)
spouse
is positive
l
or s/he have high
Nutrition
programmes.
behaviour.
6.2l risk
ARV
Prophylaxis
for
Infants
to Women
Presenting in
l
PostpartumBorn
ARV prophylaxis
for mother.
Infant feeding and
Active Labour
l
nutrition
counselling.
l
All infants born to women who present directly-in-labour and receiving intra partum ART and regularly
l
thereafter, should be started on daily NVP prophylaxis at birth and continued for a minimum of 6 weeks.
These needs to be extended to 12 weeks as mother has not received adequate duration of ART to
suppress viral replication. However, EID should be carried out at 6 weeks as per guidelines.

breastfeeds upto for
6 months
(preferred
Option-I
WHO/NACO
Guidelines
2010-'11)
6.3l Exclusive
ARV Prophylaxis
Infants
Born
to Women
who
did not
and
continuedAny
breastfeeds
addition to
complement feeds after 6 months upto 1 year for
Receive
ART in(Home
Delivery)
In case
of infants who
born to HIV
l
Postpartum
ARVare
prophylaxis
for infected
infant formothers
6 weeks.who did not receive any antenatal or pre-partum
infant
diagnosis
(EID)HIV
at 6infection
weeks ofisage;
repeatafter
testing
6 months,
12 months
6 weeks
ART,l orEarly
in cases
where
maternal
detected
the at
birth
of the infant
(home&delivery):

Infants should prophylaxis
be started on
daily
Sy NVP
prophylaxis at their first contact with health services.
l
Co-trimoxazole
from
6 weeks
of age.
l
l
44
l
l
the child.
emmacan
rgorbe
P TC
TPP fo seven
tnenoifpm
oC :2 than
erugiF72 hours have passed since birth.
Daily infant NVP prophylaxis
started
more
Daily infant NVP prophylaxis should continue for atleast 12 weeks, by which time the mother
nebe
molinked
W tnatongappropriate
erP lla ot sART
ecivservices.
reS gnitseT dna gnillesnuoC VIH fo reffO
should
The duration of daily infant NVP prophylaxis will depend on whether the mother is to be initiated on
life-long ART and infant feeding practices (see Chapter 12).
evitageN VIH
n
e
m
oW tnangerP
5 Dos for infants at 6 weeks
xes efaS l
.
g
n
i
llesnuoc
fo noitanimret lacideItmisroimportant
noitaunitnto
ocdo
fo sthe
eciofollowing
hc no gnifor
llesinfants
nuoC lat 6 weeks:
elpuoC l
gnillesnuoc
Do re-inforcement for Exclusive Breastfeeding for the first 6 .months
.ylno ycnangerp
y
l
i
m
a
f
o
t segfeeds
akniL l
(Continuation of breastfeeds with introduction of complementary
.
s
e
c
i
v
r
e
s
g
n
i
n
nalp
Box 7
thereafter)
.smodnoc eerF l
Do.gEID
egnahc ruoivaheB l
nitsetesting
t 4DC dna gnigats lacinilc OHW l
noitacinummoc
Do Immunization
ksir hgih rof )CCB(
reh dna nemow
Do
dna esuops fo gnit
set V
IHCPT
dna ginitiation
nillesnuoand
c xescontinue
efas dnauntil
elpuobaby
C l is 18 months old
.rentrap
or longer if baby is .confirmed
positive
nerdlihc gnivil rehto
VIH taepeR l
,gniof
tset
.retneC TR
A obaby
t larreatfe6
R weeks
l
Do stop NVP Prophylaxis
for
(maternal ART is not
g
n
i
r
e
d
i
s
noc
tnuoc 4DC no desab neadequate
miger citcduration)
alyhporp VRA ro TRA edivorP l
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
7
Special Considerations
margorP TCTPP fo stnenopmoC :2 erugiF

7.1 Pregnant Womenemwith
Active TB
The risk of active TB is approximately 10 times higher in HIV-infected pregnant women compared
to HIV uninfected women. Active TB in HIV-infected pregnant women can contribute to increased
risk of maternal mortality, and is also
associated with prematurity, low birth weight, and perinatal
2
tuberculosis. A recent study in India found that maternal TB increases the risk of HIV transmission
from mother-to-child by 2.5 times. nemoW tnangerP detcefnI VIH
evitageN VIH
emoW tnafor
ngeall
rP HIV
RA/TRA ylh
tnoMFinding
)stisiv 4(ICF)
tsaeas
l-taper
erusnational
ne( eraC lTB-HIV
atanetnprotocols
A l
V
Intensified
Case
must be ninstituted
xes efaS l
infected pregnant women. .sretneC TRA ta sixalyhporp
.gnillesnuoc
All HIV-infected pregnant women presenting with a cough, fever, night sweats andelpweight
uoC lloss
should be evaluated for TB and started on TB treatment when indicated. .gnillesnuoc
.ylno ycnangerp
.sIOwith
rehtactive
o dna Btuberculosis
T rof gnineercshould
S l start ART, .irrespective
HIV-infected pregnant women
seciv res gninof
naCD4
lp cell
count.
.smodnoc eerF l
egnahc ruoivaheB l
.
g
n
i
t
s
e
t
4
D
C
d
n
a
g
n
i
g
a
t
s
l
a
c
i
n
i
l
c
O
H
W
l
The tuberculosis treatment should be started first, and followed by ART as soon as feasible
noitacinummoc
dna(usually
gninnalpafter
-htrib 2,y rweeks)
eviled efas ,gnivil evitisop no gnillesnuoC l
ksir hgih rof )CCB(
reh dnaincluding
nemow NVP,
Drug interactions between Rifampicin and some of the antiretroviral drugs,
.
rentNNRTI
rap
complicate simultaneous treatment of the two diseases. EFV is the preferred
for
VIH taepeR l
pregnant women which can be used in those with concurrent TB treatment also.
,gnitset
g
n
i
r
e
snoc
not
PI
tn
uocFor
4Dthose
C no dHIV-TB
esab neco-infected
miger citcalywomen
hporp VR
A roable
TRAtoedtolerate
ivorP lEFV, a NVP-based or adiboosted
f
i
d
o
i
r
e
p
,
w
o
d
n
i
w
regimen can be considered after .expert
With the use of a boosted PI
gnigats clinical
lacinilc rconsultation.
o/dna
evitisop si esuops
regimen,
Rifampicin
should
be
substituted
with
Rifabutin.
hgih evah eh/s ro
.ruoivaheb ksir
.rehtom rwith
of sixalyHIV-2
hporp VRInfection
A mutraptsoP l
7.2 Pregnant Women
noitirtun
Although the great majority of HIV infections in India are due to HIV-1, there are small
.gnillesfoci
nuoof
c HIV-2
infection as well, primarily in western India. HIV-2 will also progress to AIDS, although progression is
generally much slower. HIV-2 has the same modes of transmission as HIV-1 but has been shown to be
much less transmissible from mother-to-child (transmission risk 0-4%).
DETECTION OF HIV-2 INFECTION SHOULD BE DONE ACCORDING TO NACOS TESTING GUIDELINES for HIV-2
)IEHTherefore,
( tnafnI defor
sowomen
pxE VIHwho
NNRTI drugs, such as NVP and EFV, are not effective against HIV-2 infection.
)
1
1
'
0
1
0
2
s
e
n
i
l
e
d
i
u
G
O
C
A
N
/
O
H
W
I
n
o
i
t
p
O
d
e
r
r
e
f
e
r
p
(
s
h
t
n
o
m
6
o
t
p
u
s
d
e
e
f
t
s
a
e
r
b
e
v
i
s
ulcxE l
are infected with HIV-2 alone should:
Follow
.TRA cistandard
rtaideaP eadult
viecerguidelines
ohw seibafor
b eHIV-2
vitisoptreatment
DIE rof srwhich
aey 2 oconsists
tpu dnaofse2NRTIs
ibab evit+
agLPV/r.
en DIE
.skeNVP)
ew 6 rotof tbe
nafngiven
i rof sto
ixababies
lyhporpinVRmothers
A mutrapwith
tsoPHIV
l -2
Prophylaxis NVP with AZT (instead of Syp
skeew(Dosage
6 & shtndetails
om 21are
,shgiven
tnom 6
gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE l
inta
Table-8)
2
Maternal Tuberculosis: A Risk Factor for Mother-to-Child-Transmission of Human Immunodeficiency virus. Gupta A, Bhosale
R, Kinikar A, et al for the Six
Week Extended-Dose
.DIE Nevirapine
hguorht ev(SWEN)
itisop VIndia
IH saStudy
desoTeam.
ngaidJID
ne2011:203
rdlihc dna(1stFebruary)
nafni rof TRA deP dna erac VIH l
.dlihc eht
2: Components
Programme
Table 8: DoseFigure
of AZT
for Infants of
of PPTCT
Mother
with HIV-2 Infection
Birth Weight
of
Infant with birth Offer
weight of
< 2000 gms
<2500 gms
2500 gms and >
AZT Daily Dosage in mg.
AZT Daily Dosage in ml.
Duration
HIV Counselling and Testing Services to all Pregnant Women

5mg/dose twice daily
10mg/dose twice daily
15 mgs/dose twice daily
0.5 ml twice daily

1 ml twice daily
1.5 ml twice daily
6 weeks
6 weeks
6 weeks
Source:
Guidelines
HIVWHO
Negative

Pregnant Women
l
l
Safe sex
counselling.
l
l
Couple
If a pregnant woman
is detected
to haveundertake
BOTH HIV-1
and the
HIV-2
infections,
sheof
pregnancy
(MTP)to
within
first
3 months
Box 8 should receive standard
counselling.
first
ART Regimen (TDF+3TC+EFV) recommended
pregnancy
only.
l
Linkages to family
for women with
HIV-1
infection
l
planning services.
l
l
Free condoms.
l
Behaviour change
l
communication
l
(BCC) for high risk
and her Women with Hepatitis B or Hepatitis C Virus
7.3 women
Pregnant
l
partner.
Co-infection
l
Repeat HIV
testing,
The HIV
epidemic in India is driven lbyReferral
injectingtodrug
use in some regions of the Country. Hepatitis B
ART Center.
considering
and Hepatitis C may be a concern inl these
areas.
Provide
ART or ARV prophylactic regimen based on CD4 count
window, period if
spouse is positive
For Women Co-infected with HIV andl HBV
or s/he have high
Nutrition
3
behaviour.is required for HBV infectionprogrammes.
risk
If treatment
, ART should be started irrespective of the CD4 cell
l
Postpartum
ARV prophylaxis for mother.
l
Infant
feeding
and
count or the WHO clinical stage:
l
nutrition
counselling.
The regimen preferred is TDFl+EBF
3TCreinforcement/Infant
+ EFV.
feeding support through home visits.
Psycho-social
support through
follow-up
An elevation in liver enzymesl following
the initiation
of ART may
occurcounselling,
in HIV-HBVhome
co-infected
visits
and
support
groups.
women because of an immune-mediated flare in HBV disease secondary to immune reconstitution
(IRIS) with therapy, particularly in women with low CD4 cell counts.
HBV infection may also increase the risk of hepatotoxicity with certain antiretroviral drugs,
specifically NVP and protease inhibitors.
l
and
Pregnant
women
with HIV-HBV
co-infection
should be
counselled
about signs
continued
breastfeeds
in addition
to complement
feeds
after 6 months
upto 1and
yearsymptoms
for
of liver
toxicity
.
EID
negative
babies
and upto 2 years for EID positive babies who receive Paediatric ART.
l
For women who do not require HBV treatment, ART general recommendations for HIV-infected
l
Early
infantwomen
diagnosis
(EID)beat followed.
6 weeks of age; repeat testing at 6 months, 12 months & 6 weeks
pregnant
should

l
Co-trimoxazole
from
6 weeks
3(Anti-HBV
therapy shouldprophylaxis
be considered
for all
women of
co age.
infected with HIV and Hepatitis B virus with evidence of severe
liver disease)
l
l
48
l
l
the child.
mmaHCV
rgorP TCTPP fo stnenopmoC :2 erugiF
For Women Co-infected with HIVeand
No specific changes in treatment are recommended in the adult ART treatment guidelines.
Pregnant women co-infected with HIV and HCV should receive ART according to the general
recommendations for HIV-infected pregnant women.
Those women on ART require careful clinical and laboratory monitoring.
evitageN VIH
n
e
m
oW tnHence,
angerP all
VRA/Twith
RA ylHIV
htnoand
M)sHBV
tisiv 4ortsHCV
ael-taisercommon
usne( eraCamong
latanetnInjecting
A l
Drug Users (IDUs).
Co-infection
xesforefHepatitis
aS l
.sretneto
C Tbe
RAIDUs
ta sixashould
lyhporproutinely be offered testing
women living with HIV who are recognized
.gnillesnuoc
B and
fo noHepatitis
itanimret lCacinfections
idem ro noand
itaunmonitored.
itnoc fo seciohc no gnillesnuoC l
elpuoC l
.gnillesnuoc
.ylno ycnangerp
.seciv res gninnalp
.smodnoc eerF l
Box 9 Provision
of treatment for Hepatitis B & C for HIV co-infected pregnant women
egnahc ruoivaheB l
(with Hepatitis B or C) will be the responsibility of the general
noithealth
acinumsystems
moc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
g
n
i
r
e
disnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
8
Labour and Delivery in the

8.1 Intra-partum Management
The womens sero-status should be recorded in the RCH/MCH Card (Antenatal card) and maternity
register. Health care workers should check the womans HIV status and details of the ART drugs
during pregnancy. If her HIV status is unknown and she is in the first stage of labour, offer HIV counselling
and testing using Whole Blood Finger Prick Testing. If found positive, she should be administered the first dose of
ART and advised for confirmation of tests nthrough
eviday.
tageShe
N Vshould
IH
emoWICTC
tnanCounsellor
gerP detceand
fnI Lab
VIHtechnician the following
be counselled
on
Exclusive
Breast
Feeds
(EPF)
to
the
baby
for
the
first
six
months
and
the
baby
should
be
given
n
e
m
o
W
t
n
a
n
g
e
rP Sy
Niverapine for a minimum of 6 weeks and .another
6
weeks
continuation
if
need
be.
xes efaS l
sretneC TRA ta sixalyhporp
.gnillesnuoc
elpuoC l
f
o shtIntra-partum
nom 3 tsrif eht nihAnti
tiw ekRetroviral
atrednu ot)PTTherapy
M( ycnangerp
8.2
.gnillesnuoc
.ylno ycnangerp
Women on life-long ART should continue
receive
usual schedule including during
.sIO rehtotodn
a BT roART
f gninas
eerper
cS the
l
.seciv res gninnalp
labour and delivery.
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
dna Special
gninnalp-htrCircumstances:
ib ,y reviled efas ,gnivil evCaesarean
itisop no gnillesnSection
uoC l
8.3
ksir hgih rof )CCB(
reh dnand
a neonly
mowif there
Caesarean section is not recommended for prevention of mother-to-child-transmission
.
r
e
n
trap
is an Obstetric indication for the same.
VIH taepeR l
,gnitset
Use of ARV drugs during Caesarean Sections
g
n
i
r
e
disnoc
fi dooperation.
irep ,wodniw
For planned (elective) Caesarean sections,
.gnigatsART
lacinshould
ilc ro/dnbe
a given prior to the
evitisop si esuops
re
htoWomen
/tnemnreon
voG
ot seART
gaknshould
il dnacontinue
gnillesntheir
uoc standard
noitirtuNART
l
life-long
regimen. hgih evah eh/s ro
.ruoivaheb ksir
In case of an emergency
inm
pregnant
women
who arednot
.rehtomCaesarean
rof sixalyhpsection
orp VRA
utraptsoP
l
na gon
nidART,
eef tnensure
afnI lthat
the women receive ART prior to .the
seciprocedure
v reS gninnaand
lP ycontinues
limaF l thereafter.
noitirtun
.gnillesnuoc
.stisiv emoh hwomen
guorht trowho
ppusundergo
gnideef tn
afnI/tnemesection
crofnier Fshould
BE l receive the standard
All HIV-infected
Caesarean
prophylactic
e
m
o
h
,
g
n
i
l
l
e
s
n
u
o
c
p
u
w
o
l
l
o
f
h
g
u
o
r
h
t
t
r
o
p
p
u
s
l
a
i
c
o
s
o
h
c
y
s
P
l
antibiotics. Complications of Caesarean section are higher in women with HIV, with the most frequently
puorg troppus dna stisiv
reported complication being post-partum.sfever.
)IEshould
H( tnafbe
nI performed
desopxE VIfor
H
sections in HIV positive pregnant women
Box 10 Caesarean
)11'-0102 senileObstetric
diuG OCAindications
N/OHW I-nonly.
oitpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
skeewFalse
6 & shtnLabour
om 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE l
8.4
In the case of false labour or mistaken ruptured membranes,
for
women
.ega fo skeew 6 morf sixalytaking
hporp eART
lozaxshould
omirt-ocontinue
C l
of
the
combination
regimen.
with normal dosing
schedule
.dlihc eht

8.5 Safer Delivery Techniques
Mother-to-child -transmission risk is increased by the prolonged rupture of membranes, repeated P/V
examinations, assisted instrumental delivery (vacuum or forceps), invasive foetal monitoring procedures
(scalp/foetal blood monitoring), episiotomy and prematurity. Thus, when delivering HIV-infected women,
observe:
Standard/Universal
Work Precautions
(UWP)
HIV
Negative
HIV Infected
Pregnant Women
Pregnant
Women
Antenatal
Caremembranes
(ensure at-least
4 visits)Monthly
ART/ARV
Do NOT
rupture membraneslartificially
(keep
intact
for as long as possible).
l
Safe sex
o The membranes should be left intact as long as possible and artificial rupture of membrane
counselling.
l
Counselling
on choices
of continuation
reserved for cases of foetal
distress
or delay
in progress
of labour. or medical termination of
l
Couple
counselling.
pregnancy
only. techniques.
Minimize vaginal examination and
use aseptic
l
Linkages to family
Screening
TB and other
services.
planning
Avoid invasive
procedures likel foetal
bloodfor
sampling,
foetalOIs.
scalp electrodes.
l
l
Free condoms.
Behaviour
Avoid instrumental
much as possible.
l
change delivery as
l
communication
o Unless required in cases lof foetal
distress
significant
maternal
fatigue
to shorten labour
Counselling
onor
positive
living,
safe delivery,
birth-planning
and or
(BCC)the
forduration
high riskof ruptured membranes.
women and her
l
Couple
andissafe
sex counselling
and HIV
of spouse
and
o If indicated, low-cavity outlet
forceps
preferable
to ventouse,
as testing
it is generally
associated
partner.
with
lower rates of foetal trauma
than children.
ventouse.
other living
l
Repeat
HIV
testing,
l
Referral
to ART Center.
Avoid routine episiotomy as far
as
possible.
considering
l
period
window,
Suctioning
the ifnewborn with a and/or
nasogastric
should be avoided unless there is meconium
clinicaltube
staging.
spouse
is of
positive
staining
the liquor.
l
or s/he have high
Nutrition
programmes.
Safer surgical
techniques
are
useful
in
conducting
any operative procedures such as the Caesarean
risk behaviour.
section,
repairing
wounds/lacerations
l etc.
l
Infant
feeding
and
Family Planning
Services.
nutrition
Use of dry
haemostatic techniques lto minimize
bleeding;
i.e. good observation and following of surgical
counselling.
l
EBFuse
through
home
visits.
fascial planes during dissection, judicious
of electro-cautery feeding
during support
Caesarean
section
etc.
l
During Caesarean section, wherever possible, the membranes are left intact until the head is delivered
and
groups.
through the surgical incision. The cord visits
should
besupport
clamped
as early as possible after delivery;
Use of round-tip blunt needles for Caesarean section

not useInfant
fingers(HEI)
to hold the needle;
HIVDo
Exposed
Exclusive
breastfeeds
months
(preferred Option-I WHO/NACO Guidelines 2010-'11)
l

Use forceps
to receiveupto
and6hold
the needle
Observe good practice when transferring sharps to surgical assistant eg. holding container for
sharps.
l
Early infant
diagnosis
(EID) at
6 weeks
age; repeat testingwaste
at 6 months,
12from
months
6 weeksof
For ldisposal
of tissues,
placenta
and
other ofmedical/infectious
material
the&delivery
after cessation
breastfeeds.
HIV-infected
deliveriesofStandard
waste disposal management guidelines should be followed.
l
l
l
52
l
l
the child.
9
Care during the Postnatal Period

9.1 The Post-partumFigure
Period
WithinOffer
an Hour
of Delivery
of HIV
Counselling and Testing Services to all Pregnant Women
o Infants born to HIV-infected mothers should receive NVP prophylaxis immediately after
birth.
HIV oNegative
HIV Infected
Infants after delivery should
be putPregnant
on the Women
mothers abdomen for skin contact to be
Pregnant
Women which helpsl inAntenatal
established
bonding and
of 4babys
body temperature
Caremaintenance
(ensure at-least
visits)Monthly
ART/ARVas well
l
Safe as
sexhelps initiation of breast prophylaxis
milk within at
1 hour
of
birth.
ART Centers.
counselling.
Counselling
on choices
or medical
termination
of
o Infants should be given lexclusive
breastfeeds
for of
thecontinuation
first six months
preferably.
Exclusive
l
Couple
pregnancy
(MTP)to
undertake
within
the
first
3
months
of
replacement feeding may be done only if the mother has died or has a terminal illness
counselling.
pregnancy
or decides
not to breastfeed
despite only.
adequate counselling. (See chapter 11 for updated
l
Linkages
to family
l
Screening
for
TB and other OIs.
guidelines
on infant feeding).
planning
services.
l
l
Free condoms.
If the mother has not made a decision about feeding yet, she should be counselled to give exclusive
l
Behaviour change
l
breastfeeds for the first 6 months which is the preferred option, followed by complementary feeds
communication
l
Counselling
on positive
living, safe
birth-planning
after 6formonths.
No abrupt weaning
to be done
after 6 months.
Thedelivery,
follow up
guidance forand
babies
(BCC)
high risk
infant
feeding
options.
on exclusive
breast feeding and exclusive replacement feeding is given in (Table 9).
women
and her
l
partner.
Counsel and support parent to give infant NVP prophylaxis using the syringe/dropper provided.
l
Repeat HIV
testing,
Emphasize on washing the equipment
clean
boiled water after every use.
l
Referralwith
to ART
Center.
considering
l
Provide
ART
ARV prophylactic
based on
count
Duringwindow,
the post-delivery
important
toorcontinue
follow-upregimen
and support
theCD4
postpartum
period if period, it is and/or
clinical staging.
motherspouse
, considering
the fact that this is a stressful period and she has to assume multiple roles and
is positive
l
Nutrition
counselling
and possible,
linkagesinclude
to Government/other
responisbilities
as mother,
infected person.
Wherever
family counselling
or s/he have
high wife and HIV
Nutrition
programmes.
(of husband,
in-laws, direct family members) to support care of the HIV infected mother and HIV
risk behaviour.
l
Postpartum
ARV
prophylaxis
for mother.
l
Infant
feeding
and
exposed
infant.
Postpartum
depression
& psychosis
is common
in HIV
infected women.
l
nutrition
counselling.
Involvement of men (husband/close male family members) is important so that the family
l
support to the HIV-infected mother and infant is optimal. Husbands support to the motherl
baby pair (m-b pair) should be encouraged so as to:
o To remind the HIV positive mother to take ART regularly
o Support administration of daily infant NVP prophylaxis medications for 6 weeks to the baby.
o Be involved in care and follow-up of the infant including clinic visits and immunization
l
follow-up; EID and CPT initiation and continuation up to 18 months at least.
o Be
involved
in care
mother
for ART
visits babies who receive Paediatric ART.
EID
negative
babies
andofupto
2 years
for centre
EID positive
l
Postpartum
prophylaxis
for infant for
o SupportARV
exclusive
breastfeeding
for6aweeks.
minimum period of 6 months and continuation of
l
Earlybreastfeeds
infant diagnosis
(EID)
at
6
weeks
of
age;
repeat
testing
months,
12positive
months babies
& 6 weeks
and
up toat26years
in EID
with
for 1 year in EID negative babies,
after initiation
cessationofofPaediatric
breastfeeds.
ART. Weaning foods should be introduced from 6 months onwards in
l
Co-trimoxazole
prophylaxis
fromfed
6 weeks
of age. feeds fed.
all babies whether
breast
or replacement
l
l
54
l
l
the child.
emmargocontraceptive
rP TCTPP fo stnemethod)
nopmoC :2for
eruHIV
giF infected mother at 6 weeks if a
o Insertion of Cu-T (temporary
post-partum IUD (PP-IUD) has already not been inserted within 48 hours in addition to
the
use
of tcondoms
nem
oW
nangerP lwill
la oprevent
t secivreunwanted
S gnitseT pregnancies
dna gnillesn(dual
uoC Vprotection)
IH fo reffO
o Encourage male sterilization in father (No Scalpel Vasectomy (NSV) between 18 months
to 2 years when babys survival has been ensured).
Table 9: Pointsnto
embe
oWFollowed
tnangerPfor
deBabies
tcefnI Von
IH EBF OR ERF
evitageN VIH
n
e
m
tnangerP
VRA/TReceiving
RA ylhtnExclusive
oM)stisBreastfeeds
iv 4 tsael-t(EBF)
a erusne( eraCBabies
lataneReceiving
tnA l Exclusive ReplacementoW
Babies
Feeds (ERF) for
xes efaS l
for the First 6 Months .sretneC TRA ta sixalyhporp
the First 6 Months
.
g
n
i
llesnuoc
Mother
Mother
fo noitanimret lacidem
ro noitaunitnoc fo seciohc no gnillesnuoC l
elpuoC l
Life-long
fo shtnART
om initiated
3 tsrif asehsoon
t nihas
tiwpossible
ekatreincluding
dnu otentire
)PTM(Life-long
ycnangART
erp initiated as soon as possible even though the
.gnillesnuoc
breast feeding period
.ylnobaby
ycnaisngetting
gerp exclusive replacement feeding
y
l
i
m
a
f
ot segakniL l
Infants
Infants
.seciv res gninnalp
birth until 6
i) At Birth: Start Sy. NVP Prophylaxis immediately
.sITS rof tneand
mtgive
aert dnaI) At
gniBirth:
neercStart
S lSy. NVP Prophylaxis.sfrom
modnoc eerF l
weeks
until 6 weeks (or more indicated)
egnahc ruoivaheB l
.gnitset 4DC dna gnigats laii)
cinAtilc6 Oweeks:
HW l
ii) At 6 weeks:
continue until baby
a.dStart
noitaisci18
numonths
mmoc of age
na gnCPT
innand
alp-continue
htrib ,y runtil
evilebaby
d efaiss18
,gnmonths
ivil eviof
tisage
op no gna.
illeStart
snuCPT
oC and
l
(and may be thereafter, if babies
b. Immunization: Start 1st dose of DPT/OPV/Hep-B vaccine
ksir hstatus
gih roisf )positive
CCB( in the
.snoitpo gnideeconfirmatory
f tnafni
test)
(2nd dose)
reh dna nemow
c. dEarly
na eInfant
suopsDiagnosis(EID):
fo gnitset VIHDodnDBS
a gnatill6esweeks
nuocfor
xes efas dnb.a Immunization:
elpuoC l Start 1st dose of DPT/OPV/Hep-B
.rentrap
vaccine (2nd dose)
all babies; if positive do WBS. If WBS positive, start
.nethan
rdlihc gnc.ivEarly
il rehInfant
to
VIH at
tae6pweeks
eR l for
Diagnosis(EID): Do DBS
Paediatric ART irrespective of CD4% for babies less
all
babies;
if
positive
do
WBS.
If
WBS
positive,
2 years.
,
g
n
i
t
s
et start
Paediatric ART irrespective of CD4%
for
babies
d. NO MIXED FEEDING is to be done during the first 6
g
n
i
r
e
d
i
s
n
o
c less
tnumonths
oc 4Di.e.(not
C no detosagive
b nalong
emigwith
er ciBreastfeeds
tcalyhporpany
VRother
A ro TRA ethan
divo2rPyears.
l
irep ,wodniw
.gnigmilk)
ats lacind.
ilcNO
ro/dMIXED
na FEEDING is to fibedodone
during the first 6
milk (tinned formula food or cows milk or dairy
e
v
i
t
i
s
op si esuoother
ps milk
months
i.e.(not
to
give
Breastfeeds+any
liquid,
juices
or
even
water
h
g
i
h
e
v
a
h
e
h
/
s
ro liquid,
(tinned formula food or cows milk or dairy milk)
.semmargorp nojuices
itirtuor
N even water. No breast.rfeed
uoivto
ahbe
ebgiven
ksir within
.rehtom rof sixalyhporp VRA mutrfirst
aptsix
soPmonths
l
noitirtun
Post-partum Follow-up and Care Extends Beyond the Six-weeks Postpartum Period and Includes:
.gnillesnuoc
eAssessment
for post partum infectious
moh ,gnillesnof
uomaternal
c pu-wollohealing
f hguorhtafter
troppudelivery
s laicos-oand
hcysevaluation
P l
complications.
Continued counselling and information on fertility choices and effective post partum
Contraceptive methods as well as condom promotion and ensuring Cu-T IUD adoption and
)IE,Hin
( tnHIV
afnIinfected
desopxEpregnant
VIH
continued motivation for NSV for males at 18 months Specifically
)1women,
1'-0102 there
seniledshould
iuG OCA
N/linking
OHW I-of
noithe
tpO baby
derrefto
erpthe
( shtEarly
nom 6Infant
otpu sDiagnosis
deeftsaerb(EID)
evisuprogramme
lcxE l
be
roand
f raeART
y 1 oprogramme
tpu shtnom for
6 rmother/child
etfa sdeef tneas
meindicated.
lpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
skeew 6 & shtnom 2Condom
6 ta gnbe
itsetconsistently
taeper ;ega fo
skeew
ta )D
IE( sinfected
isongaid tmales
nafni yldespite
raE l
used
by6 all
HIV
Box 11 1 ,shtnomshould
.
s
d
e
e
f
t
s
a
e
r
b
f
o
n
o
i
t
a
s
s
e
c
r
e
tfa
following any other Family Planning Method (Dual Protection)
.dlihc eht

9.2 Screening for Post-Partum
Depression
Postnatal blues
occur
almost
80 per cent
of women,
most commonly
in the first post
natal week, and
Offer
ofinHIV
Counselling
and
Testing Services
to all Pregnant
Women
improves afterwards. The post natal or baby blues refers to a range of feelings between the third and
tenth day after delivery:
HIV
Negative
Infected
Pregnant
The
feelings include being HIV
tearful,
irritable,
moodWomen
changes, fatigue, anxiety and feelings of
Pregnant
Women
l
sadness
or loneliness.
l
Safe sex
counselling.
These feelings are thought to
be
caused by
a number
of factors, including
changes
l
Counselling
on choices
of continuation
or medicalsudden
termination
of
l
Couple
pregnancy
(MTP)to
undertake
within
the
first
3
months
of
in hormone levels after childbirth, unexpected discomfort from breast engorgement and birth
counselling.
pregnancy only.
pain, adjustment
l
Linkages
to family to parenthood and sleep deprivation.
l
planning services.
Free
These
feelings should disappear
a f t e r and
a few
days and
no specific treatment is required,
l
Screening
treatment
for STIs.
l
condoms.
Behaviour
l
WHO
and CD4
apart fromchange
recognition, empathy
and clinical
supportstaging
from family
andtesting.
friends.
communication
l
(BCC)
high risk
However
, in aforgroup
of post partum women, these feelings may persist and become post partum
women and her
depression. Two prospective studiesl onCouple
pregnant
women,
in the states
Goa
and rural
South
India,
and safe
sex counselling
andofHIV
testing
of spouse
and
partner.
detected
depressive
centliving
and children.
16 per cent respectively, with depression persisting
l
Repeat
HIV disorder in 23 perother
6
testing,
six months
after child birth in 11-14
centto
ofART
women
. In HIV infected women, this may be higher.
l per
Referral
Center.
considering
l
window,
period if may begin at delivery,
Post partum
depression
or a month
later; in some women, it may begin during
and/or clinical
staging.
spouse is positive
the first post-natal menstrual period or
l weaning:
or s/he have high
Nutrition
programmes.
risk
Thebehaviour.
symptoms include crying, irritability, sleep problems (insomnia or sleeping all day), eating
l
l
Infant feeding and
problems
(no
appetite
or
eating
all Planning
day), persistent
l
Family
Services.feelings of sadness, lack of desire or
nutrition
counselling.
inability to care for self or baby
exaggerated
concerns about
thesupport
baby, and
memory
loss.
l , EBF
feeding
through
home
visits.
l
Some women may feel extremely anxious or fearful, sometimes experiencing panic attacks
including palpitations, chest pain, dizziness, cold flushes and shaking.
l
Post partum depression should be detected early so that counselling support and other interventions
Exposed Infant
(HEI) depression can interfere with mother-infant bonding, cause problems
mayHIV
be provided.
Postpartum
l
with spouse and family or other children; and may affect health of the mother. More importantly,
postpartum
depression
mayand
reduce
adherence
ART especially
the receive
infant NVP
prophylaxis
EID negative
babies
uptothe
2 years
for EIDtopositive
babies who
Paediatric
ART. for the
first l6 weeks
of life.ARV prophylaxis for infant for 6 weeks.
Postpartum
l
Screening for postpartum depression should be done before the mother goes home after delivery and
during follow-up visits. See Annex 7 for the screening tool.
l
l
l
56
l
l
the child.

9.3 Counsel and Follow-up
Mother-baby (m-b) Pairs after
Discharge
Counselling on Issues Related to the Mother:
Counsel mothers taking ART for her own health for good adherence to life-long ART.
evitbreastfeeding
ageN VIH
moW
nantransmission
gerP detcefnIthrough
VIH
The ART drugs will reduce thenerisk
of tHIV
breastmilk during
n
e
m
o
W
tnangerP
Counsel mother who came directly-in-labour about the importance o f A R T.
xes efaS l
.
g
n
i
llesnuoc
have
fo noiCounsel
tanimret mother
lacidemto
ro n
oitauadequate
nitnoc fo serest,
ciohcnutrition
no gnillesand
nuoCto ltake iron-folate during the lactation
elpuoC l
in(the
fo shperiod,
tnom 3 ensure
tsrif ehenough
t nihtiwproteins
ekatredand
nu ofluids
t)PTM
ycndiet.
angerp
.gnillesnuoc
.yln
o ycnangetorphelp out with baby care so that she can
Family support: involve husband and family
members
.sIremind
O rehto her
dna of
BTher
rofART
gninand
eercinfant
S l ARV prophylaxis.
rest and recuperate, and to
.seciv res gninnalp
.smodnoc eerF l
Counsel mother for her post-natal checkup at 6 weeks to coincide with the infants first
egnahc ruoivaheB l
immunization visit.
noitacinummoc
k
s
i
r
hgih rof )CCB(
Discuss and ensure contraception.snCooitp
popgenri-T
de(eCu-T)
f tnafniinsertion and condom use as dual
r
e
h dna nemow
4
protection at subsequent visits.
.rentrap
.nerdlihcwith
gnivthe
il rehART
to Centre.
Arrange for the mother on ART to be followed
VIH taepeR l
,gnitset
ANMs/ASHAs/Counsellors/ORWs will follow-up the mother and baby within a week
ofsndischarge
g
n
i
r
e
oc
tnuocfor
4Dmothers
C no desprogress,
ab nemigsupport
er citcalinfant
yhporpfeeding
VRA ropractice,
TRA edivensure
orP ladherence to infant NVPdiprophylaxis
fi doirep ,wodniw
.gnand
igatsinfant
lacinifollow-up.
lc ro/dna
at home, general counselling advice
evitisop si esuops
hgih evah06
eh/smonths.
ro
Refer to Annex 9: Counselling the HIV infected
mother/family
.semm
argorp noitirtufor
N infant feeding options:
.ruoivaheb ksir
Counselling for Issues of Infant to the Parents/ Caregivers:
noitirtun
nillesnuoc

for
.stisCounsel
iv emoh hand
guorreinforce
ht troppusdecision
gnideef ton
nafinfant
nI/tnemfeeding
ecrofniepractice
r FBE lwhether exclusive.gbreastfeeding
efirst
moh6,gmonths
nillesnuo(preferably)
c pu-wollof horguexclusive
orht troppreplacement
us laicos-ohcyfeeding
sP l (for first six months if not willing
to breast-feed and resistant to doing
so).
All infants (irrespective of maternal ART in mother) must receive a minimum of 6 weeks of
infant NVP prophylaxis daily until the first visit for immunization at 6 weeks of age.
H( tnafnI dmay
esopbe
xE stopped
VIH
o If exclusive replacement feeding is being done, then infant NVP)IE
prophylaxis
)11'-0at
1062 weeks
seniledof
iuage.
G OCAN/OHW I-noitpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
Infants
.TRA cirwho
taideare
aP ediagnosed
viecer ohwDNA/
seibaPCR
b evnegative.
itisop DIE rof sraey 2 otpu dna seibab evitagen DIE
skere-evaluated
ew 6 rof tnafnas
i roper
f sixEID
alyhprotocol.
porp VRA mutraptsoP l
o Should continue breastfeeding and .be
o Stop NVP prophylaxis at 6 weeks for babies given exclusive
.sdereplacement
eftsaerb fo nofeeding.
itassec retfa
4
Postpartum psychiatric care in India: the need for integration and innovation. Prabha S Chandra. World Psychiatry. 2004
June; 3(2): 99100.
.dlihc eht
Figure
Components
Programme
Infants who are diagnosed
DBS2:positive,
areoftoPPTCT
be referred
to the ART Centre for Whole Blood
Specimen (WBS) collection. If WBS is also positive, then the infant will be initiated on Paediatric
of CD4
%.
ART, irrespective
Offer of HIV
Counselling
and Testing Services to all Pregnant Women
Final confirmation of the HIV status in the baby should be done at 18 months in ICTC by doing all
3 Rapid Tests even if the first rapid antibody test comes negative.
HIV Negative
5
Dos
for
infants
at 6 weeks
Pregnant Women
l
Antenatal
Care (ensure at-least 4 visits)Monthly ART/ARV
l
Safe sex
prophylaxis
at ART Centers.
For infants at 6 weeks,
it is important
to do the following:
counselling.
l
l
Couple
pregnancy
(MTP)to undertake within the first 3 months of
Do re-inforcement
for Exclusive
Do EID testing
counselling.
pregnancy
only.
Breastfeeds
for
the
first
6
months
l
Linkages to family
DoOIs.
Immunization
l
Screening
for TB and other
for (Continuation
of breastfeeds
Box 12
planning
services.
l
Screening
and treatment for STIs.
of complementary
l
Free condoms. with introduction
Do CPT initiation and continue until
l
Behaviour changefeeds thereafter)
l
WHO clinical staging andbaby
CD4 is
testing.
18 months/continue if baby
communication
l
Counselling on positive living,
safe
is tested positive
(BCC) for high risk
women and her
Do stopand
NVP
Prophylaxis
for b aand
by
l
Couple and safe sex counselling
HIV
testing of spouse
partner.
after 6 weeks (may need extension
l
Repeat HIV
to 12 weeks if mother has been
testing,
l
initiated late on ART)
considering
l
window, period if
spouse is positive
l
or s/he have high
Nutrition
programmes.
risk behaviour.
l
l
Infant feeding and
l
nutrition
counselling.
l
l

l
l
l
l
l
l
58
l
l
the child.
10
Infant Feeding Practice
Figure 2: Components
of PPTCT
Programme
Refer to National Guidelines for Nutrition
of HIV affected
and
infected infants and children, 2011.
More than 50 per cent of children under 5 years of age in India have malnutrition. NFHS-3
Offer
of that
HIVoverall,
Counselling
Services
to all Pregnant
Women
(2005-06) data
show
57 perand
centTesting
of women
of childbearing
age in India
(urban and rural)
have anaemia with 30 per cent of infants being born underweight. Growth retardation in young children
starts during pregnancy and is irreversible by age of two years if not corrected. But especially in rural
areas, where women often go back to the fields a few days after giving birth, babies diets are often
HIV Negative
supplemented with cows milk and water, which exposes them to infection.
Pregnant Women
l
l
Safe
sex
The infant feeding guidelines for HIV-exposed
and atinfected
infants age 0 to 6 months has been up
prophylaxis
ART Centers.
counselling.
dated in 2011. After 6 months of age,
complementary
foodsofshould
be introduced
just
like for other
l
Counselling
on choices
continuation
or medical
termination
of
l
Couple
infants of this age.
counselling.
pregnancy only.
l
Linkages to family
l
planning services.
Recommendations for infant feeding in HIV exposed and infected infants < 6
l
Free condoms. months of agel Screening and treatment for STIs.
l
Behaviour change
l
Guidelinesonon
Feeding
for HIV-exposed
infected infants
communicationThe 2011 National
l
Counselling
positive
living,
safe delivery,and
birth-planning
and
(BCC) for high risk
< 6 months old recommends:
women and her
Box 13 Exclusive breastfeeding
l
Couple andfor
safe
counselling
at sex
least
6 monthsand HIV testing of spouse and
partner.
l
Repeat HIV
Only in situations where breastfeeding cannot be done (maternal death,
testing,
l
severe maternal illness) or individual mothers choice (at her own risk), then
considering
l
feeding may be considered
window, period if exclusive replacement
spouse is positive
l
or s/he
have high is the preferred
Exclusive
breastfeeding
feedingprogrammes.
option for HIV-exposed infants <6 months of age.
Nutrition
risk behaviour.
However, it is recognized that for some
women, breastfeeding
mayfornot
be possible for example in
l
Postpartum
ARV prophylaxis
mother.
l
Infant feeding and
situations
of maternal death and severe
maternal
illnessServices.
in which case Exclusive Replacement Feeding
l
Family
Planning
nutrition
shouldcounselling.
be done only when AFASS criteria is fulfilled:
l
l
Psycho-social
support
A Affordable F Feasible A Acceptable
S Sustainable
S through
Safe follow-up counselling, home
10.1 Principles of Infant Feeding for HIV Infected Pregnant Women

The 10 principles of infant feeding options for HIV infected pregnant women and their infants are:
Exclusive
breastfeeds
upto women
6 months
(preferred
Option-Iinterventions
WHO/NACOprovided
Guidelines
2010-'11)
l
1.
All HIV infected
pregnant
should
have PPTCT
early
in pregnancy
and
continued
breastfeeds in addition to complement feeds after 6 months upto 1 year for
as far
as possible.
2. Exclusive breastfeeding is the recommended infant feeding choice in the first 6 months, irrespective
l
of the fact that mother is on ART early or infant is provided with ARV prophylaxis for 6 weeks.
l
3. after
MIXED
FEEDING
SHOULD NOT BE DONE AT ANY COST WITHIN THE FIRST 6 MONTHS
cessation
of breastfeeds.
(Feeding breast-feeds
and from
replacement
l
Co-trimoxazole
prophylaxis
6 weeks feeds
of age.simultaneously in the first 6 months).
l
l
60
l
l
the child.
nemoW AFASS
tnangecriteria
rP lla for
ot Exclusive
secivreSReplacement
gnitseT dnaFeeding
gnillesnuoC VIH fo reffO
Mothers known to be HIV-infected, if insist on opting for exclusive replacement
feeding which is contrary to the WHO/NACOs guidelines of giving exclusive
breastfeeds for nfirst
vitagshould
eN VIbe
H
emo6Wmonths,
tnangerPare
detcdoing
efnI Vso
IH at their own risk. eThey
MIXED
FEEDING
should
counselled
not
to
give
any
breast
feeds
during
the
first
six
months.
n
e
m
o
W
t
n
a
n
g
e
r
P
a baby with both breast
NOT be done during
xes efafeeds
S l
.sretnthe
eC first
TRA6tamonths.
sixalyhp(Feeding
orp
.gfeeding
nillesnuwhich
oc
and
replacement
feeds
in
the
first
6
months
is
known
as
mixed
elpuoC l
mucosal
fo shtnom 3 tsrif eleads
ht nihtotiw
ekatredabrasions
nu ot)PTin
M(the
ycngut
angof
erpthe baby facilitating HIV virus entry
.gnillesnuoc
through these abrasions) .ylno ycnangerp
y
l
i
m
a
f
ot segakniL l
Box 14
.
s
I
O
r
e
h
t
o
d
n
a
B
T
r
o
f
g
n
i
n
e
e
r
c
S
l
.
s
e
c
i
v
r
es AFASS
gninnacriteria
lp
When opting for Exclusive Replacement Feeding, they should fulfil the
.
s
I
T
S
r
o
f
t
n
e
m
t
a
e
r
t
d
n
a
g
n
i
n
e
e
r
c
S
l
.smodnoc eerF l
given below:
egnahc ruoivaheB l
noitalevel
cinuand
mmoinc the
dna gninnalp-htrib ,y re1. Safe
viled efaswater
,gniviand
l evitsanitation
isop no gnare
illesassured
nuoC l at the household
community, and can prepare clean feeds
ksir hgih rof )CCB(
reh dna nemow
dna esuops fo gnitset V
IH The
dna gmother
nillesnuor
oc other
xes efacaregiver
s dna elpucan
oC reliably
l
2.
afford to provide.resufficient
ntrap
(milk),
to
support
normal
growth
and
development
replacement feeding
VIH taepeR l
can
sustain
it
un-interruptedly
for
first
6 ,months
of the infant,.rand
gnitset at
etneC TRA ot larrefeR l
g
n
i
r
e
disnoc
tnuoc 4DC no desab nemigleast.
er citcalyhporp VRA ro TRA edivorP l
fi doirep ,wodniw
3. The mother or caregiver can prepare it frequently enough
evitiin
soap clean
si esumanner
ops
gih malnutrition.
evah eh/s ro
so that it is safe and carries a low risk of diarrhoea hand
.ruoivaheb ksir
.4.
rehtThe
om rmother
of sixalyhorpocaregiver
rp VRA mucan,
traptin
soPthel first six months
dna gnexclusively
ideef tnafnIgive
l
replacement
.secfeeding,
iv reS gnand
innaislPfeasible.
ylimaF l
noitirtun
gnillesnuoc
.stisiv emoh hguorht tr5.
oppThe
us gnfamily
ideef tisnasupportive
fnI/tnemecrof
ofnthis
ier Fpractice,
BE l and accepts it .without
forcing
emoh ,gnillesnuoc pu-wher
olloto
f hbreastfeed
guorht tropp
us laicthe
os-ofirst
hcy6
sPmonths.
l
during
4. Only in situations where breastfeeding cannot be done or on individual parents informed decision,
then replacement feeding may be considered only if AFASS Criteria for exclusive replacement
feeding is fulfilled (Figure 8).
f raey 1 obreastfeeding
tpu shtnom 6should
retfa sbe
deedone
f tnem
pmleast
oc ot6nmonths,
oitidda nafter
i sdewhich
eftsaercomplementary
b deunitnoc dnafeeding
5. r oExclusive
forelat
.TRA cirbe
taidintroduced
eaP eviecegradually,
r ohw seibirrespective
ab evitisop DofIEwhether
rof sraeythe
2 oinfant
tpu dnisa diagnosed
seibab evitaHIV
gennegative
DIE
should
or
.
s
k
e
e
w
6
r
o
f
t
n
a
f
n
i
r
o
f
s
i
x
a
l
y
h
p
o
r
p
V
R
A
m
u
t
r
a
p
t
s
o
P
l
positive by EID.
6. Mother should be receiving ART during the whole duration.sof
debreastfeeding
eftsaerb fo noita(remember
ssec retfa it is
lifelong ART for the mother).
.dlihc eht
l
l
l
l
61
2: Components
of PPTCT
Programme should be continued until 12
7. For breastfeeding infants Figure
diagnosed
HIV negative,
breastfeeding
months of age ensuring the mother is on ART as soon as possible.
8. The EID is repeated for the 3rd time (when previous 2 EIDs have been negative) after 6 weeks of
stopping breast feeds, repeat EID i.e., Rapid test followed by DBS (if Rapid Test turns positive)
send DBS test. If DBS is positive, do a WBS test. If WBS test is positive, Paediatric ART should
confirmation
for HIV has to be done at 18 months using
initiated in ART centre. However,
HIV be
Negative
HIV Infected
Pregnanttest
Women
Tests for all babies lirrespective
the(ensure
earlier at-least
EID status
or the fact thatART/ARV
Paediatric ART
3 Rapid
Pregnant
Women
Antenatalof
Care
4 visits)Monthly
l
Safe
has sex
already been initiated.
counselling.
l
Counselling
choices of
continuation
or medical termination
9. Couple
For breastfeeding infants who
have been on
diagnosed
HIV
positive, paediatric
ART shouldofbe
l
counselling.
started and breastfeeding to be continued ideally until the baby is 2 years old.
pregnancy only.
l
Linkages to family
l
Screening
for TBadequate
and other OIs.
10.planning
Breastfeeding
should stop once
a nutritionally
and safe diet without breast milk can
services.
l
be provided.
l
Free
condoms.
l
Behaviour change
l
11. Breast-feeding
ABRUPTLY.
communication should NOT belstopped
(BCC) for high risk
feeding options.
Refer to Annex 9 for flowchartinfant
on counselling
mothers and families for infant feeding 0-6
women and her
l
months of age.
partner.
l
Repeat HIV
The summary charts given in the next few pages, gives the various action points in the continuum
testing,
l
of the PPTCT activities according to infant feeding practices. Most HIV infected women should
considering
l
theirif infants, unless there are special situations described previously.
breastfeed
window,
period
spouse is positive
Nutrition
andchart
linkages
to Government/other
usehave
the summary
charts, lstart
from thecounselling
left side of the
and continue
towards the right
orTos/he
high
Nutrition
programmes.
side.
Advice to the mother/child for ART and for ARV prophylaxis, when to stop or continue infant
risk
behaviour.
l
Postpartum
ARV prophylaxis
l
Infant
feeding and when to continue
or stop breastfeeding
etc.for
is mother.
described on the headings of the
NVP prophylaxis,
l
Family
Planning
Services.
nutrition
charts.
counselling.
l
l
All babies detected positive <2years of age are given Paediatric ART
Box 15 irrespective of CD4 %

l
l
l
l
l
l
62
l
l
the child.
Chart 1: Exclusive Breastfeeding (EBF)
nesummary
moW tnan
gerP llContinuum
a ot secivreofS Prevention
gnitseT dnof
a gHIV
nilleTransmission
snuoC VIH fofrom
reffOParent-to-Child
Infant feeding
charts:
(PPTCT) through ante natal, labour/delivery, post partum and infant feeding options
6 weeks
when
em
oh ,mother
gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP
has been initiated on
ART later in pregnancy
or post partum)
EID positive
6 months
24 months
Confirmation of HIV status by 3 antibody HIV tests at 18

months of age, irrespective of the results of the earlier EID
status
Introduce complementary feeding at 6 months of age as

usual
HIV positive pregnant woman
evitageN VIH
Mother antiretroviral drug regimen
n
e
m
oW tnangerP
xes efaS l
ART
Infant Feeding
.
g
n
i
llesnChoice
uoc
Eligibility
elpuoC l
fo shtnom 3 tsrif eht nihtiw ekatrednu ot)PTAntenatal
M( ycnangerp During
Postpartum
.gnillesnuoc
Mother
and
.yln(AN)
o ycnangerLabour
p
yl(PP)
imaf ot segakniL l
Delivery
.seciv res gninnalp
.sITS rof tnemtaertInitiate
dna gnmother
ineercon
S lifelong
l
.smodnoc eerF l
ART, irrespective
egART
nahc ruoivaheB l
tset regimen
4DC dnfor
a gnigatsoflapregnancy
cinilc OHgestation
W l and Continue
HIV Positive .gniART
throughout AN, labour/delivery, PP throughout
noitacinummEBF
oc
dna gninnalp-hPregnant
trib ,y revilemothers
d efas ,gown
nivihealth
l evitisop breastfeeding
no gnillesnuperiod
oC land thereafter life-long
women
TDF+3TC+EFV
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
Infant NVP: Give first
dose of NVP within
EID*results at
Stop
BF
at
,gnitset
6 weeks
EBF till
6 to 12 hours of
Remarks
(Maximum
g
n
i
r
e
disnoc
tnuoc and
4DCcontinue
no desab nemiger citcalyhporp VRA ro TRA edivorPTime
l
delivery
fi doirep ,wodniw
daily NVP for ***
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
dna gnideefStopping
tnafnI l
breastfeeds should
EID negative
.6semonths
civ reS gninnalP ylim12
aF months
l
n
o
i
tirtgradually
un
be done
6 weeks minimum
.gnwithin
illesn1uomonth
c
.stisiv eanother
moh hguorht troppus gnideef tnafnI/tnemecrofnier FBE l
(consider
Infants diagnosed
EID positive should
be on ART as per
national paediatric
tnafnI desguidelines
opxE VIH
)IEH(
*EID means DNA /PCR screening at ICTC, and if detected positive, confirmation by Whole Blood Specimen (WBS) at the ART
centre. .TRA cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIE
**Wherever written HIV positive pregnant women, kindly read it as HIV infected pregnant women.
***6 weeks after cessation of breastfeeds the babys 3rd EID should be done if earlier EID tests were negative(Rapid Test
skeewdo6DBS;
& shiftnDBS
om positive;
21 ,shtndoom
6 taifgWBS
nitsepositive,
t taeperstart
;egaPaediatric
fo skeewART,
6 tairrespective
)DIE( sisoofnbabys
gaid tnCD4
afni%.ylraE l
positive,
WBS;
.
s
d
e
e
f
t
s
a
e
r
b
f
o
n
o
i
t
a
s
sec retfa
+ Follow up as usual at ART centre for routine ART monitoring.
.dlihc eht
Chart 2: Exclusive Replacement Feeding (ERF)
4.
Offerwomen
of HIVwho
Counselling
and Testing
to all also
Pregnant
Note: HIV infected
become pregnant
whileServices
on ART should
follow Women
the charts below
Confirmation of HIV status by 3 antibody HIV tests at 18

months of age, irrespective of the results of the EID tests
done earlier
when mother has been

initiated late in pregnancy
or post-partum)
Introduce complementary feeding at 6 months of age as

usual and continue BF
HIV positive Pregnant Woman
Infant feeding summary charts: Continuum of Prevention of HIV Transmission from

Parent-to-Child (PPTCT) through ante natal, labour/delivery, postpartum and infant feeding options
HIV Negative
Pregnant Women
l
l
Safe sex
prophylaxis
at ART Centers.
Mother
Antenatal (AN)
Postpartum
counselling.
Infant feeding
ART eligibility
Mother
antiretroviral
labour
l
Counselling
on choicesDuring
of continuation
or (PP)
medical termination
choice of
l
Couple
drug (MTP)to
regimen
and delivery within the first 3 months of
pregnancy
undertake
counselling.
pregnancy only.
l
Linkages to family
l
planning services.
l
l
Free condoms.
l
Behaviour change
l
WHO
clinical
CD4 testing.
Initiatestaging
mother and
on life-long
ART, irrespective of
ART regimen
for
HIV positive
pregnancy gestation and continue ART throughout
mothers own
health
communication
l
Counselling on positive living, safe delivery, birth-planning
and
pregnant
ERF
AN, labour/delivery, PP and thereafter life- long
(BCC) forwomen
high risk TDF+3TC+EFV
women and her
l
partner.
l
Repeat HIV
testing,
Infant
NVP: Give first
EID* results at
EBF till
Remarks
l
Referral
to ART Center.
dose of
NVP within 6 to
6 weeks
considering
l
12 hours
of delivery
and if
window,
period
continue daily
spouse
is positive
NVP for....
l
or s/he have high
Nutrition
programmes.
risk behaviour.
l
l
Infant feeding and
l
nutrition
counselling.
l
EBF6 reinforcement/Infant
EID negative
months
l
6 weeks minimum
Infants diagnosed EID
(consider another 6 weeks
positive should be initiated
on ART as per national
paediatric guidelines

EID positive
6 months
l
* EID means DNA/ PCR screening at ICTC, and if detected positive, confirmation by Whole Blood Specimen (WBS) at the
ART l
centre.
Follow
up asinfant
usual at
ART centre(EID)
for routine
ART monitoring.
l
Early
diagnosis
at 6 weeks
of age; repeat testing at 6 months, 12 months & 6 weeks
* If pregnant
woman
is
detected
HIV
positive
do
not
delay
initiation of ART as per National Guidelines.
If mother is detected as HIV positive AFTER DELIVERY, her infant should receive infant NVP prophylaxis for minimum of 6
l
Co-trimoxazole
prophylaxis
from ART
6 weeks
weeks.and
she should be linked
to the closest
Centreof age.
l
l
64
l
l
the child.
Chart 3: Antiretroviral Treatment for Women Presenting Directly-In-Labour, Immediately

Postpartum and prophylaxis for their Infants, Including Infant Feeding Options
Women with unknown status
presenting in labour or immediately
post-delivery and undergoes HIV
screening

ART
eligibility
Mother antiretroviral drug regimen

Mother
Antenatal
(AN)
During labour
and delivery

VRA/TRA ylhtnoMWomen
)stisiv 4
tsael-ta erusne( eraC latanetnA l
in direct
labour who are
Unknown
detected HIV
fo noitanimreCD4
t lacatidem ro positive
noitaunusing
itnoc fo secnone
iohc no gniTDF+3TC+EFV
llesnuoC l
baseline
fo shtnom 3
tsrif eht whole
nihtiwblood
ekafinger
trednu ot)PTM( ycnangerp
.ylno ycnangerp
prick testing
Postpartum ART to be initiated as soon as
possible (sample for CD4 testing
.gncollected
itset 4Dby
C dna gnigatsInfant
lacinNVP:
ilc OHW l
Give first dose of NVP within
Lab Technician the following day during HIV
dna gninnalp-htrib ,y reviled efas ,gnivil ev6itto
iso12
p nhours
o gnioflledelivery
snuoC and
l
confirmation and reached to ART Centre and
CD4 report handed over to Mother before
.scontinue
noitpo gfor
nidminimum
eef tnafnofi 6
weeks
discharge if mother is not likely to go to ART
dnacentre
esuopwithin
s fo gthe
nitsnext
et V2IHdays)
dna gnillesnuoc xes efas dna elpuoC l
After initial 6 weeks, continue
.reinfant
tneC NVP
TRAuntil
ot lamother
rrefeRhasl
Mother
needs
ART
for
her
own
health*
completed
at
least
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA ed6ivweeks
orP of
l
maternal ART. Thereafter, infant
.gnigNVP
ats lacan
cinbe
ilcstopped
ro/dna
Postpartum (PP)
Infant feeding
choice
evitageN VIH
nemoW
anmonths,
gerP
EBFtn(6
ifxalready
es efaSstarted
l
on
.gnillebreast
snuocfeeds)
TDF+3TC+EFV
otherwise
elp(6months
uoC l
ERF
.gnifillalternate
esnuoc feeds
ylimaf ot salready
egaknstarted)
iL l
.seciv res gninnalp
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir EID
hgihresults
rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
EID positive
,gnitset
gniredisnoc
fi EID
doirnegative
ep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
11
Care and Follow-up of
HIV Exposed Infants
emand
margfollow
orP TCTup
PP factivities
o stnenopmfor
oC all
:2 eHIV
rugiFexposed infants.
Table 10: A checklist for the care
Any intervention or ARV prophylaxis given to the HIV exposed newborn should be documented in the
child health card
nembefore
oW tnadischarge.
ngerP lla The
ot sfollowing
ecivreS gshould
nitseTbe
dnnoted
a gnilin
lesthe
nuocard:
C VIH fo reffO
Whether the infant had received ARV prophylaxis and the duration received/advice
What feeding choice the mother has made? Whether EBF or ERF?
evitageN VIH
Date of next follow-up.
n
e
m
oW tnangerP
.sretneC TRA taVisit
sixalyhat
porp6 Weeks/ First xes efaS l
11.1 During the First Post-delivery
.gnillesnuoc
fo noitImmunization
animret lacidem ro noVisit
itaunitnoc fo seciohc no gnillesnuoC l
elpuoC l
.gnillesnuoc
All HIV exposed infants must be checked for the following
.ylno ycnaat
ngethe
rp first immunization visit to ICTC health
facility:
.seciv res gninnalp
.
s
I
T
S
r
o
f
t
n
e
m
t
a
e
r
t
d
n
a
g
n
i
n
e
e
r
c
S
l
.smodnon
oc eextending
erF l
Co-trimoxazole Prophylactic Therapy (CPT) initiated at 6 weeks of age (decision
Syp NVP to 12 weeks).
egnahc ruoivaheB l
noitacinummoc
dnaAdherence
gninnalp-hof
tribinfant
,y reviNVP
led efprophylaxis
as ,gnivil evifor
tisothe
p nopast
gnill6esweeks.
nuoC l

ksir hgih rof )CCB(
reh dna nemow
EID (DNA/PCR) as per National Guidelines.
.rentrap
Decision made whether to stop infant.nNVP
prophylaxis
or
continue
as
per
guidelines
erdlihc gnivil rehto
VIH ta(see
epeRbelow)
l
,
g
n
i
t
s
e
t
.retnemothers
C TRA otare
larrnot
efeRtaking
l
For exclusively breastfed infants whose
ART:
gniredisnoc
tnuoco 4DThe
C nopattern
desab nofemfeeding,
iger citcaattachment
lyhporp VRAand
ro TR
A edivorP &l mothers breast condition
positioning
be
fi doirep ,wodnimust
w
enquired.
evitisop si esuops
hgih evah eh/s ro
o Any infant with problems must .have
semmaamedical
rgorp noiassessment.
tirtuN
.ruoivaheb ksir
.rehsupply
tom rofofsixinfant
alyhposyrup
rp VRANVP
mutprophylaxis
raptsoP l at ICTCs fordnall
o Provide 6 weeks
a gHIV
nideexposed
ef tnafnIbabies
l
(3 bottles of Sy NVP:25 ml).seciv reS gninnalP ylimaF l
noitirtun
.gnillesnuoc
.stisoiv em
oh hgufor
orhmonthly
t troppusfollow-up
gnideef tnofafthe
nI/tninfants.
emecrofnier FBE l
Arrange
o Such mothers have to be on life-long ART
For infants on exclusive replacement feeding, check with the parents and family if any problems
faced so far:
o Emphasise good hygiene, use of clean boiled water, hand-washing.

)
1
1
'
0
1
0
2
s
e
n
i
l
e
d
i
u
G
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C
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I
n
o
i
t
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d
e
r
r
e
f
e
r
p
(
s
h
t
n
o
m
6
o
t
p
u
eeftsaprophylaxis
erb evisulcxEis to
l
Any infant with problems must have a medical assessment. NVPsd
infant
be
rostopped
f raey 1at
otp
shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
6uweeks:
o How and what are being given as exclusive replacement feeds?
o

When
has
the
mother
been
started
on
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeperlife-long
;ega fo sART
keewto6know
ta )DIthe
E( sduration
isongaid t(atleast
nafni ylr24
aE weeks
l
of ART)
o All infants with HIV DNA/ PCR positive results
.ega fo stokebe
ewreferred
6 morf surgently
ixalyhporto
p ethe
lozaART
xomcentre
irt-oC asl per
guidelines.
.dlihc eht
l
l
l
67
Figure
2: Components
PPTCTtest
Programme
o Confirmation with Whole
Blood
Specimenof(WBS)
will be done at the ART centre.
o All infants/children less than 2 years of age with a confirmed Whole Blood Specimen(WBS)
Offer status
of HIVatCounselling
and Testing
Services
to all Pregnant
Women of CD4 % at
positive
ART centre should
be initiated
on Paediatric
ART, irrespective
the earliest.
o All HIV-exposed infants should be followed-up monthly, in the first year of life and every
3 months thereafter, regardless of the infant feeding practice being adopted.
HIV Negative
o
Any
infant
clinically
suspected
of having
HIV(ensure
shouldat-least
be tested
for HIV, regardless
of their age.
Pregnant Women
l
Antenatal
Care
4 visits)Monthly
ART/ARV
l
Safe sex
prophylaxis
at ART
Centers.
o All HIV exposed infants irrespective
of prior
status,
should have the final confirmatory HIV
counselling.
l
tests at
l
Couple
counselling.
o 18 months in any ICTC using
3 Rapidonly.
Anti-body tests, even if the first rapid test is negative.
pregnancy
l
Linkages to family
Screening
TBat
and
o No DBS/WBS
to be for
done
orother
afterOIs.
18 months.
planning
services. (DNA/PCR) ltesting
l
l
Freethat
condoms.
Activities
need to be conducted at each visit are shown below:
l
Behaviour change
l
Table
10: Activities at Each Follow-up Visit for HIV Exposed Infants and Children < 18 Months
communication
l
(BCC) for high
risk 6 wks 10 wks 14 wks
Visit
Birth
6 mths
9 mths
12 mths
18 mths
women and her
Co-trimoxazole
l Start CPTl from
6 weeks
(orsafe
first sex
immunization
visit) and
for allHIV
HIV-exposed
and children
Couple
and
counselling
testing infants
of spouse
and
partner.
prophylactic
l Continue CPTother
for all living
babieschildren.
up to 18 months irrespective of EID status and thereafter if
l
Repeat
HIV
therapy
(CPT)
confirms positive
testing,
l
Counselling for
Exclusive
BF+complementary
If EID is ve
considering
l
Provide ART or ARVfeeds
prophylactic regimen based
breast
stop BF.on CD4 count
Infant feeding
window, period
if
feeds for
Continue
spouse is positive
first six
BF if EID is
l
Nutrition counselling and linkages to +ve
Government/other
months
after
or s/he have
high
Nutrition
programmes.
12 months
risk behaviour.
l
Postpartum ARV prophylaxis for mother. up to 2 yrs
l
Infant feeding and
Growth
l
Family
Planning
Services.
nutrition
monitoring
counselling.
l
EBFreinforcement/Infant
feedingsupport through
homevisits.
Developmental
assessment
l
Immunization
BCG
OPV 1
OPV 2visits
OPV
3 support groups.
Measles
OPV DPT
and
& Vitamin A
supplements
HBV0*
OPV0
Clinical
HIV ExposedInfant
assessment
DPT 1
HBV 1*
DPT 2
HBV 2
DPT 3
HBV 3
+ Vit. A
and Measles
(Booster
doses) Vit.A
(HEI)
l
HIV testing
+/- (12
and continued breastfeeds

1 yearAllfor
(DNA/ in addition to complement
(Rapid feeds
Test after 6 months upto
months)
3 Rapid
(-if required)
PCR) upto 2 years for EID positive
+ DNA/PCR)
Rapid TestART.
Tests(No
EID negative babies and
babies who receive Paediatric
+ DNA/PCR) DNA/PCR)
l
*HBV vaccines as per state approved schedules
infant
diagnosis
(EID) at 6 weeks of age; repeat testing at 6 months, 12 months & 6 weeks
Note:l 18Early
months
OPV
and DPT booster
For any illness
educate
parents/caregiver
after cessation of breastfeeds.to bring infant/child back to ICTC at the earliest.
6 weeks after cessation of breastfeeds, HIV testing to be done (Rapid and DNA/PCR, if former is positive).
l
l
l
68
l
l
the child.

11.2 Confirmation ofemHIV
Status in HIV Exposed Infants should be
done at 18 Months, Regardless of Earlier Diagnosis
All HIV exposed infants and children regardless of HIV status will be followed-up until 18 months
of age for care, monitoring and the final confirmatory HIV test at 18 months using 3 HIV Rapid
tests (even if HIV-1 rapid test is negative).
evitageN VIH
If any HIV exposed infant or child develops clinical signs and symptoms suggestive of HIV infection,
n
e
m
oW tnangerP
the Medical Officer at the health care facility should start immediate treatment for the acute
xes efaS l
.sretnetoC T
RA Centre.
ta sixalyhHIV
portesting
p
ART
according to the
illness, stabilise and refer urgently
.gnnational
illesnuoctesting
fo noialgorithm
tanimret lafor
cidinfants
em ro nand
oitauchildren
nitnoc fo <18
seciohcmonths
no gnillealso
snuohas
C to
l
be done.
elpuoC l
.gnillesnuoc
.ylno ycstarted
nangerpon ART shall be done by ART centres in
Follow-up of HIV infected infants and children
collaboration with the Paediatrician
.sIO rehto at
dnathe
BTinstitution
rof gnineerwhere
cS l ART Centre.sis
eclocated.
iv res gninInfants
nalp and
children on ART must undergo
.sITS rothe
f tnconfirmatory
emtaert dna gthree
nineeantibody
rcS l tests at 18-months
.smodnoof
c eage
erF inl the
test. egnahc ruoivaheB l
nearest ICTC, irrespective
.gnitseof
t 4the
DC results
dna gnigofatthe
s lacfirst
inilcrapid
OHWantibody
l
noitacinummoc
dnaNo
gniDBS
nnalp
htrib ,(DNA/PCR)
y reviled efatesting
s ,gnivilto
evbe
itisodone
p no at
gnior
lleafter
snuoC18 lmonths.

&-WBS
ksir hgih rof )CCB(
reh dna nem18
owmonth
dnaInescase
there
is
discordance
with
DNA/PCR
WBS) and subsequent
uops fo gnitset VIH dna gnillesnuoc xes efas tests
dna e(DBS
lpuoC and
l
.rentrap
anti-body test, such cases should be referred to NPO (ART) electronically for further guidance
VIH taepeR l
but to be on or continued paed. ART. (this guidance shall be finalised over the next six months
,gnitset
and intimated accordingly)
g
n
i
r
e
disnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
12
Essential Gynaecologic Care for
emHIV
marginfected
orP TCTPpregnant
P fo stnenowomen,
pmoC :2 erapart
ugiF from ART and pre-ART care, key
During the long term follow-up of
areas which must be discussed, are:
nem
oW tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO
Cervical
screening
Family planning and birth-spacing
Contraception
evitageN VIH
n
e
m
oW tnangerP
12.1 Cervical Screening .sretneC TRA ta sixalyhporp
xes efaS l
.
g
n
i
llescancer.
nuoc The
Women
leading to cervical
fo noitinfected
animret with
lacidHIV
em rare
o noatitahigher
unitnorisk
c fo of
secdeveloping
iohc no gnicervical
llesnuoCdysplasia
l
e
l
p
uoC Geno
l
Human
more
pregnant women, particularly
fo shPapilloma
tnom 3 tsvirus
rif eh(HPV)
t nihtinfection
iw ekatreisdn
u otcommon
)PTM( yin
cnHIV
anginfected
erp
.gnillesnuoc
types 16, 18 and others incriminated to be carcinogenic
.ylno ycbeing
nangeIARC
rp (WHO) 31,33,35,39,45,51,52,56,
cancer.
ART Guidelines for adults and
58,59 & 68 more incriminated to cause
.sIO recervical
hto dna B
T rof gniIn
nethe
ercSNational
l
.seciv res gninnalp
adolescents, cervical screening .eg.
Pap
smear
or
trichloro-acetic
acid
screening
of the cervix should be
sITS rof tnemtaert dna gnineercS l
.smodnoc eerF l
done annually for all HIV infected pregnant women.
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB(
12.2 Family Planning and Birth-spacing
reh dna nemow
na esand
uopsPPTCT
fo gnitsbeing
et VIH increasingly
dna gnillesnuavailable,
oc xes efas HIV
dna infected
elpuoC pregnant
l
With dART
women and .men
rentraare
p now
living longer and healthier lives and desiring .to
have
children.
Accordingly,
reproductive
plans
including
nerdlihc gnivil rehto
VIH taepeR l
pre- conception counselling, and counselling
regarding
reversible
methods
of
contraception
be
,gnitshould
set
discussed with HIV infected pregnant women of child bearing age.
g
n
i
r
e
d
i
s
n
o
c
fi doirep ,wodniw
.gnigats lawomen
cinilc ro/d
na similar to non-HIV
Pre-conception counsellingHIV infected pregnant
are
evitisoinfected
p si esuopregnant
ps
rehto/tThe
nemgoals
nrevoare
G otot improve
segaknithe
l dhealth
na gnof
illethe
snuwoman
oc noitbefore
irtuN conception
l
women.
and
to
identify
hgih evah ehrisk
/s rofactors
semmainclude:
rgorp noitirtuN
for adverse maternal and foetal outcomes. .These
.ruoivaheb ksir
d
n
a
gnideef tnafnI l
Safe sex practice
noitirtun

Prevent
test
and
treat
STI.
.gnillesnuoc
eReproductive
including
moh ,gnillesnuhistory
oc pu-w
ollof hguonumbers
rht troppof
uspregnancies
laicos-ohcysand
P loutcomes of pregnancies.
.spuopartner,
rg troppuHIV
s dnstatus
a stisivof partner and couples sexual history
Length of relationship with current
including condom use and sexual decision-making or control of reproductive choices.
Patients and partners reproductive desires and discussion of options.
Reduce/avoid risky behaviour eg. smoking, substance abuse.
roTake
f raefolic
y 1 oacid
tpu sbefore
htnomconception.
6 retfa sdeef tnemelpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
Family planning counselling5 information includes:
sk
eewInformation
6 & shtnomabout
21 ,sheffective
tnom 6 tacontraceptive
gnitset taepermethods
;ega fo sktoeeprevent
w 6 ta )Dpregnancy,
IE( sisongaidual
d tnaprotection;
fni ylraE l the
.
s
d
e
e
f
t
s
a
e
r
b
f
o
n
o
i
t
a
s
s
ec retfa
effects of progression of HIV disease on the womans health;
.egGuidelines
a fo skeew
mortreatment
f sixalyhpand
orpsupport
elozaxfor
omwomen
irt-oCliving
l
5
Sexual and reproductive health of women living with HIV/AIDS
on6care,
with HIV/AIDS and.Dtheir
IE hchildren
guorht in
evresource-constrained
itisop VIH sa desonsettings.
gaid neWHO/UNFPA
rdlihc dna s2006.
tnafni rof TRA deP dna erac VIH l
.dlihc eht
2: Components
of PPTCT Programme
The importance of family Figure
planning
and birth planning;
The risk of HIV transmission to an uninfected partner while having unprotected intercourse (for
Offer
of HIV
and Testing Services to all Pregnant Women
tryingCounselling
to become pregnant);
instance,
when
The risk of transmission of HIV to the infant and the risks and benefits of Antiretroviral prophylaxis
in reducing transmission; and
HIV Negative
Information on the interactions between HIV and pregnancy, including a possible increase in
Pregnant Women
l
certain
l
Safe
sex adverse pregnancy outcomes.
counselling.
l
Contraceptive
l
Couple Methods
counselling.
Most women with asymptomatic HIV and
those who
pregnancy
only.are on ART can safely use the available forms of
l
Linkages to family
pregnancies.
However,
prevention of cross-infection of HIV
contraception for preventing unintended
l
Screening for TB and
other OIs.
planning services.
virusl toFree
thecondoms.
partner as well as STIs isl important
dual for
protection
Screeningand
andhence
treatment
STIs. with consistent condom use
is important.
Dualchange
protection refers to
simultaneous
protection
against
both unplanned pregnancy and
l
Behaviour
l
and CD4
testing.
HIV by using:
STIs and
communication
l
(BCC) for high risk
infant
feeding options.
women
Condoms
with another
effective
method of contraception, including emergency
and together
her
l
contraception.
partner.
l
Repeat HIV
Available forms of contraception for HIV infected pregnant women include: Hormonal contraception: is
testing,
l
safe in women living with HIV. These may be either:
considering
l
period if
window,
Oral contraceptives
spouse is positive
l
s/he have
high
orDepot
medroxyprogesterone
acetate (DMPA)
Nutrition
programmes.
risk behaviour.
DMPA
is safefeeding
to useand
in women living
with HIV asARV
wellprophylaxis
as those on
There is no hormone-drug
l
Postpartum
for ART.
mother.
l
Infant
interaction
with several ARV drugs commonly
suchServices.
as NVP, EFV and Nelfinavir.
l
Family used
Planning
nutrition
counselling.
feedingcontraception
support through
homeAdherence
visits.
> 350
cells/mm3), hormonal
is safe.
In women living with HIV (whose CD4l isEBF
l
Psycho-social
support through
follow-up
counselling,
to oral contraception needs to be counselled.
Dual protection
with consistent
condom
use ishome
important.
In women taking ART for their own health, they should be assessed for oral contraception use according
to the WHO Medical Eligibility Criteria for Contraceptive Use guidelines6. There may be hormone-drug
interactions which need dosing to be adjusted or an alternative contraception to be used
l
Ritonavir
for women
taking
ritonavir EID
Combined
contraception
arefor
generally
not recommended
negativeoral
babies
and upto 2pills
years
EID positive
babies who receive
Paediatric
ART.
efficacy of the contraception
boosted PIs,
dueprophylaxis
to the potentially
decreased
l
Postpartum
ARV
for infant
for 6 weeks.
l
7
Medical
Eligibility Criteria for
Contraceptive
Use.
4th edition.
WHO 2009. http://www.who.int/reproductivehealth/publical
Co-trimoxazole
prophylaxis
from
6 weeks
of age.
tions/family_planning/en/index.html
l
l
72
l
l
the child.
Nevirapine
o NVP reduces the levels of combined oral contraception (ethinyl estradiol and norethindrone)
neat
mopresent,
W tnanno
gerdosage
P lla otmodification
secivreS gare
nitsbeing
eT dnsuggested
a gnillesnuoC VIH fo reffO
but
Efavirenz:
o Women taking EFV may be able to take combined oral contraception without loss of
evitageN VIH
contraceptive efficacy
n
e
m
oW tnangerP
xes efaS l
NRTI such as AZT and TDF: .sretneC TRA ta sixalyhporp
.gnillesnuoc
elpuoC l
o Women taking AZT and TDF may take combined oral contraception without loss of contraceptive
.gnillesnuoc
efficacy
.ylno ycnangerp
.sIO redoes
hto dnnot
a Bprotect
T rof gniagainst
neercS STIs,
l
Lactational Amenorrhoea Method (LAM)
pregnancy
Correct
.seand
civ reHIV.
s gnin
nalp and
.
s
I
T
S
r
o
f
t
n
e
m
t
a
e
r
t
d
n
a
g
n
i
n
e
e
r
c
S
l
consistent condom use should be adopted at every sexual encounter.
.smodnoc eerF l
egnahc ruoivaheB l
Male sterilization (NSV): Males should be motivated at every mother-baby pair follow-up
noitacivisit
numto
moundergo
c
sterilization. No Scalpel Vasectomy (NSV) when the baby attains 18 months/2
ksir hyears
gih roof
f )Cage
CB((at 18
months confirmatory test, irrespective of the babys HIV status). However, afterreNSV
h dnoperation,
a nemow male
d
n
a
e
s
u
o
p
s
f
o
g
n
i
t
s
e
t
V
I
H
d
n
a
g
n
i
l
l
e
s
n
u
o
c
x
e
s
e
f
a
s
d
n
a
e
l
p
u
7 oC l
.rentrap
should continue to use a condom at every sexual encounter.
VIH taepeR l
,gnitset
Intra-Uterine Contraceptive Device (IUCD) is a good contraceptive gmethod
n
i
r
e
disnfor
oc HIV
tnuoc 4DC no desabinfected
nemigepregnant
r citcalyhpwomen.
orp VRAIUCD
ro T8RCopper
A edivoTrP380A
l
is recommended
fi doirepby,wMoHFW
odniw as
nigats lacinilc ro/dna
Box 16 a long term reversible.gmethod
of contraception up to 10 years.
evitisopPPsi IUD
esuo(Cu-T
ps
hgih evah eh/s ro
A-380) to be inserted within 48 hrs of delivery.
.ruoivaheb ksir
PP .IUD
rehto- mPostpartum
rof sixalyhpoIUD
rp Vrequires
RA mutraspecialised
ptsoP l training before
dna gnthe
ideefhealthcare
tnafnI l
personnel undertake
.secthe
iv resame.
S gninnalP ylimaF l
noitirtun
.gnillesnuoc

8
IUCD Reference manual
.DIE hgfor
uoMedical
rht evitOfficers
isop VI2007.
H sa dFamily
esongPlanning
aid nerdDivision.
lihc dnaMoHFW.
stnafni rof TRA deP dna erac VIH l
.dlihc eht
13
Monitoring and Evaluation Tools
emmathe
rgorassessment
P TCTPP fo stnof
enothe
pmoperformance
C :2 erugiF of an individual as well as the
Monitoring and evaluation facilitates
performance of the programme, which forms the basis of decision making, policy planning and resource
allocation andnemid-term
moW tnacorrections,
ngerP lla oift required.
secivreS gnitseT dna gnillesnuoC VIH fo reffO
Client Monitoring
Monitoring of HIV infected pregnant women is an essential component of quality patient care in PPTCT
evitageN VIH
programme. It involves documenting all client encounters by maintaining regular and accurate records of
n
e
m
oW tnangerP
key aspects of the services provided to the PPTCT beneficiaries and her baby.
xes efaS l
.
g
n
i
llesnuoc
A set
fo nof
oitM&E
animtools
ret lachave
idembeen
ro noidevised
taunitnoto
c foensure
seciohthat
c no gcontinuum
nillesnuoC oflcare from detection of HIV infection
elpuoC l
among
fo shpregnant
tnom 3 twomen
srif eht to
nihtheir
tiw elinkage
katrednto
u ART
ot)Pcentre
TM( yand
cnanfor
gerEID
p after delivery is well maintained. In
.gnillesnuoc
.ylno aycPPTCT
nangerpbeneficiary Line-list has been designed,
addition to regular CMIS format of monthly reporting
basis
which shall be updated on an event
.sIO
rehtobydnICTCs
a BT rand
of gnART
ineecentres
rcS l to ensure delivery
.seciv resofgnthe
innacomplete
lp
Feeding
package of PPTCT services to all.spregnant
ITS rof tnewomen
mtaert dviz
naAnti-Retroviral
gnineercS l Therapy, Delivery;
.smodnoc eerFhistory;
l
Early Infant Diagnosis along.gwith
confirmation
egnahc ruoivaheB l
nitsefinal
t 4DC
dna gnigats at
lac18
inilcmonths.
OHW l
noitacinummoc
ksir hgih rof )CCB(
13.1 Guidance on Data Flow .of
snoPPTCT
itpo gnideeBeneficiaries
f tnafni
reh dna nemow
.rentrline-list
ap
1. A line-list has been devised for the PPTCT beneficiaries and is labeled as Tool 1. This
is
.
n
e
r
d
l
i
h
c
g
n
i
v
i
l
r
e
h
t
o
V
I
H
t
a
e
p
e
R
l
meant for all PPTCT beneficiaries (Pregnant Women in antenatal care, Direct-in-labour & Post,gnitswhere
et
.retnelineC TRA
larreoriginate
feR l at the concerned ICTC
delivery; breastfeeding mothers). This
listot will
a
g
n
i
r
e
d
i
s
n
o
c
tnuocpregnant
4DC no dwoman
esab neismdetected
iger citcalto
yhpbe
orp
VRA ro This
TRA will
edivobe
rP anl electronic format and shall NOT be
positive.
fi doirep ,wodniw
.
g
n
i
g
a
t
s
l
a
c
i
n
i
l
c
r
o
/
d
n
a
printed in a register form at present.
evitisop si esuops
hgih evah eh/s ro
2. The ICTC generating this line-list will
numbers 1 to 17 d; 29 to 37c and 42 &
.sefill
mmup
argthe
orpcolumn
noitirtuN
.ruoivaheb ksir
43 (Colour coded .in
rehyellow).
tom rof sixalyhporp VRA mutraptsoP l
civ rICTC
eS gniwith
nnalPthe
ylimART
aF lcentre, where the positive
noitirtupregnant
n
3. When this line-list is shared by.sethe
.g18
nilletosn28;
uoc38a to
.stiswoman
iv emohishgregistered,
uorht troppthe
us gconcerned
nideef tnafART
nI/tnecentre
mecrowill
fnierfill
FBup
E the
l column numbers
e38d;
moh ,39
gnilto
les41;
nuo44a
c pu-to
wo47
llof (Colour
hguorhtcoded
troppuin
s lagreen).
icos-ohcysP l
4. Columns 23, 24 and 25 can be filled up by ICTC counsellor if and when applicable.
5. The line-lists should be generated at ICTC on the first visit of a new HIV positive pregnant case
presenting either during pregnancy, direct-in-labour or after delivery.
)IEOne
H( trow
nafnshould
I desopbe
xEassigned
VIH
the
when
auwomen
ante-natal
is
)1for
1'-0each
102 client.
senilediMost
uG OCoften,
AN/OH
W first
I-noitvisit
pO diserrat
efethe
rp( sICTC
htnom
6 otp
sdeeftsainerb
evisulcxEcare
l
detected
to
have
HIV
infection.
Hence,
line-lists
will
be
generated
there
and
details
shared
with
the
.TRAART
cirtaCentre
ideaP efor
vieentry
cer ohof
w relevant
seibab evinformation.
itisop DIE roSometimes
f sraey 2 otpan
u dHIV
na sinfected
eibab evipregnant
tagen DIEwoman
may have her first visit at the ART Centre,
.skerather
ew 6 rothan
f tnafICTC
ni rof eg.
sixaalypositive
hporp VRfemale
A mutraclient
ptsoPalready
l
enrolled
at
ART
centre,
gets
pregnant
or
has
a
second
pregnancy
after
previously
being
detected.
In such cases, the line-list will be generated at the ART Centre
.sdeeand
ftsaeafter
rb fo the
noitarelevant
ssec retfcolumns
a
have been filled up, the line-list will be shared
by
the
ART
centre
with
the
ICTC
for
.ega fo skeew 6 morf sixalyhporp elozaxomirt-oC further
l
follow-up.
.dlihc eht
Figure 2:at
Components
of PPTCT
Programme
6. This line-list should be updated
each activity
in the
continuum of PPTCT care services eg.
ANC/ICTC visits, CD4 test, ART initiation, delivery, Syp. NVP initiation, CPT initiation, EID visits,
immunization
shared onand
a weekly
between
ICTC
and ART
centre counsellors
Offer ofetc.
HIVand
Counselling
Testingbasis
Services
to all
Pregnant
Women
and staff. If it is not possible to share information weekly then the information about all newly
detected HIV positive cases at ICTCs must be given to the ART Centre by the District Supervisor/
DAPCU officer where client wants to get enrolled for the early registration and initiation of ART.
outs of this electronically
shared
line-lists
on a Women
monthly basis after updating them should be
HIV Print
Negative
HIV
Infected
Pregnant
kept
in
a
ringbinder
file
both
at
the
ICTCs
and
ART
Pregnant Women
l
Antenatal Care (ensureCentres.
at-least 4 visits)Monthly ART/ARV
l
Safe sex
at ARTICTCs
Centers.
7. counselling.
The updated line-lists should beprophylaxis
shared between
and ART Centres on a monthly basis at
l
Counselling
on
choices
of
continuation
or the
medical
termination
of
DAPCU/District level monthly co-ordination meetings (which
are held by
5th of
every month).
l
Couple
pregnancy
(MTP)to
undertake
within
the
first
3
months
and
List of LFUs should be generated during DAPCU/Monthly co-ordination meetings at District of
counselling.
pregnancy only.
with
respective
ICTCs/ANMs/
ASHAs
/Outreach
workers/District
Level
Networks
for
followshared
l
Linkages to family
l
planning
services.
up. District
Nodal persons should take responsibility of linkages of all the newly detected HIV
l
Screening
and treatment
for STIs. Networks of Positive People
l
Free
condoms.
cases
with ANMs/ASHAs /Community
Out-reach
Workers/District
l
Behaviour
l
WHO
clinical staging
andby
CD4
testing.
Accompanied
referral
them
should be ensured so that the
as well aschange
tracking of LFU cases.
communication
Counselling
positive
living, safe delivery, birth-planning and
Centre ason
soon
as possible.
pregnant woman reaches thel ART
(BCC) for high risk
her
8. women
In caseand
the expected
place of delivery is in another district, it is the responsibility of ICTC counsellor
l
partner.
of the centre where her original registration was done, to inform the ICTC counsellor of expected
l
Repeat
HIV
delivery with copy to DAPCU/District Supervisor and other concerned officials at SACS.
place of
testing,
l
Referral
ART
This is to ensure that this woman
is nottolost
-toCenter.
-follow-up and is not registered again at another
considering
l
Provide
ART
or
ARV
regimen
based
on CD4The
count
ICTC where
sheif delivers. This will ensure that thereprophylactic
is no double
counting
of cases.
ICTC
window,
period
and/or
clinical
staging.
Counsellor
at second ICTC will be responsible for updating the line- list of this woman, linking this
spouse
is positive
l
Nutrition
counselling
to Government/other
and ART services.
Once this woman
comesand
backlinkages
to the original
(previous) ICTC, the
to EID
orpatient
s/he have
high
Nutrition
programmes.
risk
behaviour.
data
in the line-list should also be transferred to this ICTC and ART Centre.
l
l
Infant feeding and
9. nutrition
At district level, the updatedlline-lists
from all ICTCs
should be compiled into one Consolidated
Family Planning
Services.
basis
DAPCU/ Nodal Person
for HIV
in the
district.
The visits.
compiled
list and updated on a monthly
counselling.
l
EBF by
feeding
support
through
home
district level line-list should be cross checked and validated by the nodal person in district and
l
then sent to M&E officer at SACS with copy to JD (BSD) and PPTCT focal person in SACs by 10th of
every month. The responsibility of compilation of District level, PPTCT beneficiaries linelists lies
with District Supervisor (in DAPCU Districts) and ICTC Counsellor/s (preferably located in Gynae
OPD) of District headquarters.
10. The
M&E breastfeeds
officer at SACS
then compile
these
districtWHO/NACO
level line-lists
into one 2010-'11)
State level lineExclusive
uptowill
6 months
(preferred
Option-I
Guidelines
l
PPTCT to
beneficiaries
sent
by JD (BSD)
at year
SACSforto BSD
list.continued
This Statebreastfeeds
level line-list
and
in of
addition
complementshould
feeds be
after
6 months
upto 1
and babies
CST Division
at NACO
with
RCs bybabies
15th who
of every
month.
Division
EID
negative
and upto
2 years
forcopy
EID to
positive
receive
Paediatric ART.
l
Postpartum
ARV prophylaxis
for infantofforline-lists
6 weeks. at District/State/NACO level is primarily the
11. The
generation
and compilation
l
Early
infant diagnosis
at 6 weeks
of age;
testingofatthe
6 months,
months
& 6 weeks
ARTrepeat
component
line- list12shall
be filled
in and
responsibility
of BSD(EID)
division.
Only the
after
cessation
of breastfeeds.
Centres and shared with ICTCs after each activity is accomplished electronically
updated
by ART
l
Co-trimoxazole
prophylaxis
from 6 weeks of age.
&/or in the monthly
meetings.
l
l
76
l
l
the child.
emmargoNACO
rP TCTPshall
P fo scompile
tnenopmoand
C :2 analyse
erugiF these reports every month and
12. The M&E officer at BSD Division,
give feedback to the concerned person at BSD and CST at NACO on gaps in the cascade of service
tooPPTCT
delivery
nem
W tnanbeneficiaries
gerP lla ot so
secthat
ivremeasures
S gnitseTtodnfilla in
gnthese
illesngaps
uoC can
VIHbe
fo instituted.
reffO
13. Another tool shall be used by ART centre for reporting on PPTCT and EID indicators. This is
presently being sent as a separate tool (Tool-2) but ultimately will be part of monthly reporting
format from ART centres (once new form page format is rolled -out across the country.)
evitageN VIH
15.2
Tool
1:
PPTCT
Beneficiary
Line-List
(ICTC-ART)
n
e
m
oW tnangerP
xes efaS l
.sretnfor
eC the
TRA
ta sixalyhporp
Name of the State:
Updated
month:
.gnillesnuoc
elpuoC l
Year:
.gnillesnuoc
.ylno ycnangerp
.seciv res gninnalp
District:
.sITName
S rof tof
neMO
mtaI/cerof
t dICTC:
na gnineercS l
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
dna gninnalp-htrib ,y reviled efas Contact
,gnivil eNo.
vitiof
soMO:
p no gnillesnuoC l
ksir hgih rof )CCB(
reh dna nemow
Name
dnofaICTC:
esuops fo gnitset VIH dna gne-mail
illesnid:
uoc xes efas dna elpuoC l
.rentrap
VIH taepeR l
,gnitset
(where generated)
Name of.rSMO/MO
of
ART
Centre:
etneC TRA ot larrefeR l
g
n
i
r
e
disnoc
fi doirep ,wodniw
.gniof
gaSMO/MO
ts lacinilc ro/dna
Contact No.
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
Name of ART:
e-mail id:
noitirtun
(with whom shared)
Name of DAPCUO/Nodal Officer I/c of HIV Programme:
.gnillesnuoc
Designation of I/c Officer
Contact No.:

)11'-0102 senilediuG OCAN/Oe-mail
HW Iid:
-noitpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
TRICTC
A cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIE
Pertains .to
skeewto6ART
& shcentre
tnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE l
Pertains
.ega fo15.2
skeTool
ew 1:
6m
orf sixalyhporp elozaxomirt-oC l
PPTCT Beneficiary Line-List (ICTC-ART) Contd....
.dlihc eht
15.2 Tool 1: PPTCT Beneficiary Line-List (ICTC-ART) Contd....
11
4

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l
3
Husbands
Fathers name
Date of
name and
and Parental
HIV Test
Current
Address
(Confirmatory
Address
(including
test)
(including
Door no./
Door no./
Village/
Village/
Block/ Taluka/
Block/ Taluka/
District/
District/
State) with
State) with
Landmark,
Landmark,
Pin Code
Pin Code
and contact
and contact
number
number
Age
(in years)
...15.2 Tool 1: PPTCT Beneficiary Line-List (ICTC-ART) Contd.
ICTC PID
Number
Name of the
ICTC where
tested
Type of Client
ANC/ Directin -Labour/
Post-delivery
mother
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.
10
Gestational
Age (in
weeks)
Expected Date
of Delivery
(EDD)
iv
iii
ii
2
1
Name of the
Pregnant
Women in
ANC/ Directin labour/
Post- delivery
mother
Clients Sl. No.
(Expandable)

l
l
l
l
l
l
78
l
l
the child.
Place of
Delivery
(refer to
guidance)
21
19
17d
17c
17b
17a
16
evitageN VIH
nemoW tnangerP
xes efaS l
.gnillesnuoc
elpuoC l
.gnillesnuoc
.seciv res gninnalp
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
gniredisnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc
15
at 12
months
at 6
months
Outcome of
Pregnancy
(Live Birth/
Still Birth/
MTP/
Abortion)
Status of
Mother
after
delivery
up to 6
weeks
(Alive/
Dead)
at 6 weeks
17. Infant feeding practice
at 18
months
18
New Case/
Already
Registered
at ART

.ylno ycnangerp
Date of
Delivery
13
12
14

.dlihc eht
Expected
Place of
Delivery
20
Date
Date of
of CD4
Registration
count and
at ART
Baseline
Centre and
CD4 Count
Pre-ART
Registration
No.
WHO
Clinical
Stage
30
29
28
27
26
25
24
ART Registration
no.
dd/mm/yy
Date of ART
initiation
dd/mm/yy
Date of
stopping ART
dd/mm/yy
Reason for
Stopping
ART *
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.
Date of
Completing ATT
(DOTS/ NonDOTS)
(dd/mm/yy)
31
Date of
Date of
If stopped before
starting NVP completing 6 6 weeks, reason
Syp at birth weeks of NVP for stopping NVP
dd/mm/yy
Syp dd/mm/yy
Syp

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l
If Column 22
is Yes, date
of starting ATT
(DOTS/NonDOTS)
(dd/mm/yy)
23
Whether
diagnosed as
having TB
(Yes/No)
22

l
l
l
l
l
l
80
l
l
the child.
38b
38a
37c
37 b
37a
36
evitageN VIH
nemoW tnangerP
xes efaS l
.gnillesnuoc
elpuoC l
.gnillesnuoc
.seciv res gninnalp
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
gniredisnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc
35
at 6 weeks
after
stopping of
breastfeeds
at 6 months
(positive or
negative)
at 6 weeks
(positive or
negative)
Name of
Infant
ICTC ID of
infant
Unique DNA
infant code
37. DNA /PCR: DBS tests
WB
specimen
collection
date (dd/
mm/yy)
WB
Specimen
Result for
test Positive
or Negative

.ylno ycnangerp
At 6 weeks,
what
temporary
FP method
is being
followed
(Copper-T
or OCP) in
addition
to use of
condoms
(Dual
Protection)
33
32
34

.dlihc eht
Date of
initiation of
CPT in baby
dd/mm/yy
38c
38. DNA/ PCR: WBS tests
38d
Result of
2nd WBS
If infant is
(in case of
negative
DBS &
with
1st WBS
2nd WBS,
discordance)
Date of
Positive or
Referral
Negative
back to ICTC
(dd/mm/yy)
***Relevant information to be captured, eg:

1. Clients current location with date
2. Information on authorized attendant to
whom ART can be dispensed(from 6 months
of pregnancy upto 2 months post delivery)
3. Any other important information on related or
to client her baby
47
46b
**A Maternal death,

B Stopped on Medical advice,
C Transfer out,
D Lost to follow up.(LFU)
E opted out of the programme
*1. After one week of stopping breastfeeding

2. Death of baby
3. Death of mother
4. Parent/Guardian decision
5. Medical Reason
44a
44b
45a
45b
46a

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l
43
Alive & On
Treatment
Date and reason
(code) for ART
/discontinuation**
Alive & On
Treatment
44. ART Outcome (Mother)
45. ART/ ARV prophylaxis

Outcome (Child)
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.
42
Date and
Primary
First booster
reason for ART
including
dose at 18
discontinuation** measles and
months
Vitamin A
(Y/N)
(Y/N)
46. Whether immunization Remarks***

completed
Date (dd/mm/ Date of

yy)
stopping
& result of
CPT dd/
Antibody
mm/yy
Tests (Rapid)
conducted at
18 months
- Confirmed
negative or
Date of
Confirmed
Initiation of
positive
Paed ART
(dd/mm/yy)
41
40
39
Registration
Baseline
Date (dd/mm/ CD4 count
yy) and Pre
or
ART Number
CD4 %
HIV +ve infant

l
l
l
l
l
l
82
l
l
the child.
emminarPPTCT
gorP TCTBeneficiary
PP fo stnenopLine-list
moC :2 erugiF
15.3 Definition of Tool 1 Variables
Tool 1: Definition of Different Variables in PPTCT Beneficiary Line List

Sl. No.
1
Variable
Sl. No.
Description
It is a number provided to the each client coming
to avail the PPTCT package of service on her first
visit.
evitageN VIH
Name of the Pregnant Women/ Direct-in- labour ANC/PostWrite the complete name of the Client here in
nemoW tnangerP
VR
A/TRAmother
ylhtnoM)stisiv 4 tsael-ta erusne( eraC latanetnblock
A lletters.
delivery
xes efaS l
.sretneC TRA ta sixalyhpoWrite
rp the age of the Client in years.
.gnillesnuoc
fo4 noitaHusbands
nimret laname
cidemand
ro Current
noitaunAddress
itnoc fo(including
seciohcDoor
no gNo./
nillesnuoWrite
C lthe address of the client where currently
elpuoC l
Husbands name, along with Door No./
fo shtnVillage/Block/
om 3 tsrif Taluka/
eht niDistrict/State)
htiw ekatrewith
dnu Landmark,
ot)PTMPin
( ycCode
nangeresiding:
rp
.gnillwith
esnulandmark
oc
and contact number
.ylno ycnangeVillage/Block/Taluka/District/State
rp
ylimafNumbers
ot segakniL l
and Pin code and Contact
.seciv rof
esfather
gninnofalthe
p
5
Fathers name and Parental Address (including Door no./
Write the name and address
.
s
I
T
S
r
o
f
t
n
e
m
t
a
e
r
t
d
n
a
g
n
i
n
e
e
r
c
S
l
smodnoc No./Village/
eerF l
Village/Block/ Taluka//District/State) with Landmark, Pin Code client along with Fathers.name/Door
and contact number .gnitset 4DC dna gnigats lacinilc OHBlock/Taluka/District/State
with
egnah
c rulandmark
oivaheBandl
W l
Pin code and Contact Numbers
noitacinummoc
6
Date of HIV Test
Mention the Date (dd/mm/yy)
ksir hgihwhen
rof )HIV
CCBTest
( of
.snoitpo gnideef tnathe
fni client conducted. This should be a test at
reh dna nemow
not the screening test)
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoICTC
C (and
l
.rentrap
7
ICTC PID Number
Mention
the
PID
number
provided
VIH tto
aeclient
peR from
l
the ICTC, where she got tested for HIV
,
g
n
i
t
s
e
t
8
Name of ICTC where tested
Write the Name of the ICTC where
gniredthe
isnclient
oc got
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivotested
rP lfor HIV
fi doirep ,wodniw
.gnigats lamother
cinilc ro/dMention
na
9
Type of Client ANC/ Direct-in- Labour/ Post-delivery
whether the e
Client
vitisoispANC
si ecase
suopors
a post-delivery case
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuDirect-inN l Labour Casehor
gih eregistered
vah eh/spost
ro
.semmargorp noitirtu(who
N have been diagnosed/
.ruoivaheb ksir
delivery)
d
n
a
gnidher
eefGestational
tnafnI l
10
Gestational Age (in Weeks)
If the client is ANC case write
.seciv reS gninnalP ylimAge
aF inl weeks.
noitirtun
nillesnuoc
.stisivExpected
emoh hDate
guorofhtDelivery
troppu(EDD)
s gnideef tnafnI/tnemecrofnier FB
E ANC
l case, write the date.g
11
For
(dd/mm/yy) on
3
12
Age (In Years)
emoh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcywhich

sP lshe is expected to deliver.
Expected Place of Delivery
For
.spuorg troppus dna stisiv ANC Case, Write the name of the place
(Health Facility) where she opts for delivery.
13
Date of Delivery
Write the date (dd/mm/yy) when she has

delivered.
EHthe
( tplace
nafnI(Health
desopFacility,
xE VIH
Place of Delivery (refer to guidance)
Write the name)Iof
)11'-0102 senilediuG OCAN/OHW I-noitpO derreferp( shHome
tnomdelivery
6 otpuetc)
sdewhere
eftsashe
erb has
evisdelivered.
ulcxE lIn
this case data needs to be transferred to ICTC at
rof raey 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noiplace
tiddaofndelivery.
i sdeeftRefer
saerbtodpoint
euni7tnin
ocdata
dnaflow for
.TRA cirtaideaP eviecer ohw seibab evitisop DIE rof sradescription
ey 2 otpuofdthis
na sindicator.
eibab evitagen DIE
15
Outcome of Pregnancy (Live Birth/ Still Birth/ MTP/
Abortion)
Write
here
the
outcome
.skeew 6 rof tnafni rof sixalyhporp Vof
RAthe
mPregnancy
utraptsoP l
whether it is a Live Birth, Still Birth, Medical
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeTermination
ew 6 ta )Dof
IEPregnancy
( sisongaior
d an
tnaAbortion.
fni ylraE l
.
s
d
e
e
f
t
s
a
e
r
b
f
o
n
o
i
t
a
s
s
ec retfa
16
Status of Mother after delivery up to 6 weeks (Alive/ Dead)
Mention here the status of client after delivery
.ega fo skeewand
6m
rf s6ixweeks
alyhp(whether
orp elozalive
axom
t-oC l
upoto
orirdead)
.dlihc eht
14

Sl. No.
Variable
Description
Please ask the mother at each of the 4 visits:

Infant feeding practice at:
regarding infant feeding practice.
(a) 6weeks:
(a) At 6 weeks, whether the baby is receiving Exclusive Breast
1. Exclusive Breast Feeding
feeds only or Exclusive Replacement feeds or if any Mixed
2. Exclusive Replacement Feeding
feeding has occurred (Baby is receiving both breast feeds and
3. Mixed feeding*
HIV Negative
HIV Infected Pregnant
Women
replacement
feeds within first 6 months).
(b) 6months:
Pregnant1. Women
At (ensure
6 months,at-least
enquire 4
whether
baby which is
continued on
Continued Breast Feedingl +Antenatal (b)
Care
visits)Monthly
ART/ARV
breast feeds has also been started on complementary feeds
solids
l
Safe sex Complimentary feeds & semiprophylaxis
atand
ART
Centers.
semisolids or whether the baby was getting exclusive
2. Continued Replacement feeding +
counselling.
replacement
for the first 6
andtermination
now has beenof
semi solids
l
Counselling on
choices offeeds
continuation
ormonths
medical
l
Couple
started on semisolids. Enquire
mixed of
3. Whether mixed feeding occurred
pregnancy (MTP)to
undertake
within also
thewhether
first 3any
months
counselling.
feeding happened any time from 6 weeks up to 6 months.
between 6 weeks to 6 months
pregnancy only.
(c) At 12 months, enquire from the mother whether breast feeds
l
Linkages (Yes/No)
to family
l
Screening
for has
TB been
and other
OIs.
stopped.
If yes, indicate date (dd/mm/yy)
(c)
12
months:
planning services.
(d) At 18 months, enquire whether 1. Breast feeding is being
1. Continued Breast Feeding
l
l
Free condoms.
continued or 2. Breast- feeding has been stopped. If stopped,
2. Breast Feeds stopped (dd/mm/yy)
l
Behaviour
change
l
WHO clinicalindicate
stagingdate
andofCD4
testing.
stopping
(dd/mm/yy).
(d) 18 months:
1. Continued Breast Feedingl Counselling on positive living, safe delivery, birth-planning and
communication
Breast Feeding (dd/mm/yy)
(BCC)2. forStopped
high risk
17
18
l
19
20
21
l
22
23
24

New Case/
Mention whether the client availing the service is a fresh case or
women
and Already
her Registered at ART
l
Couple andhas
safe
sex counselling
and
HIVwith
testing
of spouse
already
been registered
at ART
Pre ART
number.and
Write
partner.
New
Case
for
fresh
case
and
Already
Registered
at
ART
for
Repeat HIV
client registered at ART.
testing,
l
Date of Registration at ART Centre and PreMention the Date (dd/mm/yy) of registration of the client under
considering
l
Provide ART
ARV prophylactic
regimen based on CD4 count
ART Registration No.
HIVor
(Pre-ART)
care at ART Centre.
window, period if
staging.
Date of CD4 count and Baseline CD4and/or
Count clinical
Mention
the date (dd/mm/yy) of assessment of CD4 count of the
spouse is positive
client.
Mention
baseline
CD4 count
the client.
l
Nutrition counselling theand
linkages
to of Government/other
or s/he have high
WHO Clinical Stage
Write the WHO Clinical stage (whether I,II,III or IV) of the client
risk behaviour.
here.
l
Postpartum
Infant feeding and
Whether Diagnosed as having TB (Yes/No)
If the client have been diagnosed as having TB write YES, if not
l
Family Planning
Services.
nutrition
write NO
counselling.
l
If Column 22 is Yes, date of starting ATT
If yes, date of starting of TB treatment (ATT)
(DOTS/Non-DOTS) (dd/mm/yy) l Psycho-social support through follow-up counselling, home
Date of completing ATT (dd/mm/yy) visits and support
Write the groups.
exact date when TB treatment (ATT) was completed
25
ART Reg no.
When initiated on ART, write the ART registration number

allotted to the client.
26
Date of ART initiation
Write the date (dd/mm/yy) of initiation of ART to the client.

27
Date of stopping of ART
If ART stopped, write the date
Exclusive
breastfeeds upto 6 months (preferred
Option-I WHO/NACO Guidelines 2010-'11)
l
(dd/mm/yy)
*Mention the Reason for stopping of ART
28
Reason for Stopping ART*
EID1.negative babies and upto 2 years for EID
babies
who receive Paediatric ART.
here,positive
The reason
could be:
1.
After
one
week
of
stopping
breastfeeding
2.
l
2. Death of Baby
3.
l
Early
3. repeat
Death oftesting
Mother at 6 months, 12 months & 6 weeks
4. infant diagnosis (EID) at 6 weeks of age;
4.
Patient/Guardians
decision
5.
5. Medical Reason
l
l
l
84
l
l
the child.

Sl. No.
Variable
29
Date of starting NVP Syp at birth dd/mm/yy
30
Date of completing 6 weeks of NVP Syp dd/mm/yy
Mention the date (dd/mm/yy) when NVP

syrup was initiated after birth
Mention the date (dd/mm/yy) when NVP

syrup (6 weeks) to baby has been completed
evitageN VIH
and stopped.
6
weeks,
VRIf Astopped
/TRA ybefore
lhtnoM
)stisivreason
4 tsaeforl-tstopping
a erusneNVP
( eraSyp
C latanetnA
32
Date of initiation of CPT in baby dd/mm/yy
fo noitanimret lacidem ro noitaunitnoc fo seciohc no gnillesnuoC
.ylno ycnangerp
33
At 6 weeks, what temporary FP method is being followed (Copper-T
IO reprotection)
hto dna BT rof gnineercS
or OCP) in addition to condoms.s(dual
.sITS rof tnemtaert dna gnineercS
.gnitset 4DC dna gnigats lacinilc OHW
dna gName
ninnaof
lp-Infant
htrib ,y reviled efas ,gnivil evitisop no gnillesnuoC
34
35
ICTC ID of infant
suopsDNA
fo gninfant
itset code
VIH dna gnillesnuoc xes efas dna elpuoC
36dna eUnique
37
DNA PCR: (1) DBS tests:
.retneC TRA ot larrefeR
a) At 6 weeks: Positive/Negative
tnuoc 4b)DAt
C n6months:
o desabPositive/Negative
nemiger citcalyhporp VRA ro TRA edivorP
c) At 6 weeks after stopping breast-feeds:.gPositive/Negative
nigats lacinilc ro/dna
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuN
38
DNAPCR:
a) WB specimen collection
date
.sem
ma(dd/mm/yy)
rgorp noitfor
irtuN
WBS tests
DBS test 37a or 37b or 37c
.rehSpecimen
tom rof sResult
ixalyhfor
poDBS
rp VR
Am
raptor
soP
b) WB
test
38ut(38a
38b )-Positive or .Negative
seciv reS gninnalP ylimaF
c) Result of 2nd WBS(in case of DBS & 1st WBS
.stisiv emoh hguorht trdiscordance)Positive
oppus gnideef tnaorfnNegative
I/tnemecrofnier FBE
emoh ,gnillesnuod)c Ifpuinfant
-wollisofnegative
hguorhwith
t tro2nd
ppuWBS,
s laicoDate
s-ohofcysP
Referral back to ICTC
31
39
Description
HIV +ve
infant
nemoasWtotn
angSyp
erPNVP
Try
why
l to find out the reason
was stopped
xes efaS l
.gnthe
illemother
snuocthe
At 6 weeks, find out from
l
date (dd/mm/yy) when baby was
elpuinitiated
oC l on
Co- trimoxazole prophylactic
therapy
.gnillesnuoc(CPT)
At 6 weeks visit,
ylienquire
maf otfrom
segthe
aknmother
iL l
l to whether she has had a Copper-T
as
.seciv res gninnalp
inserted
or is taking Oral Contraceptive pills
l
.smodnoc eerF l
in addition to her spouse or she using a
e
g
n
ahc ruoivaheB l
l
condom as(dual protection)
noitacinummoc
ksir hgih rof )CCB(
Write the ID given to infant by the ICTC.
reh dna nemow
l
Write
the unique DNA infant .rcode
entrfor
apall
babies registering for DNA PCR testing
VIH taepeR l
The DNA PCR DBS test when,gdone
nitseatt
l
6 weeks is negative; repeat it again at 6
gniredisnoc
l
months.
If negative again, it should be
doirbreastfeeds
ep ,wodnihas
w been
repeated 6 weeksfiafter
e
v
i
t
i
s
o
p
s
i
e
s
u
o
p
s
stopped.
l
h
g
i
h
e
v
a
h
e
h
/
s
r
o
Write the date (dd/mm/yy) when whole
.ruoivisah
eb ksir
Blood Specimen of infant
collected.
l
d
n
a
g
n
i
d
e
e
f
tnafnI l
Write the result of the Whole Blood
l
n
o
i
irtunis a
Specimen of the infant. In case tthere
nillWBS,
esnuowrite
c the
discrepancy
in DBS and.gfirst
l
l
Write
the name of the baby.
result of 1st and 2nd WBS in columns 38c

&l 38c
If infant is negative, write the date

(dd/mm/yy) of referral back of infant to ICTC.
Registration Date (dd/mm/yy) and Pre ART Number If infant is positive, write the Pre ART
registration number allotted to infant.

Write the baseline CD4 count or CD4 % of
)11'-0102 senileBaseline
diuG OCCD4
AN/count
OHWorI-CD4
noit%
pO derreferp( shtnom
6 otpu sdeeftsaerb evisulcxE l
the infant.
41
Date of Initiation of Paed. ART (dd/mm/yy)
Write the date (dd/mm/yy) of registration of
.TRA cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2infant
otpuatdART
na sCentre.
eibab evitagen DIE
.skeewTests
6 ro(Rapid)
f tnafni rWrite
of sixthe
alydate
hpor(dd/m/yy)
p VRA mofutantibody
raptsoP(Rapid)
l
42
Date (dd/mm/yy) & result of Antibody
tests
conducted
for
the
infant
at
the
age
conducted
at
18
months
Confirmed
negative
or
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE lof
18 months for confirmation.
Confirmed positive
.sdethe
eftresult
saerbwhether
fo noitathe
ssebaby
c retisfa
Write
negative
.ega fo skeew 6 mconfirmed
orf sixalyashpHIV
orppositive
elozaxorom
irt-oC l
.dlihc eht
40

Sl. No.
43
Variable
Description

Date of stopping CPT dd/mm/yy
Write the date when CPT for infant has been stopped.
It is advised that CPT be continued for 18 months in
children even if the EID results are negative at
6 weeks or 6 months or after 6 weeks of stopping
HIV Negative
Women
breastfeeds, as it reduces infant mortality due to interPregnant Women
l
Antenatal Carecurrent
(ensure
at-least
visits)Monthly
ART/ARV
infections,
like4 diarrhoea
and
l
Safe sex
prophylaxis atrespiratory
ART Centers.
infections or other OIs.
counselling.
44
ART**
a) Alive & On Treatment
this cellofifcontinuation
the client is alive
and on ART
l
Counselling onTick
choices
or medical
termination of
l
Couple
pregnancy
(MTP)to
undertake
within
the
first
months of
Outcome
b) Date and reason (code) for
**Put the appropriate Code in this Cell with 3date
counselling.
pregnancy only. A Death,
(Mother)
ART discontinuation
l
Linkages to family
l
Screening for TBBand
other OIs.
Stopped
on Medical advice,
planning services.
C
Transfer-out,
l
l
Free condoms.
D Lost-to-follow-up
(LFU)
l
Behaviour change
l
and CD4 testing.
E
opted
out
of
the
programme
communication
l
45 (BCC)
Antiretroviral
a) Alive & On Treatment
Tick this cell if the client is alive and on ART
for high risk
women
and her a) Date and reason for ART/ ARVs **Put the appropriate Code in this Cell with date
treatment
l
partner.
Outcome
discontinuation
A Death
l
Repeat
HIV
(Child)**
B Stopped on Medical advice
testing,
l
C Transfer-out,
considering
D Lost-to-follow-up
(LFU)
l
Provide ART or ARV
prophylactic regimen
based on CD4 count
window, period if
E Opted out of the programme on her own
spouse is positive
46
Whether immunization
(a) Write Yes
if all linkages
primary immunization
has been
l
and
to Government/other
or s/he have high
Nutrition
programmes.
completed:
completed or No if any immunization, including
risk behaviour.
(a) Primary immunization,
and Vitamin
A have not been received (the baby
l
Postpartum ARV measles
prophylaxis
for mother.
l
Infant feeding and
including
measles
and
should
be
sent
for
completion
of immunization schedule
l
nutrition
Vitamin A (Y/N)
within a week)
counselling.
l
(b) Whether 1st booster dose at
Write Yes if DPT/ OPV have been received at 18 months or
l
18 months received
No if baby has not yet received (ensure baby receives the
visits and support
(Yes/No)
samegroups.
within a week)
47
Remarks***
This column is common for both ICTC and ART centres

***Relevant information to be captured, eg:
1. Clients current location with date

2. Option-I
Information
of authorizedGuidelines
attendant to 2010-'11)
whom ART can
Exclusive breastfeeds upto 6 months (preferred
WHO/NACO
l
be dispensed(from
of upto
upto two
months
and continued breastfeeds in addition to complement
feeds after 66 months
months
1 year
forpost
delivery)(refer letter of ADG, CST, NACO, dated 28
August 2012)
l
3. Any other important information related to client or her
l
Early infant diagnosis (EID) at 6 weeks of age; repeat
babytesting at 6 months, 12 months & 6 weeks
l
l
l
86
l
l
the child.
emm
argoEID
rP Tfrom
CTPP fART
o stneCentres
nopmoC :2 erugiF
15.4 Tool 2: Reporting on PPTCT
and
3 a. PPTCT
3.1a Cumulative number of Pregnant women ever registered/ reported in HIV care
till the end of this month (Out of 2.5)
3.2a Cumulative number of pregnant women ever initiated on ART till the end of
this month (out of 3.1a)
neinitiated
moW tnonanPPTCT
gerP dARV
etceprophylaxis
fnI VIH
3.3a Cumulative number of pregnant women
from 1stVSept
2012
till
the
end
of
December
2013
(Out
of
3.1
a)(applicable
RA/TRA ylhtnoM)stisiv 4 tsael-ta erusne( eraC latanetnAfor AP
l ,
Karnataka, Tamil Nadu)
3.4a Total number of pregnant women ever initiated on ART/ ARV prophylaxis
fo noitanim
ret lacidefor
mAP
ro, nKarnataka,
oitaunitnTamil
oc foNadu)
seciohc no gnillesnuoC l
(3.2a+3.3a)
(applicable
evitageN VIH
nemoW tnangerP0
xes efaS l
.
g
n
i
llesn0uoc 0
0
elpuoC l
.gnillesnuoc 0
.seciv res gninnalp 0
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB( 0
reh dna nemow
.rentrap 0
VIH taepeR l
,gnitset 0
gniredisnoc
fi doirep ,wodniw 0
evitisop si esuops 0
hgih evah eh/s ro
0
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.ylno ycnangerp
3.5a.1 Number of women currently on PPTCT ARV prophylaxis (dynamic figure,
.sIOand
rehtARV
o dnprophylaxis
a BT rof gnstopped
ineercS
l
as and when pregnancy/ lactation completed
reduce
from this section9 (applicable for AP,.sKarnataka,
ITS rof tneTamil
mtaeNadu
rt dnafor
gnbreast
ineercfeeding
S l
mothers: max period applicable is Dec 2014)
EID
3.6a Cumulative number of children registered at ART centre with DBS reactive for
DNA/PCR
na eofsu3.6a
ops cumulative
fo gnitset Vnumber
IH dnaofgnchildren
illesnuwho
oc xeunderwent
s efas dnaWBS
elputesting
oC lat
3.7adOut
the ART centre
3.8a Out of 3.7a cumulative number of children who are WBS reactive for DNA/
PCR
3.9a Out of 3.8a cumulative number of children initiated on ART
3.10a Out of 3.9a cumulative number of children initiated on LPV/r based regimen
3.11a Out of 3.8a cumulative number of children found HIV+ve by 3 antibody tests
at 18 months of age
ART Centres Reporting
(Section 3a of CMIS PPTCT)
(Refer to the remarks column of the HIV.scolumn
puorg tr6
opand
pus d23
naof
stiPre
siv ART register, column no. 16 of ART
enrolment register, any separate register maintained for pregnant women, if required from individual
white card or from the PPTCT line-list)
3.5a Number of pregnant women currently on ART
IEH(care
tnaftill
nI dthe
esoend
pxEof
VIthis
H
3.1a Cumulative number of Pregnant women ever registered/ reported in )HIV
)1
1
'
0
1
0
2
s
e
n
i
l
e
d
i
u
G
O
C
A
N
/
O
H
W
I
n
o
i
t
p
O
d
e
r
r
e
f
e
r
p
(
s
h
t
n
o
m
6
o
t
p
u
s
d
e
e
f
t
s
a
e
r
b
e
v
i
s
u
l
c
x
E
l
month (Out of 2.5)
Number of HIV positive pregnant women ever registered at your ART centre since the beginning. These can
be new registrations or those already registered.satkethe
ART
ew 6
rof tcentre
nafni roand
f sixthen
alyhplater
orp Von
RAbecome
mutraptspregnant.
oP l
Generation
of
this
figure
will
be
a
onetime
exercise
and
can
be
done
from
column
no.
16
and
of
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE 23
l
the HIV Care register, column no. 16 of ART enrolment register, any
for
.sdeseparate
eftsaerb fregister
o noitassmaintained
ec retfa
pregnant women or if required from individual white
.egacards.
fo skeeOnce
w 6 mthis
orf sisixfirmed
alyhporup,
p elonew
zaxoregistrations
mirt-oC l to
be added to this
.DIfigure
E hguoevery
rht evmonth,
itisop VIfrom
H sa next
desonmonth
gaid neonwards.
rdlihc dna stnafni rof TRA deP dna erac VIH l
.dlihc eht
l
l
l
87
Figure women
2: Components
of PPTCTon
Programme
3.2a Cumulative number of pregnant
ever initiated
ART till the end of this month
(out of 3.1a)
Offer ofwomen
HIV Counselling
Testing
allART,
Pregnant
Total no. of pregnant
ever initiatedand
on ART
(who Services
are eligibletofor
for theirWomen
own health) at this
centre from the beginning of this centre.
3.3a Cumulative number of pregnant women initiated on PPTCT ARV prophylaxis from 1st Sept 2012
till the end of December 2013 (Out of 3.1 a) (Applicable for AP, Karnataka and Tamil Nadu)
HIV Negative
PPTCT ARV
prophylaxis
treatment
for PPTCT (not
for their own
Total
no
of
pregnant
women
initiated
Pregnant Women
l onAntenatal
Care
(ensure at-least
4 visits)Monthly
ART/ARV
l
Safe
health)
fromsex
1st Sept 2012 onwards. prophylaxis
This only includes
women who have been given triple drug
at ART those
Centers.
counselling.
ARV prophylaxis for PPTCT. Applicable only for AP; Karnataka & Tamil Nadu States which rolled out
l
l drug
Couple
triple
ARV Prophylaxis. (This does
not include
sd NVP undertake
prophylaxis).
pregnancy
(MTP)to
within the first 3 months of
counselling.
only.on ART/ ARV prophylaxis (AP, Karnataka and TN)
3.4a
Linkages
Total number
of pregnant womenpregnancy
ever initiated
l
to family
l
(3.2a+3.3a)
planning
services.
l
Screening
and treatment
STIs.and 3.3a
l
Free
condoms.
Total
no
of women
ever initiated on ART/
ARV prophylaxis,
sum offor3.2a
l
Behaviour change
l
3.5a communication
Number of pregnant women currently on ART
l
(BCC)pregnant
for highwomen
risk
ARTfeeding
at this options.
centre. Remember to reduce the numbers as and
Total no.of
currently on
infant
women
and
her
when pregnancy is completed and then
this particular
women
becomes
like
other
women
on ART
l
Couple
and safe sex
counselling
and
HIV
testing
of spouse
and(non
partner.
pregnant) already being reflected in column no. 3.10 of monthly ART centre report.
l
Repeat HIV
testing,
3.5a.1
Number of women currently
PPTCTtoARV
(dynamic figure, as and when
l on
Referral
ART prophylaxis
Center.
considering
pregnancy/ lactation completed
and
ARV
prophylaxis
stopped
reduce
frombased
this section)
l
Provide ART or ARV prophylactic
regimen
on CD4 count
window, period if
and/or
clinical
staging. at this centre. Remember to reduce the
Total no.
of pregnant
women currently on
PPTCT
ARV prophylaxis
spouse
is positive
l
Nutrition
counselling
linkages
Government/other
numbers
as and
when
completed
and ARV and
prophylaxis
has to
been
stopped.
or s/he
have
highpregnancy/lactation
Nutrition
programmes.
risk behaviour.
EIDl Infant feeding and
l
Family
Planning
Services.
(Refer nutrition
to EID register and for 3.10a land
3.10b,
patient
white card)
counselling.
l
3.6a Cumulative number of children registered at ART centre with DBS reactive for DNA /PCR
l
EIDand
register
Cumulative no. of children entered in the
visits
support groups.
3.7a Out of 3.6a cumulative number of children who underwent WBS testing at the ART centre
Out of the total children detected DBS positive, cumulative no. of children who have undergone Whole
HIV
Exposed(WBS)
Infant testing
(HEI) (column no. 10 of EID register)
Blood
Specimen
l
3.8a Out of 3.7a cumulative number of children who are WBS reactive for DNA /PCR
Out of the
children
who
underwent
WBSfor
testing,
cumulative
no.who
of children
have had
EID total
negative
babies
and
upto 2 years
EID positive
babies
receive who
Paediatric
ART.positive
results
(column no.ARV
11 of
EID register)
l
Postpartum
prophylaxis
l
Early
infant
(EID)
at 6 weeks
of age;initiated
repeat testing
at 6 months,
3.9a
Out of
3.8adiagnosis
cumulative
number
of children
on Paedtric
ART 12 months & 6 weeks
Out of the total children who had positive WBS results (column no. 11 of EID register) how many were
l
initiated on Paediatric ART (column no. 16 of EID register)
l
l
88
l
l
the child.
mmargorPofTCchildren
TPP fo stninitiated
enopmoCon
:2 eLPV/r
rugiF based regimen due to previous
3.10a Out of 3.9a cumulativeenumber
exposure to sd NVP.
nechildren
moW tnwho
angeinitiated
rP lla otonsePaed
civreART
S gnunder
itseT the
dnaEID
gnprogramme,
illesnuoC Vcumulative
IH fo reffOno. of children
Out of the total
who have been started on LPV/r based regimen due to previous exposure to sd NVP
3.11a Out of 3.8a cumulative number of children found HIV+ve by antibody tests at 18 months of age:
evitageN VIH
Of all the patients with WBS positive, how many children had HIV +ve status at 18th
month
n
e
m
oW tnof
anage.
gerP
retnmonths
eC TRAago,
ta sixno.
alyof
hpchildren
orp
3.12 a. Out of the total no. of live births.s18
reported to be living:xes efaS l
.gnillesnuoc
elpuoC l
b. No. of children born to HIV positive pregnant women born 18 months ago, reported to be dead
.gnillesnuoc
.ylno ycborn
nang18
erpmonths ago tested for confirmation of status
c. No. of children born to HIV positive pregnant women
at 18 months:
.seciv res gninnalp
.smodnoc eerF l
15.5 SIMS Monthly Progress
egnahc ruoivaheB l
.gnReport
itset 4Dfor
C dPPTCT
na gnigats lacinilc OHW l
noitacinummoc
Monthly Input Formats for Integrated Counselling and Testing Centres (ICTC)
ksir hgih rof )CCB(
NRHM-NACO Convergence Action Section D: Progress during the month (only for Pregnant Womenre) h dna nemow
.rentrap
i. Pregnancy, delivery and breastfeeding
.nerdlihc gnivil rehto During ANC
VIH taepeR Total
l
S. No.
Indicators
Directly-in-labour
,
g
n
i
t
s
e
t
.retneC TRA ot larrefeDuring
R l this Month During this Month
gniredisnoc
tn1uoc 4Number
DC no of
deNew
sab ANC
nemRegistrations
iger citcalyhporp VRA ro TRA edivorP l
fi doirep ,wodniw 0
2
Number of pregnant women provided with pre-test
evitisop si esuops 0
rehto/tncounselling
emnrevoGout of
ot all sregistered
egaknil dna gnillesnuoc noitirtuN l
hgih evah eh/s ro
3
Number of pregnant women tested for HIV
.ruoivaheb ksir 0
.
r
e
h
t
o
m
r
o
f
s
i
x
a
l
y
h
p
o
r
p
V
R
A
m
u
t
r
a
p
t
s
o
P
l
4
Total number Among those detected infected, number in
first trimester
of pregnant
noitirtun
women
Among
those
detected
infected,
number
in
.gnillesnuoc
detected HIV
second trimester
emInfected
oh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP
Among those detected infected, number in
third trimester
5
Number of pregnant women who received post-test

counselling and given test results
Number of pregnant women referred by the F- ICTC

Govt(Fixed/Mobile) after HIV screening test
)IEH( tnafnI desopxE VIH0

6.1
Out of the above, Number of pregnant women diagnosed HIV
0
rof infected
raey 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
.TR
A cirtaofidpregnant
eaP eviewomen
cer ohreferred
w seibby
abthe
eviPPP
tisopICTC
DIE(Fixed/
rof sraey 2 otpu dna seibab evitagen DIE 0
7
Number
Mobile) after HIV screening test
of 6
pregnant
diagnosed
s7.1
keew 6Out
& sofhthe
tnoabove
m 21Number
,shtnom
ta gnitwomen
set taep
er ;ega fHIV
o skeew 6 ta )DIE( sisongaid tnafni ylraE l0
infected
8
Number of pregnant women referred by the PHC/Sub Centre/
.ega fo skeew 6 morf sixalyhporp elozaxomirt-oC l0
ANM after HIV screening test
.dlihc eht
8.1
Out of the above, Number of pregnant women diagnosed HIV

infected
9.a.
Number
of spouses/partners
of HIV infected
Offer
of HIV Counselling
and pregnant
Testingwomen
Services
tested
9.b.
Number of spouses/partners of HIV infected pregnant women

found HIV infected
10
Number of HIV infected pregnant women who underwent
16
Number of HIV infected pregnant women (only) received Nevirapine (single

dose) during the month (whenever new guidelines not rolled out)
17
Number of babies(only) of HIV infected mothers received Sy. Nevirapine x
to all Pregnant Women
0
0
HIV Negative
MTP during the month
Pregnant
Women
Antenatal
Care
11
Number
of HIV infected pregnantl women
expected
to (ensure
deliver at-least 4 visits)Monthly ART/ARV 0
l
Safe
sex this month
during
counselling.
l
Counselling
choices
of continuation or medical termination of
Monthly Input Formats for Integrated Counselling
and Testing on
Centres
(ICTC)
l
Couple
pregnancy
(MTP)to
undertake
within
the) first 3 months of
NRHM-NACO
Convergence Action Section D: Progress during the month (only for Pregnant
Women
counselling.
pregnancy only.
i. Pregnancy,
delivery
breastfeeding
l
Linkages
to and
family
l
S. No.planning services.
Indicators
During ANC Directly-in
Total
-labor
l
l
Free condoms.
During this During this
l
Behaviour change
l
Month
Month
communication
l
high risk a. In same Facility
0
12 (BCC)
Totalfor
number
of
HIV
infected
women and her
b. In other Govt hospitals
deliveries this
l
Couple and safe sex counselling and HIV testing of spouse and0
partner.
c. Pvt Hospitasl/ any other facilities
0
month:
l
Repeat HIV
d. Home Deliveries
0
testing,
l
13.a.considering
Total number of normal (vaginal) deliveries of HIV infected pregnant women
0
l
during this
month
window,
period
if
positive
13.b.spouse
Total is
number
of deliveries by Caesarean section of HIV infected pregnant
0
l
women
during
this month
or s/he
have
high
behaviour.
14 riskOutcome
of HIV
a. Number live male child
0
infected
deliveries
l
Infant
feeding
and b. Number llivePostpartum
female child
0
this month
l
nutrition
c. Still births
0
counselling.
l
EBF
feeding
support
through
home
visits.
d. Deaths
0
l
Psycho-social
support
through
follow-up
counselling,
home
15
Total number of mother-baby pairs who received Nevirapine (single dose)
0
(whenever new guidelines not rolledvisits
out) and support groups.
HIV Exposed
Infant (HEI)
6 weeks during month
l
22
Number of HIV infected pregnant mother opting for exclusive breast feeding
0
andforcontinued
breastfeeds in addition to complement feeds after 6 months upto 1 year for
first 6 months
negative
babies
and
upto 2mother
yearsopting
for EID
positiveReplacement
babies who receive Paediatric ART. 0
23 EIDNumber
of HIV
infected
pregnant
for exclusive
feeding for first
months
l
Postpartum
ARV6prophylaxis
24
Number
HIV
infected pregnant
registered
at ART
centre
0
l
Early
infant
diagnosis
(EID) atwomen
6 weeks
of age;
repeat
testing at 6 months, 12 months & 6 weeks
cessation
breastfeeds.
25 after
Number
of HIVofinfected
pregnant women whose CD4 count is < 350
0
l
l
l
90
l
l
the child.
Monthly Input Formats for Integrated Counselling and Testing Centres (ICTC)
ii. Age-wise distribution
Agewise Distribution
Number of pregnant
women tested for HIV
Number of pregnant women

detected infected
1. 15-19 years
evitageN VIH
n
e
m
oW tnangerP
A/TRA ylhtnoM)stisiv 4 tsael-ta erusne( eraC latanetnA l
3. 25-34VR
years
xes efaS l
4. >35 Years
.gnillesnuoc
Total
elpuoC l
.gnillesnuoc
iii. Follow -up
.ylno ycnangerp
.sIO rehto dna BT rof gnineercS This
l month
Description
.seciv res gninnalp
.
s
I
T
S
r
o
f
t
n
e
m
t
a
e
r
t
d
n
a
g
n
i
n
e
e
r
c
S
l
eerFVisit
l
A. Visit for DBS and WBS Test
First Visit
Second Visit .smodnocThird
nahc ruoi12
vahmonths
eB l
.gnitset 4DC dn6a weeks
gnigats lac6inmonths
ilc OHW 6lmonths 12egmonths
noitacinum
mmonths
oc
18 months
18
dna gninnalp-htrib ,y reviled efas ,gnivil e6vmonths
itisop no g18
nillmonths
esnuoC 12
l months
ksir hgih rof )CCB(
1. Number of infants/children visited
reh dna nemow
d
n
a
e
s
u
o
p
s
f
o
g
n
i
t
s
e
t
V
I
H
d
n
a
g
n
i
l
l
e
s
n
u
o
c
x
e
s
e
f
a
s
d
n
a
e
l
p
u
o
C
l
.rentrap
2. Number of infants/children tested for HIV
using DBS-DNA PCR/Antibody test
VIH taepeR l
,gnitset
3. No of infants/children who were found .retneC TRA ot larrefeR l
g
n
i
r
e
disnoc
tnupositive
oc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l
fi doirep ,wodniw
4. Number of infants on exclusive breast
e
vitisop si esuops
rehfeeding
to/tne(EBF)
mnrevoG ot segaknil dna gnillesnuoc noitirtuN l
hgih evah eh/s ro
5. Number of infants on exclusive replacement .semmargorp noitirtuN
.ruoivaheb ksir
feeding (ERF)
6. Number of infants on CPT initiated at 6.seciv reS gninnalP ylimaF l
noitirtun
weeks and continuing
.gnillesnuoc
2. 20-24 years
7. No. of infants registered at ART centre

C. Details at 18 months:
1. Number of infants who came for follow- up
at 18 months

otpu sdeeftsaerb evisulcxE l
sdeeftsaerb deunitnoc dna
3. Number
.TRAofcinfants
irtaideHIV
aP einfected
viecer ohw seibab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIE
4. No. of infants registered at ART centre
.dlihc eht
)11'-01
2 senwho
ilediwere
uG Otested
CAN/(using
OHW I-noitpO derreferp( shtnom 6
2. Number
of0infants
3 antibody
tests)
rof raey 1 otpu shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni
iv. Outreach Linkages for HIV Positive Pregnant Women

(By Out Reach Worker)
1. Number of Offer
outreachofworkers
(ORWs) (IL &FS)/
ANMs/
HIV Counselling
and
Testing
ASHAs/DLNs
Number
Services to all Pregnant Women
2. Number of HIV infected pregnant women visited at home

by the outreach worker during the month (specify who
visited)
Negative
HIVwho
Infected
3. HIV
Number
of HIV infected pregnant women
were Pregnant Women
expected
to
deliver
this
month,
visited
by
the
outreach
Pregnant Women
l
worker
l
Safe(specify)
sex
4. Number
of HIV infected women visited post delivery by
counselling.
l
ORWs/ANMs/ASHAs/DLNs
l
Couple

pregnancy only.
Linkages
to family
ii. 6l weeks
to 6 months
l
planning
iii. 6 months
to 12services.
months
l
l
Free condoms.
iv. 12 months to 18 months
l
Behaviour change
l
v. 18 months until the time baby is breastfed
communication
l
(BCC) for high risk
women and her
l
partner.
l
Repeat HIV
testing,
l
considering
l
window, period if
spouse is positive
l
or s/he have high
Nutrition
programmes.
risk behaviour.
l
l
Infant feeding and
l
nutrition
counselling.
l
l
i. Before
6 weeks
counselling.

l
l
l
l
l
l
92
l
l
the child.
14
Roles and Responsibilities of Staff at Different Levels
Figure 2: managers
Componentsand
of PPTCT
Programme
Roles and Responsibilities of programme
staff in
PPTCT services is shown in (Table:11)
PPTCT program is to be implemented through the ICTC and ART centres and also needs to be an
Offer of
HIV
Counselling
and Testing
Services
all Pregnant
integrated response
with
general
health system.
Following
tableto
details
terms of Women
reference of staff at
different level regarding their roles and responsibilities in implementation of PPTCT programme:
Table 11: Roles and Responsibilities of Programme Managers and Staff in PPTCT Programme
Sl.HIV
No. Negative
Designation of Official/staff
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
Project Director
l
Behaviour
changeState AIDS
1
Control Society (SACS)
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.

Women
Role
in PPTCT Implementation
l 1. Antenatal
(ensure
4 visits)Monthly
ART/ARV
Facilitate Care
development
of at-least
state micro-plan
for implementation
of PPTCT
programme
2. Facilitate establishment of Joint State PPTCT programme implementation
l
Counselling
committee on choices of continuation or medical termination of
3. pregnancy
Facilitate regular
meetings
of the implementation
for
(MTP)to
undertake
within thecommittee
first 3 months
of
programme
review
and
policy
decisions
pregnancy only.
4. Advocacy with Principal Secretary, Health & Family Welfare and MDl
Screening
TB and
otherofOIs.
NRHM to for
ensure
ownership
PPTCT programme by Director, Health &
Family Welfare Services, state RCH officer
l
5. Facilitate formation of the Joint District PPTCT implementation committee
and Case
Management
TeamCD4
in alltesting.
districts of the state
l
WHO
clinical
staging and
6. Facilitate measures to ensure ownership of the programme at district level
l
Counselling
on positive
living,
safe
delivery,
birth-planning
and
by District Health
& Family
Welfare
Officer,
CMHO,
Civil Surgeon, District
RCHfeeding
officer etc.
infant
options.
7. Advocacy with Secretary Medical Education to ensure adherence to
l
Couple
and
safe sex guidelines
counselling
and
HIV testing
of spouse
and
National
programme
so as
to minimize
linkage
loss in medical
college
hospitals
8. Facilitate joint review meetings of NACP-NRHM and Medical Education
l
Referral
to ART
Center.
programme
managers
at regular intervals
9.
Facilitate
involvement
of professional regimen
organizations
like FOGSI,
IAPcount
, IMA
l
based
on CD4
to ensure systematic involvement of private sector
and/or
clinical
staging.
10.
Overall
leadership
of programme with regular monitoring of progress
l
counselling
and linkages
to Government/other
1. Nutrition
Ensure close
coordination between
the Basic Services
division and Care
Nutrition
programmes.
and Support
& Treatment division at state and district level
2. Establish close liaison with State RCH officers and other key stakeholders
l
Postpartum
in NRHM
Establish
close liaison
with state level office bearers of professional
l 3. Family
Planning
Services.
organizations like FOGSI for systematic involvement of private nursing
l
EBF
reinforcement/Infant feeding support through home visits.
homes
Facilitate formation
of the
Joint District
PPTCTcounselling,
implementation
committee
l 4. Psycho-social
support
through
follow-up
home
and Case Management Team in all districts of the state
andregular
support
groups.
5. visits
Ensure
meeting
of Joint District PPTCT implementation committee
through supportive supervision and monitoring

6. Establish mechanisms for monitoring progress in linking up of HIV
Nodal Officer for PPTCT in
2
infected pregnant women to PPTCT services e.g. use of google doc. for
the SACS
tracking and monitoring at state level
7. Establish Stand-alone ICTCs at all CHC level health facilities
Exclusive breastfeeds upto 6 months
(preferred
Option-I
WHO/NACO
Guidelines
2010-'11)
l
8. Ensure
availability
of HIV screening
facilities
at all high delivery
points
belowtoCHCs
in the form feeds
of F-ICTCs
level screening
using
and continued breastfeeds in addition
complement
afterand
6 sub-centre
months upto
1 year for
WBFPT
EID negative babies and upto 29. years
foravailability
EID positive
babies
whoatreceive
Paediatric
ART.
Ensure
of PPTCT
services
all high delivery
points
10.
Ensure
mechanisms
for
quick
linkage
of
screened
positive
pregnant
l
women to SA-ICTCs for confirmation, to ART Centre for life-long ART and
l
Early infant diagnosis (EID) at 6 weeks
of age;for
repeat
testingbabies
at 6 months, 12 months & 6 weeks
EID services
HIV exposed
11.
Monitoring
of
compliance
of
infected
pregnant women with PPTCT
guidelines through regular follow-up visits of NACP outreach workers and
l
Co-trimoxazole prophylaxis from 6 weeks
of age.
other health
system human resources
l
94
l
l
l
the child.
Sl. No.
Role in PPTCT Implementation
1. Facilitate ownership of the PPTCT programme by the District Health &
nemoW tnangerP lla o2.

t seFamil;y
civreSWelfare
gnitseOfficers
T dna(CMHO,
gnilleCivil
snusurgeon)
oC VIH fo reffO
Facilitate ownership of PPTCT activities by PHC medical officers and the
field staff
3. Facilitate provision of support for confirmation of HIV status of pregnant
women, travel to ART centre for enrolment and drug collection along with
facilities for institutional delivery
ofI HIV
vitadelivery
geN VIH
n4.
emFacilitate
oW tnanestablishment
gerP detcefn
VIHscreening facilities at allehigh
3
State RCH Officer
points in the form of F-ICTCs and sub-centre level screening using WBFPT
n
e
m
o
W
t
nangerP
VRA/TRA ylhtnoM)stisiv 4 tsa5.
el-taEnsure
erusnavailability
e( eraC laof
tanPPTCT
etnA services
l
at all high delivery points
6.
regular
xes efaS l
.sreFacilitate
tneC TRA
ta sixmeeting
alyhpoof
rpthe Joint District PPTCT implementation
committee
.gnillesnuoc
officers and concerned ANM and
fo noitanimret lacidem ro noitaunitno7.
c foFacilitate
seciohcinvolvement
no gnillesnofuPHC
oC medical
l
elpuoC l
in the Case Management Team
fo shtnom 3 tsrif eht nihtiw ekatrednother
u othealth
)PTMsystem
( ycnafunctionaries
ngerp
8. Ensure involvement of medical officers at PHCs and ANMs
.gnillin
esmonitoring
nuoc
lnoICTCs,
ycnaART
ngercentres
p
of linkages.yto
and compliance
off HIV
infected
y
l
i
m
a
o
t
s
e
g
a
kniL l
.sIO rehpregnant
to dna Bwomen
T rof gto
niPPTCT
neercSregimen
l
.seciv res gninnalp

PPTCT implementation committee
.sITS 1.
rof tEnsure
nemtaformation
ert dna gof
ninthe
eeJoint
rcS District
l
.smodnoc eerF l
and Case Management Team in all districts of the state
of W
JointlDistrict PPTCTeimplementation
gnahc ruoivahcommittee
eB l
.gnitset 4D2.
C dEnsure
na gnigregular
ats lacmeeting
inilc OH
3. Establish Stand-alone ICTC at all CHC level healthno
facilities
itacinummoc
dna gninnalp-htrib ,y reviled efas ,g4.
nivilEnsure
evitisoavailability
p no gnillofesHIV
nuoscreening
C l facilities at all high
delivery points
k
s
i
r
h
g
ih screening
rof )CCBusing
(
below
and sub-centre level
.snoCHCs
itpo ginnithe
deeform
f tnaoffnF-ICTCs
i
reh dna nemow
WBFPT
dna esuops fo gnitset VIH dna gnil5.
lesnEnsure
uoc xeavailability
s efas dnaofelPPTCT
puoC services
l
at all high delivery points
.rentrap
6. Ensure mechanisms for quick linkage of screened positive pregnant
.nertodlSA-ICTC
ihc gnivfor
il rconfirmation,
ehto
IH taepofeRlife l
women
to ART Centre forVinitiation
-long
ART
and
EID
services
for
HIV
exposed
babies
,gnitset
7. Monitoring of compliance of infected pregnant women gwith
PPTCT
n
i
r
e
disnoc
tn4uoc 4DDistrict
C no dHIV
esaprogramme
b nemiger citcalyhpoguidelines
rp VRA rthrough
o TRA regular
edivorP
l
follow-up
visits of NACP outreach workers and
Manager DAPCU / DNO
fi doirep ,wodniw
other
.gnihealth
gats lasystem
cinilc human
ro/dnaresources
8. Training load assessment
evitisop si esuops
rehto/tnemnrevoG ot segaknil d9.
na Establish
gnillesnclose
uoc liaison
noitiwith
rtuNDistrict
l
Health & Family
hgihWelfare
evah eOfficers
h/s ro
(CMHO/
.semmDy.
argCMHOs/
orp noitRCH
irtuNOfficers)
.ruatoithe
vahdistrict
eb kslevel
ir
10. Overall planning and implementation of programme
.rehtom rof s11.
ixalyEnsure
hporpup
VRtoA mdate
utrarecording
ptsoP atl all facilities and
toI state
dnatimely
gnidreporting
eef tnafn
l
.selevel
civ reS gninnalP ylimaF l
noitirtun
12. Supervisory visit to ART centres, ICTCs and other HIV screening centres
ni,llIMA
esnu
tooc
.stisiv emoh hguorht troppus gnide13.
ef tnClose
afnI/liaison
tnemewith
crofprofessional
nier FBE lassociation like FOGSI,.gIAP
facilitate involvement of private nursing homes & institutions
emoh ,gnillesnuoc pu-wollof hgu14.

orhAdvocacy,
t troppusCommunication
laicos-ohcysPandlsocial mobilization activities for effective
.simplementation
puorg troppusofdPPTCT
na stisservices
iv
1. Advocacy with District Health & Family Welfare Officers (CMHOs Civil
surgeons) for ownership of PPTCT programme
2. Ensure ownership of PPTCT activities by PHC medical officers and the
field staff
)IEHof( HIV
tnafstatus
nI deof
sopregnant
pxE VIH
3. Ensure provision of support for confirmation
)11'-0102 senilediuG OCAN/OHW Iwomen,
-noitpOtravel
derrto
efeART
rp( centre
shtnofor
m enrolment
6 otpu sdand
eefdrug
tsaecollection
rb evisulalong
cxE with
l
facilities for institutional delivery
rof raey 1 otpu shtnom 6 retfa 4.
sdeeFacilitate
f tnemeestablishment
lpmoc ot noofitiHIV
ddascreening
ni sdeeffacilities
tsaerb d
unhigh
itnocdelivery
dna
ateall
5
District RCH Officer
points
in
the
form
of
F-ICTC
and
sub-centre
level
screening
using
.TRA cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIWBFPT
E
5. Ensure availability of PPTCT services at all high delivery points
skeewmeeting
6 rof tnofafJoint
ni roDistrict
f sixalyPPTCT
hporpimplementation
VRA mutraptscommittee
oP l
6. Ensure .regular
7.
Ensure
involvement
of
PHC
medical
officer,
concerned
ANM
and
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraother
E l
health system functionaries in Case Management Team so as to ensure
.
s
d
e
e
f
t
s
a
e
r
b
f
o
n
o
i
t
a
s
s
e
c
r
e
t
f
a
linkage to screened positive pregnant women to ICTCs for confirmation,
to ART centre for enrolment and to monitor compliance with PPTCT
programme guidelines
.dlihc eht
l
l
l
l
95
Sl. No.
6
Monitoring and evaluation

1. Maintenance of consolidated PPTCT line-lists
assistant
at
DAPCU
/ICTC
2. Updating
PPTCT Services
line-lists with
events,
compilation,
analysis and
and Testing
toallall
Pregnant
Women
counsellor at the district
interpretation etc.
headquarter
3. Timely reporting of PPTCT line-lists to SACS
HIV Negative
Pregnant Women
l
Safe sex
7 counselling.
District ICTC supervisor
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat
HIV medical officer at
In-charge
8 testing,
ICTC
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.
1. Supervisory visit ART centres, ICTCs and other HIV screening centres (TB
and STI)
2.
SupportivePregnant
supervisionWomen
of ICTC
HIV Infected
3. Facilitate co-ordination between ICTC/ART centre staff with general health
l
Antenatal
(ensure at-least 4 visits)Monthly ART/ARV
staff (RCHCare
/ NRHM)
4. prophylaxis
Ensure preparedness
for conducting HIV positive deliveries at delivery
at ART Centers.
points
l 5. Counselling
on of
choices
of continuation
termination
Ensure linkage
HIV exposed
infants (HEIs)ortomedical
Early Infant
diagnosis of
sites ICTCs (MTP)to
where DBC is
being done within the first 3 months of
pregnancy
undertake
6. pregnancy
Ensure follow-up
only. visits to HIV infected pregnant women by health staff /
outreach workers/District Level Networks
l 7. Screening
for TB and
other
OIs. to district M and E assistants for
Facilitate reporting
of all
key events
updating
line-lists
l
1. Measures to ensure 100% screening of all pregnant women enrolled into
Ante-Natal Care
l 2. Counselling
on positive
living,
safe delivery,
Measure to ensure
HIV, STI,
TB screening
early birth-planning and
3. Ensure uninterrupted availability of test-kits, drugs, referral forms and
registers
l 4. Couple
safereferral
sex counselling
and
testing
of spouse
and
Ensureand
prompt
and linkage of
HIVHIV
infected
pregnant
women
to
ART centres
5. Ensure safe institutional deliveries
Ensure to
provision
of ARV prophylaxis for the baby for 6 weeks Sy.NVP for
l 6. Referral
ART Center.
6 weeks (3 bottles each) 25ml
l
7. Ensure linkage of the baby to EID services
clinical
staging.
8. and/or
Clinical
assessment
and care of patients while on ART
9.
Monitoring
adherence
to ART
l
and linkages to Government/other
10. Ensure home visits to the infected pregnant women at prescribed
Nutrition
programmes.
frequency
Ensure timely
follow-up
visits of for
infected
pregnant women to ART centres
l 11.
Postpartum
ARV
prophylaxis
mother.
l
Provision
of preventive
health education to all Ante-natal care women and
Family
Planning
Services.
explain about screening of women for HIV, Syphilis and TB
l
feeding
through
home visits.
2. EBF
Ensure
coverage of all registered
ANCssupport
in the area
of jurisdiction
with HIV
counselling testing
Provision
of psychosocial
to all infected
l
Psycho-social
support
through
follow-upsupport
counselling,
homewomen
3. Ensure prompt referral of infected ANCs with ART centres
and support
groups.
4. visits
Coordination
with ART
/ LAC Plus / LAC for confirmation of linkages and
l 1.
follow- up
5. Track evaluation at ART centre, initiation of ART and referral back for care
9
6. Maintaining record of referral, its outcomes, planned place for delivery,
planned follow -up dates, person responsible for follow-up etc.
7. Ensure hospital delivery
Exclusive breastfeeds upto 6 months
(preferred
Guidelines 2010-'11)
l
8. Ensure
provisionOption-I
of ARV to WHO/NACO
baby as prescribed
9. Ensure
of ART feeds
to all direct-incases
and continued breastfeeds in addition
to provision
complement
after 6 labour
months
upto 1 year for
10. Maintain up- to-date recording of all events and communication of the
EID negative babies and upto 2 years
for EID positive babies who receive Paediatric ART.
same to District M&E Assistants
Ensure
of HIV exposed infants (HEIs) to EID
l
Postpartum ARV prophylaxis for11.
infant
for linkage
6 weeks.
Counsellor stand-alone ICTC
/ F-ICTC
Nurseofatage;
F-ICTCs
all activities
mentioned
for counsellors
Early infant diagnosis (EID) at 61. weeks
repeat
testing at
6 months,
12 months & 6 weeks
2. Administration of ART (TDF+3TC+EFV) to pregnant women presenting
cessation of breastfeeds.
10 after Nurse
directly- in- labour and initiation of Sy. Nevirapine for 6 weeks to HIV
l
Co-trimoxazole prophylaxis from 6 weeks
age.
exposedofbabies
l
l
96
l
l
the child.
l
Sl. No.
1. Screening test for HIV and Syphilis using WBFPT for all ANCs registered.
for TB screening
nemoW tnangerP lla ot seIfcireactive,
vreS grefer
nitsetoTART,
dnaSTIgnand
illeGene-xpert
snuoC Vtesting/DMC
IH fo reffO
2. Screening the pregnant women for Syphilis using WBFPT, if reactive then
refer to STI clinic/PHC for RPR confirmation
3. Screening the pregnant women for TB if symptomatic refer to a health
facility where Gene-xpert testing is done or PHC with DMC
evitANCs
ageN VIH
n4.
emEnsure
oW tnaconfirmation
ngerP detcofeHIV
fnI Vstatus
IH among screened positive
11.
ANM
5.
Establishing
linkage
of
HIV
infected
pregnant
women
to
ART
n
e
m
o
W
tCENTRE
nangerP
6. Facilitate institutional deliveries
xes efaS l
.sreFollow-up
tneC TRAwith
ta sthe
ixamother
lyhporpafter delivery to monitor compliance
7.
in ART
.
g
n
i
llesnuoc
consumption
elpuoC l
linkages
babies to EID
fo shtnom 3 tsrif eht nihtiw ekatr8.
ednFacilitate
u ot)PT
M( ycof
naHIV
ngeexposed
rp
nillcentre,
esnuocCD4
9. Provide reminders to mother on ART regarding visit to.g
ART
.ylno ycnangerp
test, etc.

.seciv res gninnalp
1. Conduct HIV testing as per guidelines and provide feedback to referring
.sITS rof tPHC
nemMO
taerregarding
t dna gnistatus
neercwith
S lconcurrence of patient
.smodnoc eerF l
e
g
n
ahcstaff
ruofor
ivaearly
heB l
.gnitset 4D2.
C dLiaison
na gnigwith
ats lF-ICTCs
acinilc and
OHW
l
Sub-centre screening facility
information
on
screening
positive
women
and
track
their
arrival
noitacinummforoc
confirmation collection and dispatch of blood kspecimen
sir hgihfor
rofCD4
)CCtesting
B(
.snoitpoand
gndispatch
ideef tnaoffnblood
i
12
ICTC Lab technician
3. Collection
specimen for CD4
testing
reh dna nemow
dna esuops fo gnitset VIH dna gnil4.
lesnMaintaining
uoc xes efastock
s dnaofeWBFPT
lpuoC forl F-ICTCs and sub-centre screening
.rentrap
facilities
VIH tin
aethe
peR l
5. Ensure uninterrupted supply of test kits to Screening facility
,
g
n
i
tset
.retneC Twith
RA ocold
t lar-chain
refeR maintenance
l
jurisdiction
g
n
i
r
e
d
i
s
noc
tnuoc 4DC no desab nemiger citcaly6.
hpoRecord
rp VRmaintenance
A ro TRA edand
ivotimely
rP l reporting to district and state level
fi doirep ,wodniw
.gnigatpregnant
s lacinilwomen
c ro/dnscreened
a
1. Mobilize
positive with WBFPT to visit ICTC for
e
vitisop si esuops
rehto/tnemnrevoG ot segaknil dna confirmation
gnillesnuoc noitirtuN l
h
gihto eART
vahcentre
eh/s or
ro STI
2. Facilitate
pregnant women
.semmaLinkage
rgorp nofoHIV
itirtuinfected
N
.ruoivaheb ksir
clinic or Gene-xpert testing site/DMC for TB
Outreach worker (ILFS/
.rehtom rof s3.
ixalyFacilitate
hporp Vinstitutional
RA mutrapdelivery
tsoP l
d
n
a
gnideef tnafnI l
13
Link-workers, CSC outreach
4. .se
Facilitate
visit
of
the
HIV
Exposed
c
i
v
r
e
S
g
n
i
n
n
a
l
P
y
l
i
m
a
F
l Infants(HEIs) to ICTC for
noEID
itirtun
worker, etc.)
5. Facilitate regular follow-up visits to ART centre for ART,
CD4
.gnillestesting
nuoc etc.
6. Home visit to monitor adherence to ART medication
emoh ,gnillesnuoc pu-wollof hgu7. orhLiaison

t troppwith
us laANMs/ASHAs/Community
icos-ohcysP l
Outreach Workers/DLNs for followup
with
the
infected
Pregnant
women
1. Ensure safe delivery practices, availability of safe delivery KITs
2. Ensure continuation of ART during labour and delivery
3. Provide ART (TDF+3TC+EFV) for direct- in- labour positive pregnant
EH( tto
naHIV
fnI exposed
desopxnew
E VIborns
H
Medical Officer of facility
women and Nevirapine suspension for 6)Iweeks
14
confirmation
)11'-0conducting
102 senipositive
lediuGdelivery
OCAN/OH4.
W IEnsure
-noitpO
derreferpof( sHIV
htnstatus
om 6ofodirect-intpu sdeelabour
ftsaercases
b eviat
suearliest
lcxE l
5. Counsel the infected pregnant women regarding importance of enrolling
ART centre and receiving life-long ART
.TRA cirtaideaP eviecer ohw se6.
ibaCounsel
b evitisinfected
op DIE pregnant
rof sraewomen
y 2 otpregarding
u dna simportance
eibab evitof
agEID
en DIE
.skeew 6 rof tnafni rof sixalyhporp VRA mutraptsoP

skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE
.ega fo skeew 6 morf sixalyhporp elozaxomirt-oC
.dlihc eht
l
l
l
l
l
l
l
97
Sl. No.
1. Prompt evaluation of HIV infected pregnant women at ART centre

2. Prompt
initiation Services
of life-long ART
(TDF+3TC+EFV)
to every infected
and Testing
to all
Pregnant Women
pregnant women regardless of CD4 levels or clinical stage
3. Ensure feedback to referring ICTC regarding receipt of case at ART centre,
outcome of evaluation and prescribed drug regimen for the patients
4. Formulation of Case Management Team comprising ICTC counsellor,
15
ART centre SMO/MO
concerned ANM, concerned out-reach worker
HIV Negative
HIV
Infected Pregnant Women
5. Draw plan for follow-up visits including linkage to LAC in consultation
Pregnant Women
with the infected
pregnantat-least
women 4
forvisits)Monthly
assessment and drug
collection
l
Antenatal
Care (ensure
ART/ARV
6. Ensure uninterrupted supply of drugs and logistics to LAC-Plus, LAC
l
Safe sex
7. Ensure provision of information on all events to the districts M&E assistant
counselling.
l
Counselling
choices
of continuation or medical termination of
for updatingon
in PPTCT
line-lists
Couple
counselling.
l
Linkages to family
planning services.
ART centre counsellor/ staff
l
16 Free condoms.
nurse change
l
Behaviour
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.
l
(MTP)to
undertake
theART
first
3 monthsandof
1. pregnancy
Prioritisation
of HIV infected
pregnantwithin
women for
preparedness
pregnancy
adherence only.
counselling
2. Counselling on important components of PPTCT programme like role of
l
ART, duration, safe hospital delivery, EID, breastfeeding etc.
l 3. Screening
treatment
for STIs.
Up-to-dateand
record
keeping and
documentation of follow- up and ensure
tracking of missed cases
l
4. Liaison with referring ICTC counsellor, outreach workers to track
l
Counselling
living,
safe delivery,
birth-planning
and
compliance on
andpositive
adherence
to schedule
of follow-up
visit to ART centre
5. infant
Liaison
with
referring
ICTC
counsellor
for
whole
blood
specimen
testing
of
feeding options.
DBS positive babies at ART Centres
l
l
l
l
l
l
l

l
l
l
l
l
l
98
l
l
the child.
Annexures
(1-20)

Annex 1: Guidelines forFigure
Rollling
out NACP and NRHM Convergence
Plan in No X-19020/17/2009-NACP (IEC), 10 August 2010
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l

l
l
l
l
l
l
100
l
l
the child.
emmNACP
argorPand
TCTPNRHM
P fo stneconvergence
nopmoC :2 erugplan
iF in the states.
Annex 1: Guidelines for rolling out
No. X-19020/17/2009-NACP(IEC), 10 August 2010

.ylno ycnangerp
evitageN VIH
nemoW tnangerP
xes efaS l
.gnillesnuoc
elpuoC l
.gnillesnuoc
.seciv res gninnalp
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
gniredisnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.erac tnafni enituor dna snoitazinummI l101
.dlihc eht
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l

l
l
l
l
l
l
102
l
l
the child.

.ylno ycnangerp
evitageN VIH
nemoW tnangerP
xes efaS l
.gnillesnuoc
elpuoC l
.gnillesnuoc
.seciv res gninnalp
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
gniredisnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l

l
l
l
l
l
l
104
l
l
the child.

.ylno ycnangerp
evitageN VIH
nemoW tnangerP
xes efaS l
.gnillesnuoc
elpuoC l
.gnillesnuoc
.seciv res gninnalp
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
gniredisnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l

l
l
l
l
l
l
106
l
l
the child.

.ylno ycnangerp
evitageN VIH
nemoW tnangerP
xes efaS l
.gnillesnuoc
elpuoC l
.gnillesnuoc
.seciv res gninnalp
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
gniredisnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l

l
l
l
l
l
l
108
l
l
the child.

.ylno ycnangerp
evitageN VIH
nemoW tnangerP
xes efaS l
.gnillesnuoc
elpuoC l
.gnillesnuoc
.seciv res gninnalp
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
gniredisnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l

l
l
l
l
l
l
110
l
l
the child.

Annex 2: Dosing Schedules
for ART for Pregnant Women
Clinical Scenario
nemoW
Pregnant women
requiring ART
Postpartum
tnARV
angProphylaxis
erP lla otand
secivreS gAntepartum
nitseT dna gnillesIntrapartum
nuoC VIH fo reffO
dosing
TDF 300mg once daily

3TC 300 mg once daily
EFV 600mg once daily
Start ART as soon as

possible
(first trimester)
Continue ART
Continue ART life-long
evitageN VIH
n
e
m
oW tnangerP
Annex 3: ART for Pregnant.srWomen
Presenting
in
Active
Labour
xes ewith
faS l
etneC TRA ta sixalyhporp
.gnillesnuoc
No.
Prior
ART
elpuoC l
.gnillesnuoc
Maternal Status
Intrapartum
Postpartum
.ylno ycnangerp
Presenting in active labour,
TDF 300mg once daily
.sTDF
IO r300mg
ehto dnonce
a BTdaily
rof gnineercS l
.se300
civ rmg
es gonce
ninndaily
alp
No Prior ARV prophylaxis
3TC 300 mg once daily
3TC
.sITEFV
S ro600mg
f tnemtonce
aert daily
dna gnineercS l
.smodonce
nocdaily
eerF l
EFV 600mg
egnahc ruoivaheB l
noitacinummoc
dna gn4:
innaInfant
lp-htrib ,yNVP
reviledProphylaxis
efas ,gnivil evitisop
no gnillesnuoC l
Annex
dosing
ksir hgih rof )CCB(
reh dna nemow
Duration
dna eBirth
suopWeight
s fo gnitset VIH dnNVP
a gndaily
illesndose
uoc (in
xesmg)
efas dnNVP
a elpdaily
uoCdose
l (in ml)**
.rentrap
Birth to 6 weeks: *
VIH taepeR l
,gnitset
.retneC TRA o0.2
t laml/kg
rrefeR
l
once daily
Up to 6 weeks irrespective of
Infants with birth weight
2 mg/kg once daily.
g
n
i
r
e
disnobreastfed
c
whether exclusively
< t2000
nuoc gm
4DC no desab nemigeInr cconsultation
itcalyhporwith
p VRaA ro TRA edivorP l
doirep ,replacement
wodniw fed.
orfiexclusive
pediatrician trained
.gniginatHIV
s lacinilc ro/dna
care.
evitisop si esuops
hgih evah eh/s ro
Birth weight 2000 2500 gm
10 mg once daily
.semmargorp1nml
oitonce
irtuNa day
.ruoivaheb ksir
rehto15
mmg
rofonce
sixaldaily
yhporp VRA m1.5
utraml
ptonce
soP a lday
Birth weight more than 2500 .gm
ec1ml.
iv reSsuspension
gninnalPbased
ylimaon
F WHO
l
noitirtun
* * considering the content of 10 mg Nevirapine.sin
Guidelines.
gnillesnuocin these
* Infants
birth
ofe2crmg/kg
.stiswith
iv em
oh hweight
guorh<t t2000
roppugm
s gshould
nideefreceive
tnafnIdose
/tnem
ofnieronce
FBEdaily.
l Consult expert HIV .paediatrician
cases.

Source: WHO Guidelines
Annex 5: WHO Clinical Staging for Adults and Adolescents

Asymptomatic
rof generalized
raey 1 otplymphadenopathy
u shtnom 6 retfa sdeef tnemelpmoc ot noitidda ni sdeeftsaerb deunitnoc dna
Persistent
CLINICAL STAGE 2
Moderate unexplaineda weight loss (under 10% presumed or measured body weight)b Recurrent respiratory tract infection
(sinusitis, tonsillitis, otitis media, pharyngitis)
Herpes zoster Angular cheilitis Recurrent oral ulceration
.dlihc eht
CLINICAL STAGE 1
Papular pruitic eruptions Seborrhoeic dermatitis Fungal nail infections

CLINICAL STAGE 3
Unexplaineda severe weight loss (over 10% of presumed or measured body weight)b
Unexplaineda chronic diarrhoea for longer than one month
Unexplaineda persistent fever (intermittent or constant for longer than one month) Persistent oral candidiasis
Oral hairy leukoplakia
HIV Negative
Pulmonary tuberculosis
Pregnant Women
Antenatal
Care (ensure
at-least
4 visits)Monthly
ART/ARV Acute
Severe bacterial infections (e.g. pneumonia,l empyema,
pyomyositis,
bone or
joint infection,
meningitis, bacteraemia)
l
Safe
sex
necrotizing ulcerative stomatitis, gingivitis or periodontitis
counselling.
Unexplaineda
anaemia (below 8 g/dl ), neutropenia
(below 0.5
100/1) and/or
chronic thrombocytopenia
l
Counselling
onxchoices
of continuation
or medical termination of
l
Couple
(below
50 x 100 /1)
counselling.
pregnancy only.
l
Linkages to family
l
planning
services.
HIV wasting
syndrome
l
Free condoms.
Pneumocystis
jeroveci pneumonia (PCP) l Screening and treatment for STIs.
l
Behaviour
change
Recurrent
severe bacterial
pneumonia
l
Chroniccommunication
herpes simplex infection (orolabial,lgenital
or anorectal
more than
one months
durationbirth-planning
or visceral at anyand
site)
Counselling
onofpositive
living,
safe delivery,
Oesophageal
(or candidiasis of trachea, bronchi or lungs)
(BCC)candidiasis
for high risk
Extrapulmonary
women tuberculosis
and her
l
Kaposipartner.
sarcoma
Cytomegalovirus
infection (retinitis or infection other
of other
organs)
Central nervous system toxoplasmosis
living
children.
l
Repeat HIV
HIV encephalopathy
testing,
l
Extrapulmonary
cryptococcosis including meningitis Disseminated non-tuberculous mycobacteria infection Progressive
considering
l
multifocal
leukoencephalopthy
window,
period if
Chronicspouse
cryptosporidiosis
is positive
l
Chronicorisosporiasis
s/he have high
Nutrition
programmes.Recurrent septicaemia (including non-typhoidal
Disseminated
mycosis (extrapulmonary histoplasmosis, coccidiomycosis)
risk behaviour.
Salmonella)
l
l
Infant feeding and
Lymphoma
(cerebral
or
B
cell
non-Hodgkin)
Invasive
carcinoma
l
Familycervical
Planning
Services.
nutrition
Atypical
disseminated
leishmaniasis
counselling.
l
Symptomatic HIV-associated nephropathy or HIV-associated cardiomyopathy
l
a Unexplained refers to where the condition is not explained by other conditions.
b Assessment of body weight among pregnant women
needs
to consider
the expected weight gain of pregnancy.
visits and
support
groups.
CLINICAL STAGE 4C
c Some additional specific conditions can also be included in regional classifications, such as the reactivation of American
trypanosomiasis
(meningoencephalitis and/or myocarditis) in the WHO Region of the Americas and penicilliosis in Asia.
Source: Revised WHO clinical staging and immunological classification of HIV for surveillance. 2006 (in press).

l
l
l
l
l
l
112
l
l
the child.

Annex 6: Grading of Selected
Clinical and Laboratory Toxicities
(Reference: WHO 2010 Guidelines for ART in Adults and
Adolescents)
Mild
Grade 1
Moderate
Grade 2
Severe
Grade 3
Potentially lifethreatening Grade 4
evitageN VIH
n
e
m
oW tnangerP
VRA/TRA ylhSymptoms
tnoM)sticausing
siv 4 tsno
ael-ta Symptoms
erusne( ercausing
aC latanetnASymptoms
l
Symptoms causing
causing
Clinical adverse
xestoeperform
faS l
.sretngreater
eC TRthan
A taminimal
sixalyhporp
inability
inability to perform
or minimal interference
event Not identified
.gnilselfcare
lesnuocor
basic
interference with usual usual social and
with usual social and
elsewhere in the
medicalelor
functional activities
social and functional
functional activities
table
puoperative
oC l
fo shtnom 3 tsrif eht nihtiw ekatrednuactivities
ot)PTM( ycnangerp
intervention
.gnillesnuindicated
oc
.ylno ycnangerp
to prevent permanent
ylimaf impairment,
ot segakniL l
.secivpersistent
res gninndisability
alp
or
.sm
odnoc eerF l
death
egnahc ruoivaheB l
Haemoglobin
8.09.4 g/dl OR
7.07.9 g/dl OR
6.56.9 g/dl OR
< 6.5 g/dl OR
noi<
tac65
ing/l
umOR
moc
dna gninnalp-htr8094
ib ,y reg/l
vileOR
d efas ,gnivil e7079
vitisog/l
p nOR
o gnillesnuoC6569
l
g/l OR
ksir hg<ih4.03
rof )mmol/l
CCB(
4.935.83 mmol/l
4.314.92
mmol/l
4.034.30
mm0l/l
reh dna nemow
3
3
Absolute
OR
<500/mm
dnaneutrophil
esuops fo gn10001500/mm
itset VIH dna g3 nillesnu750999/mm
oc xes efas d3 nOR
a elpuoC500749/mm
l
.rentrOR
ap
count
0.750.99/g/I*
0.5 -0.749/g/I*
<0.5/g/I*
or 1.01.5/g/I*
VIH taepeR l
3
3
Platelets
75000-99000/mm3
2000049999/mm
5000074999/mm
<20000/mm
,gnitse3tOR
OR 5074.9/g/I*
<20/g/I*
OR 75-99/g/I*
OR 2049.9/g/I*
gniredisnoc
fi doirep ,wodniw
Chemistries
evitisop si esuops
rehto/tnemnrevoG>1.01.5
ot segxaULN
knil dna >1.52.5
gnillesnuxocULNnoitirtuN>2.55
l
Hyperbilirubinaemia
x ULN
hgih >5
evaxhULN
eh/s ro
.ru>oi500
vahemg/dl
b ksir
Glucose (fasting)
110125 mg/dl
126250 mg/dl
251500 mg/dl
Hypoglycaemia
5564 mg/dl OR
mg/dl OR
<30 n
mg/dl
.se4054
civ reSmg/dl
gninnOR
alP ylimaF3039
l
oitirtOR
un
3.013.55 mmol/l
2.193.00 mmol/l
1.672.18 mmol/l
<1.67 mmol/l
.gnillesnuoc
Estimating severity grade
Hyperglycaemia
mg/dl OR
emoh ,gnilles116160
nuoc pu-mg/dl
wolloOR
f hguorht161250
troppus mg/dl
laicosOR
-ohcysP251500
l
(nonfasting and no
6.448.90 mmol/l
8.9113.88 mmol/l
13.8927.76 mmol/l
prior diabetes)
>500 mg/dl OR
>27.76 mmol/l
Triglycerides
>1200 mg/dl or
>13.55 mmol/l
400750 mg/dl OR
4.528.47 mmol/l
7511200 mg/dl or
8.4813.55 mmol/l
)IEH( tnafn>6.0
I desXoULN
pxE VIH
>1.01.5 x ULN
>1.53.0 x ULN
>3.0-6.0 x ULN
AST (SGOT)
1.252.5 x ULN
>2.55.0 x ULN
>5.010.0 x ULN
>10.0 x ULN
ALT (SGPT)
.TRA cirtaide1.252.5
aP eviecxerULN
ohw seibab>2.55.0
evitisop xDULN
IE rof srae>5.0-10.0
y 2 otpu dxnULN
a seibab e>10.0
vitagexnULN
DIE
.skexew
6 rof tnaf>5.010.0
ni rof sixalyxhULN
porp VRA>10.0
mutraxpULN
tsoP l
GGT
1.252.5 x ULN
>2.55.0
ULN
Alkaline
1.252.5 x ULN
>2.55.0 x ULN
>5.010.0 x ULN
>10.0 x ULN
phosphatase
.dlihc eht
Creatinine
Mild
Grade 1
Chemistries
Moderate
Grade 2
Severe
Grade 3
Bilirubin
1.11.5 x ULN
1.62.5 x ULN
2.65.0 x ULN
> 5 x ULN
Amylase
>1.01.5 x ULN
>1.52.0 x ULN
>2.05.0 x ULN
> 5.0 x ULN
HIV Negative
Pancreatic
amylase
>1.01.5 x ULN
HIV Infected
Pregnant
>1.52.0
x ULN Women
>2.05.0 x ULN
> 5.0 x ULN
Pregnant Women
Care
(ensure at-least
4 visits)Monthly
Lipase
>1.01.5 x ULN l Antenatal
>1.52.0
x ULN
>2.05.0
x ULN
> ART/ARV
5.0 x ULN
l
Safe sex
Increased
Lactatecounselling. <2.0 x ULN without
>2.0 x ULN without
Increased lactate with
l
Counselling
continuation
or medical
termination
lactate
with pH of
acidosis
acidosis on choices of pH
<7.3 without
l
Couple
pregnancy (MTP)to undertake
within the first
3 without
months of
<7.3
lifethreatening
counselling.
lifethreatening
consequences
pregnancy only.
l
Linkages to family
consequences
l
planning services.
Gastrointestinal
l
l
Free condoms.
l
Behaviour change
Nausea
Mild OR transient; l WHO
Moderate
discomfort OR
Hospitalisation
clinicaldiscomfort
staging and Severe
CD4 testing.
reasonable intake
OR intake decreased
minimal intake for 3
required
communication
l
Counselling
on positive living,
safe delivery, birth-planning and
for <3 days
days
(BCC) for highmaintained
risk
women and her
Hypotensive shock
Severe vomiting of
Vomiting
Mild OR transient; 2-3
Moderate OR
l
Couple
and safe sex counselling
and HIV
testingOR
of spouse
and
hospitalisation
all foods/fluids
in 24
episodes per day OR
persistent;
partner.
for intravenous
hours OR orthostatic
4-5
episodes
per day
living
children.
l
Repeat HIV mild vomiting <1 weekother
treatment required
hypotension OR
OR
testing,
l
Referral
to ART
Center.
intravenous treatment
vomiting
lasting
1
considering
required regimen based on CD4 count
week ART or ARV prophylactic
l
Provide
window, period if
and/or
clinical staging. Bloody diarrhoea OR
Hypotensive shock
Moderate OR
Mild OR transient;
spouse is positive
counselling
and
linkages
to
Government/other
OR
orthostatic
hypotension
persistent;
Diarrhoea
3-4 loose stools perl Nutrition
or s/he have high
hospitalisation
OR 7 loose stools/
5-7 loose
stools per
day OR mild diarrhoeaNutrition
programmes.
risk behaviour.lasting<1 week
day OR intravenous Rx required
day OR diarrhoea
l
Postpartum
for mother.
l
Infant feeding and
required
lasting 1 ARV
week prophylaxis
l
nutrition
Respiratory
counselling.
l
Dyspnoea
Dyspnoea on exertion
Dyspnoea with normal Dyspnoea at rest
Dyspnoea requiring
l
Psycho-social
support through follow-up counselling,
home
activity
O2
therapy
Urinalysis
Proteinuria

1+
or 3+
4+
Nephrotic
syndrome
breastfeeds
upto 6 months2+
(preferred
Option-I WHO/NACO
Guidelines
2010-'11)
continued200
breastfeeds
in addition
1 yearsyndrome
for
24-hourand
urine
mg to 1 g loss/day
1 gto
to complement
2 g loss/day ORfeeds
2 g after
to 3.56g months
loss/day upto
Nephrotic
OR
<0.3%
OR
<3
g/l
0.3%
to
1.0%
OR
3
g
OR
>
1.0%
OR
>10
OR
to 10 g/l
g/l
>3.5 g loss/day
l
Gross haematuria
Microscopic only
Gross, no clots
Gross plus clots
Obstructive
l
Early infant diagnosis
(EID) at 6 weeks
of age; repeat testing
at 6 months, 12 months
& 6 weeks
l
l
l
114
l
l
the child.
Spotl urine
Exclusive
Mild
Grade 1
Miscellaneous nemoW
Fever
(Oral, >12 hours)
Moderate
Grade 2
Severe
Grade 3
tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO
37.7-38.50C OR
100.0 -101.50F
38.6-39.50C OR
101.6 -102.90F
39.6- 40.50C OR
103 -1050F
> 40.50C OR
> 1050F for 12
continuous hours
evitageN VIH
Intractable
nemoW tnangerP
xes efaS l
.
g
n
i
llesnuoc
Allergic
urticaria,
Anaphylaxis
fo noireaction
tanimret lacidPruritus
em ro nwithout
oitaunrash
itnoc fo sLocalized
eciohc nurticaria
o gnillesnuoCGeneralized
l
elpuoC l
fo shtnom 3 tsrif eht nihtiw ekatrednu ot)PTM( ycnangerpangioedema
.gnillesnuoc
.ylno ycnangerpVesiculation OR moist ANY ONE OF:
Rash hypersensitivity Erythema, pruritus
Diffuse maculopapular
y
l
i
m
a
f
ot segakniL l
dryrof gnineercSdesquamation
OR
mucous membrane
.sIO rehtorash
dnaORBT
l
.
s
e
c
i
v
r
es gninnalp
desquamation
ulceration
involvement,
.sm
odnoc eerF l
suspected
egnahStevensc ruoivaJohnson
heB l
(TEN),
erythema
noitacinummoc
multiforme,
ksir hgexfoliative
ih rof )CCdermatitis
B(
reh dna nemow
dna esuops fo gnNormal
itset VIactivity
H dna reduced
gnillesnuoNormal
c xes eactivity
fas dna elpuoCNormal
l
Fatigue
activity
Unable
.reto
ntcare
rap for
by < 25%
reduced
by
25-50%
reduced
by
>
50%;
self
VIH taepeR l
cannot work
,gnitset
Source: Division of AIDS, National Institute of Allergy and Infectious Diseases, version 1.0 December
2004,
g
n
i
r
e
disnclarification
oc
tnuo2009
c 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l
August
fi doirep ,wodniw
.gni5gatoxicity,
ts lacinwhich
ilc rois
/ddeath.
na
NOTE: This clarification includes the addition of Grade
e
tisop sigrade
esuoin
psthe first
For abnormalities not found elsewhere in the toxicity table, use the information on estimatingviseverity
column.
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc
tnangeOR
rPnondetcefnI VSevere
IH OR responds
Mild; no treatment nemoW
Moderate
required
narcotic
analgesia
Rx
to
narcotic
VRA/TRA ylhtnoM)stisiv 4 tsael-ta erusne( eraC latanetnA initial
l
treatment
Headache


.dlihc eht

Annex 7: Postpartum Depression
Screening ToolThe Edinburgh Scale
Postnatal
Depression
Scaleto1 (EPDS)
Offer of HIV Edinburgh
Counselling
and Testing
Services
all Pregnant Women
Name: ___________________________Address: ______________________________________________
Your Date of Birth: _________________________________________________________________
HIV Negative
Babys
Date
of
Birth:
_______________________Phone:
________________________________
Pregnant Women
l
l
Safe
prophylaxis
Centers.
As you
are sex
pregnant or have recently had
a baby, at
weART
would
like to know how you are feeling. Please
counselling.
check the answer that comes closestl toCounselling
how you have
felt IN of
THE
PAST 7 DAYS,
not just
how you of
feel
on choices
continuation
or medical
termination
l
Couple
today.
counselling.
pregnancy only.
Here
is
and example,
already completed.
l
Linkages
to family
l
services.
I have planning
felt happy:
l
l
Free condoms.
-- Yes, all the time
l
Behaviour change
l
communication
Yes, most of the time
would mean:
I haveliving,
felt happy
most ofbirth-planning
the time during
l This
Counselling
on positive
safe delivery,
and the
(BCC)
high
risk
-- No,
notfor
very
often
past
week.
Please
complete the other questions in the same
infant
feeding
options.
women and her
-- No, not at all
way.
l
partner.
In the
past 7 days:
l
Repeat
HIV
Referral
to ART Center.
4. I have been anxious or worried for no good
1. testing,
I have been able to laugh land
see the
considering
funny side of the things
reason
l
regimen based on CD4 count
window, period if
as I always could and/or clinical staging.-- No, Not at all
-- As much
spouse
is positive
and linkages
to Government/other
ever
Not have
quite high
so much now l Nutrition counselling-- Hardly
or--s/he
Nutrition
programmes.
risk
behaviour.
-- Yes, sometimes
-- Definitely
not so much now
l
l
Infant feeding and
-- Yes, very often
-- Not at all
l
nutrition
*5. I have
felt support
scared through
or panicky
forvisits.
no very
2. counselling.
I have looked forward with lenjoyment
to
feeding
home
reason
things
l
Psycho-social supportgood
through
follow-up counselling, home
-Yes,
quite
a lot
-- As much as I ever did
-- Yes, sometimes
-- Rather less than I used to
-- No, not much
-- Definitely less than I used to
-- No, not at all
HIV--Exposed
Infant
Hardly at
all (HEI)
Exclusive
breastfeeds
6 months (preferred
Option-I
WHO/NACO
Guidelines
l
*6. Things
have been
getting on2010-'11)
top of me
*3. I
have blamed
myselfupto
unnecessarily
when
and
continued
breastfeeds in addition to complement -feeds
upto
1 yearbeen
for able
Yes,after
most6ofmonths
the time
I havent
things
went wrong
to cope
at receive
all
EID
negative babies and upto 2 years for EID positive babies
who
Paediatric ART.
-- Yes, most of the time
l
-- Yes, sometimes I havent been coping as
-- Yes, some of the time
wellatas6 usual
l
Early infant diagnosis (EID) at 6 weeks of age; repeat testing
months, 12 months & 6 weeks
-Not
very
often
-- No, most of the time I copied quite well
-No,
never
l
-- No, I have been coping as well as ever
l
l
116
l
l
the child.
emthat
margIorhave
P TCTPhad
P fo stneno*9. I
pmoC have
:2 erugbeen
iF so unhappy that I have been
*7. I have been so unhappy
crying
difficultly sleeping
-- Yes,nemost
moWoftthe
nantime
gerP lla ot secivreS gnitseT dna-- gYes,
nillemost
snuoofC the
VIHtime
fo reffO
-- Yes, sometimes
-- Yes, quite often
-- Not very often
-- Only occasionally
evitageN VIH
nemoW tnangerP detcef--nINo,
VIHnever
n
e
m
oW tn
angerPhas
*10.
The
thought
of
harming
myself
*8. IVR
have
felt
sad
or
miserable
A/TRA ylhtnoM)stisiv 4 tsael-ta erusne( eraC latanetnA l
xes efaS l
to me
.sretneC TRA ta sixalyhporoccurred
p
-- Yes, most of the time
.
g
n
i
llesnuoc
quite often
fo noi-tan
imrequite
t lacidoften
em ro noitaunitnoc fo seciohc no gnillesnuo-C Yes,
l
Yes,
elpuoC l
fo shtnom 3 tsrif eht nihtiw ekatrednu ot)PTM( ycnanger-p sometimes
.gnillesnuoc
-- Not very often
.ylno ycnangerp
y
l
i
m
a
f
ot segakniL l
-Hardly
ever
-- No, not at all
.seciv res gninnalp
-- Never
.smodnoc eerF l
e
g
n
ahc ruoivaheB l
.
g
n
i
t
s
e
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4
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i
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t
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a
c
i
n
i
l
c
O
H
W
l
Administered/Reviewed by__________________________Date____________________________
noitacinummoc
ksir hgih rof )CCB(
reh dna nof
emthe
ow10-item
1
Source: Cox, J.L. Holden, J.M. and Sagovsky, R.1987. Detection of postnatal depression: Development
d
n
a
e
s
u
o
p
s
f
o
g
n
i
t
s
e
t
V
I
H
d
n
a
g
n
i
l
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e
s
n
u
o
c
x
e
s
e
f
a
s
d
n
a
e
l
p
u
o
C
l
.
r
e
n
t
r
ap
Edinburgh Postnatal
Depression Scale. British Jormal of Psychiatry 150:782-786.
VIH taepeR l
2
Source: K.L. Wisner, B.L. Parry, C.M. Piontek, Postpartum Depression N Engl J Med Vol. 347, No 3, July 18, ,2002,
gnitse194-199
t
Users may reproduce the scale without further permission providing they respect copyright by quoting the names of the
g
n
i
r
e
d
i
s
n
o
c
tnuocthe4D
C nand
o dthe
esasource
b nemofigethe
r cpaper
itcalyin
hpall
orreproduced
p VRA ro Tcopies.
RA edivorP l
authors,
title
fi doirep ,wodniw
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.ruoivaheb ksir
noitirtun
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-- No, not at all


.dlihc eht
1
Figure Postnatal
2: Components
of PPTCT Scale
Programme
Edinburgh
Depression
(EPDS)
Postpartum depression is the most common complication of child bearing.2 The 10-question Edinburgh
Offer ofScale
HIV Counselling
Testing
to allofPregnant
Postnatal Depression
(EPDS) is a and
valuable
and Services
efficient way
identifyingWomen
patients at risk for
perinatal depression. The EPDS is easy to administer and has proven to be an effective screening tool.
Mothers who score above 13 are likely to be suffering from a depressive illness of varying severity. The
HIVscore
Negative
HIVjudgment.
Infected Pregnant
A careful Women
clinical assessment should be carried out to
EPDS
should not override clinical
Pregnant
Women The scale indicates
confirm
the diagnosis.
how theCare
mother
has at-least
felt during
the previous week.
In doubtful
l
Antenatal
(ensure
4 visits)Monthly
ART/ARV
l it
Safe
cases
maysex
be useful to repeat the tool
after
2
weeks.
The
scale
will
not
detect
mothers
with
anxiety
counselling.
neuroses, phobias or personality disorders.
l
l
Couple
Womencounselling.
with postpartum depression need not feel alone. They may find useful information on the web
pregnancy only.
l of
Linkages
to family
sites
the National
Womens Health information Centre <www.4women.gov> and from groups
l
planning
services.
Postpartum
Support International <www.chss.iup.edu/postpartum> and Depression after
such as
l
l
Free
condoms.
Delivery
<www.depressionafterdelivery.com>
l
Behaviour change
l
communication
Questions 1, 2, & 4 (without an *) Scoring
l
(BCC) for high risk
infantas
feeding
Are scored
0, and
1, 2her
or 3 with top box scored
0 andoptions.
the bottom box scored as 3.
women
l
Couple
and
safe
sex counselling and HIV testing of spouse and
partner.
Questions
3, 5-10 (marked with an *)
l
Repeat HIV
Are reverse
scored,
with
top
box
scored
as 3 and the bottom box scored as 3.
testing,
l
considering
Maximum
score: 30
l
window, period if
Possible
Depression:
10 or greater
spouse
is positive
l
s/heathave
Alwaysorlook
itemhigh
10 (suicidal thoughts)
Nutrition
programmes.
risk behaviour.
Users
may reproduce
further ARV
permission,
providing
they respect copyright by
l
Postpartum
prophylaxis
for mother.
l
Infant
feeding andthe scale without
quoting
the
names
of
the
authors,
the
title,
and
the
source
of
the
paper
in
all reproduced copies.
l
nutrition
counselling.
l
Instructions for using the Edinburgh Postnatal Depression Scale:
l
1. The mother is asked to check the
response
that groups.
comes closest to how she has been feeling in
visits
and support
the previous 7 days.
2. All the items must be completed.
3. Care should be taken to avoid the possibility of the mother discussing her answers with others.
l
(Answers come from the mother or pregnant woman.)
4. EID
Thenegative
mother should
complete
scale
unlessbabies
she has
limited
English
or has
difficultly
babies and
upto 2the
years
forherself,
EID positive
who
receive
Paediatric
ART.
with
reading.
l
1
Source:
Cox; J.L.
Holden,
J.M. and
Sagovsky,
R. 1987.
Detection
of testing
postnatal
10-item
l
Early
infant
diagnosis
(EID)
at 6 weeks
of age;
repeat
atdepression:
6 months,Development
12 monthsof& the
6 weeks
Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782-786.
2

the child.
Source: K.L. Wisner, B.L. Parry, C. M. Piontek, Postpartum Depression N Engl J Med vol 347, No 3, July 18, 2002, 194-199
l
l
l
118
l
l
Annex 8: Comparinng effectivveness of faamily plannning methods

Annex 8: Comparing Effectiveness
of Family Planning Methods
Comp
paring Effective
EeS gnitseTeness
of Method
ds
nemoW tnangerP lComparing
la ot secivrEffectiveness
dof
naMethods
gnillesnuoC VIH fo reffO
More Effeective
How to m
make your
method most
evitageN VIH
nemoW tnangerP detcefnI VIH effectivee
n
e
m
oW tnangerP
After proceedure, little orr xnothing
es efaS l
to do or reemember.gnillesnuoc
Vasectomyy: Use anotheer elpuoC l
.gniths
llesnuoc
method foor first 3 mon
.ylno ycnangerp
y
l
i
m
a
f
o
t
s
egakniL l
Female
Female
Vasecto
omy
Implants
IUD
Implants
.sIO rehto dSnterilization
a BT rof gnineerIUD
cS l
Vasectomy
.seciv res gninnalp
.smodnoc eerF l
Injections: Get repeat in
njections
egnahc ruoivaheB l
on time
noitacinummoc
LAM (for 6 months):
ksir hgih rof )CCB(
Breastfeed
d often,
aa nemow
rehday
dnand
dna esuops fo gnitset VIH dna gnillesnuoc xes efas dna elpuoC l night
.rentrap
Injectablees
LAM
Pills
Pills: Takee a pill each
d
VIday
H taepeR l
,gnitset
g
n
i
r
e
U disnoc
tnuoc 4DC no desab nemiger citcalyhporp VRA ro TRA edivorP l Condoms, diaphragm: Use
fi time
doireyou
pu,w
odniw
correctly eevery
have
e
v
i
t
i
s
o
p
s
i
e
suops
rehto/tnemnrevoG ot segaknil dna gnillesnuoc noitirtuN l sex
hgih evah eh/s ro
Fertility-aw
wareness bassed
.ruoivaheb ksir
methods: Abstain or use
d
n
a
gnideef tnafnI l
condoms when fertile.
.
s
e
c
i
v
r
e
S
g
n
i
n
n
a
l
P
y
l
i
m
a
F
l
noitiDays
rtun
Newest methods (Standard
Male
Female
Diaphragm
m
Fertilityy-Awareness
.gnMethod)
C h hguorht trCondoms
.stisiv emoCondoms
oppus gnideef tnafnI/tnemecBase
rofed
niMethods
er FBE l Method annd Two Day
Millesnuoc
emoh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP l may be eaasier to use.
Withdrawaal, Spermicidee: Use
Less than 1 pregnancyy per
100 women in one yea
ar
correctly eevery time you

u have
sex

StpO derreferp( shtnom 6 otpu sdeeftsaerb evisulcxE l
)11'-0102 senilediuGWithdrawa
OCAN/al
OHW I-noiSpermicide
Less effe
ective
About 30 pregnancies
p
p
per
one21
yeear
ske100
ew 6wome
& sen
htninom
,shtnom 6 ta gnitset taeper ;ega fo skeew 6 ta )DIE( sisongaid tnafni ylraE l
Reference: Reproductive Choicees and Family Plaanning for Peoplee Living.ewith
gaHIV
fo Counselling
skeew 6Tool
mlorf sixalyhporp elozaxomirt-oC l
(http://www.whoo.int/hiv/pub/toolkkits/rhr/en/index.hhtml )
116
National Guidellines for Prevention of Parent-to-Chhild Transmissionn of HIV
.dlihc eht
Annex 9: Flowchart on Counselling Mothers and their Families on Infant Feeding Options
0-6
Months
of Age
Counselling
theonHIV
mothers
Annex
A
9: Flowc
chart
on Counsselling
Mothers
s and their Fam
milies
Infanttinfected
Feeding option
ns 0-6 monthsand
o ageher family for
of
infant
feeding
options: 0-6 months
Coounselling the HIV infected
i
mothers an
nd her family for inffant feeding optionss: 0-6 months

l
l
l
l
l
117
l
120
l
l
the child.
Is
I
her husband/family
supportive
s
and willing to help babyy
care?
c
Family
F
income per month
Source of
Can
C she prepare feeds at night?
What
W is her latest CD4 count and iss she taking ART
or PPTCT regimen?
Does
D she plan to deliver in the heaalth facility or go
back
b to parent's house somewherre else? (need to
plan
p referral to other ICTCs)
Exclusive
E
breastfeeding is recommended during
the
t first 6 months of life, as if has more
m benefits to
baby
b
and mother
Antibodies
A
in breast milk protects against infections
Babies
B
on breastfeeding do not usually have health
problems
p
like diarrhoea, pneumonnia, ear infections
Always
A
available, free of cost
Most
M convenient, no need to prepaare or get out of
bed
b at night
l Convenient.
l Feasible and
l Safer with ART drugs,
l Affordable,
Breeastfeeding is recommendeed as it is
Sup
pport the decision for infannt feeding
Breast milk contains HIV virus, howevver ART or PPTCT

regiimen will significantly prevent thee transmission of
HIV virus during breastfeeding
Disaadvantages:
Complete
C
nutrition for baby for 6 months
m
Advvantages:
Exp
plain: Breastfeeding is recommen
nded
2. Counsel
C
for breastfeeding
Can
C she prepare each feed with boiiled water and
clean
c
utensils eg. up to 12-15 timees per day in the
first
f 4 months of baby's life
latriine/toiler used
ERFF milks can be given by other persons
No rrisk of HIV transmission
Form
mula milk is a complete food but is expensive (about 8,000 to 10,000
0 Rupees for 6
monnths)
Careeful and hygienic preparation requuired each time: Sterilize feeding cups, using
boiled water and fresh preparation of all
a feeds 12-15 times in the first 4 months of
babyy's life
ugs, less than 5 babies out of 100 babies

wheen mother or baby is taking ARV dru
b
may be
HIV infected
Althhough there is a small risk of transm

mission of HIV through breast milkk this must be
balaanced with the risks of other health problems (diarrhoea, respiratory infections)
due to replacement feeding.
Dis
scuss prevention and
treatmeent of cracked nipples: expressed
some brreast milk after baby has finished and
a
rub overr nipple
Discuss
prevention and
treatmeent of mastitis: breastfeed frequently
A
and feeed until the breast is empty. Avoid
breast eengorgement.
Dis
scuss prevention and
treatmeent of oral ulcers and oral thrush
in infant
Dis
scuss breast and hand
hygienee for mother, and oral hygiene for
baby
For breastfeeding inffants still on infant NVP daily propphylaxis or mothers on ART or
PPTCT option B: cheeck baby's adherence to daily NV
VP; encourage mother to continuee
breastfeeding till 12 months. Infants should start com
mplementary feeding at 6 monthss
of age
For HIV-infected Children <2 years old: check that baaby is initiated on ART; encouragee
breastfeeding to con
ntinue till 2 years of age
Discus
ss about complemeentary feeding at 6 months of age
and whether to coontinue or stop breastfeeding
Ask about baby's growth & health, look for signs of iillness and malnutrition
Asscess if further action or doctor's check is requireed and advise
ASk about baby's immunization: cotrimoxazole dossing. EID status: infant NVP
prophylaxis adherrence and monthly refill
Tell motther to prepare according to

instructtions with scoop (if formula feedin
ng)
Dis
scuss and
demonsstrate the amount to be fed
Do not re-use leftover feeds as it may

y
lead
d to food poisoning
Preppare enough for one feed
Throw
w away leftover feed if baby doess
not finish
f
Boileed water
Handd washing with soap
Cleann utensils and surface
Dis
scuss hygienic preparatiion
of feeds:
Exclusive Replacement
R
Feeding for 6 mon
nths:
Refer to ART centrre as appropriate
For infants still on

n infant NVP prophylaxis or motherrs
levvel and in the community, an

nd
l Th
he mother, or other caregiver can reliably afford to providee
suufficient RF (milk) , to supportt normal growth and
deevelopment of the infant, and
l Sa
afe water and sanitation aree assured at the household
clean manner so that

t it is safe and carries a low
w risk of
diarrhoea and mallnutrition, and
l The mother, or carregiver can, in the first six mon
nths exclusively
give replacementt feeding, and
l The mother, or carregiver can prepare it frequen

ntly enough in a
compprehensive child health servicces
l The mother,
m
or caregiver can access health care that offers
l The family
fa
is supportive of this praactice, and
Once brestfeedingg is stopped completely, DO NOT pput baby back to breast for any
sucking
Ensure complemeentary feeding is nutritionally adeqquate and safe

Check for growth and nutritional status of baby
Do not stop breasttfeeding abruptly: gradually cut doown the number of breastfeeding
sessions a day acccording to comfort of mother and iinfant over one month
For mother on AR
RT for her own health: continue ARTT
l
8. Counselling for sttopping breastfeeding
Ask status and pro

ogress for pre-ART or ART care
Reinforce adheren
nce to ART or PPTCT regimen
l
d reinforce consistent condom usee

Give condoms and
l
Ask for mother's mood

m
changes (screen for postparrtum depression)
Family planning/ contraception
c
and birth spacing
Ask how mother & family is coping with the baby

l
About mother
Follow IMNCI guidelines for complementary feeding. see National Guidelines for
nutrition for HIV affeected and infected infants and chiildren, NACO 2011.
Mothhers known to be HIV- infectedd should give replacement feeeding to their infants only wheen All of the following conditioons are met:
Box : Six Criteria for replacem

ment feeding
Go throough points 2-4 again, if necessarry
Clarify qquestions
5. Helpp mother and family declde on feeeding choice
ERFF must be correctly done otherwisee child will not grow well or may dev
velop
mallnutrition
EBF is recommended because breast milk

m contained antibodies which protect the
babiies from infetions-unless ERF can be safely done according to the 6 criteria
c
l
l
During the first 6 months of life, it is im

mportant to keep the child healthy by
b good
feedding practices
If motheer is not on ART or mother/infant not receiving new PPTCT regim

men (eg. In
the disttricts which are still using sd-NV
VP during the scale up of new PPTCT
guldelllnes), explain:
It is important to take the ART drugs ass prescribed -reinforce adherence of ART or
PPT
TCT regimen.
Thatt the risk of HIV transmission from

m mother-to-child is very low becau
use the ART
druggs will reduce the numbers of HIV virus
v
in the breast milk
If motheer or baby is taking ART or PPTC

CT regimen drug schedules, exp
plain:
Breastfe
feeding : Discuss and demonstratee
correct attachment to nipple and position
ning
of baby
NO "mixxed" feeding (ie. breastfeeding and

d
giving other
o
feeds) - animal or formula miilk
can irrittate the lining of the infant's stomacch,
causing
g inflammation and making it easieer for
the HIV virus in breast milk to get into the
baby's body
b
Ask about the progress on infant feeding
About Baby:
EBF meaans giving only breast milk and no

other liqquids or solids, not even water withh the
exceptioon of medicines
Exculve breeastfeeding for 6 months:
7. Provide follow- u
up conunselling and support at eevery visit
6. Explain the chosen feeding option

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l
4 Explaain the risks of parent-to-child trransmission
Baby has more risk of infections -diarrrhoea, respiratory and ear infectio
ons and
malnutrritions
l
Anim
mal milk is not a complete food for baby
Disadvvantages:
Advan
ntages:
Discuss Excluslve Replacement Feeding

F
(ERF) as a feeding optioon if
3. D
moth
her cannot breastfeed and only if
i the 6 criterla for RF are fulfilleed as
beloow
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.
drinnking water l Type of
Does
D her family know her HIV statu
us?
Does
D she know her husband's HIV
V
status?
s
1. Ask
A about the mother HIV/ART stattus, home &
faamily situation
l Start Paed ART

therapy as per
national protocol If
breast feed, continue
breast feeding for 2
yrs. Avoid mixied
feeding
l Mange OI, if any
l Continue
cotrimoxazole.
Advisory 2
Infant is
HIV-1
infected
HIV-1 DNA not

detected by
whole Blood
l Discourage weaning too early - use

local guidelines and ensure AFASS
criteria are met before weaning. 6
months is often a good time to discuss
possibility of weaning
l Continue cotrimoxazole until definitely

negative
l Repeat HIV-1 DNA PCR by DBS test at

6 months, 6 weeks after last breast
milk feeding or if the child develops
symptoms of HIV infection
Follow Advisory 1
Infant is
HIV-1
infected
HIV-1 DNA detected
Follow all steps

in owchart
from Guidance 1
HIV-1 DNA not detected
For more information, contact NACO at labservices.naco@gmail.com
Establish definitive
diagnosis
at 18 months,
by HIV
3 antibody
tests (rapid)
Continue Advisory 2
Infant is
HIV-1
uninfected
Not breastfed in
the 6 weeks
before test
l Rapid antibody test not

recommended
l If baby is < 6 weeks- HIV-1
DNA PCR not recommended
l 6 weeks and above is the
optimal age for a routine first
HIV-1 DNA/PCR test
Stop cotrimoxazole
Avoid putting baby
to breast
Follow Advisory 3
Breastfed in the
6 weeks before
test
HIV- 1 DNA not detected
In asymptiomatic child, repeat HIV DNA PCR at 6

months of age
HIV- 1 DNA detected
If child develops signs and symptoms of HIV infection

at <6 months of age, repeat HIV DNA PCR by DBS
HIV- 1 DNA detected
Confirm with repeat HIV-1

DNA PCR test using
Whole Blood specimen
Follow Advisory 3
HIV- 1 DNA
not detected
l Infant is probably not infected, but is at

risk
Advisory 3
HIV- 1 DNA detected
Guidance 1-Lab will request

for fresh whole blood sample
from ART centre if result is
discordant and rely on the
final whole blood test result
Collect & send Dried Blood Spot (DBS) of babies between 6 weeks to <6 months of age
for HIV-1 DNA PCR (At ICTC)
evitageN VIH
nemoW tnangerP
xes efaS l
.gnillesnuoc
elpuoC l
.gnillesnuoc
.seciv res gninnalp
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
gniredisnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc
In children (< 18 months) with signs and symptoms of HIV whose exposure status is unknown
perform rapid test for HIV antibodies. If negative, label child as uninfected, if positive follow algorithm
A or B, depending on age of child. Attempt to determine the HIV infection status of the parents to
determine if the child is HIV-exposed; thereafter follow the algorithms to determine the infection status
in the child.
l Assess and
encourage
breast feeding
if replacement
feeding not
started
l Start
cotrimoxazole
if not already
started
Advisory 1
HIV- 1 DNA detected
Collect and send whole Blood

specimen for HIV-1 DNA PCR.
Follow Advisory 1
( At ART Centre)
Refer to ART Centre
HIV- 1 DNA detected
Less than 6 months old and born to HIV positive mother

.ylno ycnangerp
Follow Advisory 2

.dlihc eht
Follow Advisory 1
A <6 months
Annex 10: Testing Algorithm for HIV-1 Exposed Infants and Children <18 Months
Establish definitive diagnosis at

18 months, by HIV antibody
test
Infant is HIV-1
uninfected
Not breastfed in the

6 weeks before test
more information contact NACO at labservies.naco@gmail.com
Advisory 2
l Continue cotrimoxazole.
l Manage OI, if any
l start ARV therapy as per national protocol
In children (< 18 months) with signs and symptoms of HIV whose exposure status is unknown, perform rapid test for HIV
antibodies. If negative, label child as uninfected, if positive follow algorithm A or B, depending on age of child. Attempt to determine
the HIV infection status of the parents to determine if the child is HIV-exposed; thereafter follow the algorithms to determine the
infection status in the child.
l Infant is probably not infected, but is at risk

l Repeat rapid HIV test 6 weeks after last
breast milk feeding or if the child develops
symptoms of HIV infection
If rapid test positive, follow ow chart from
step
onwards. If negative repeat rapid test
at 12 months
l Continue cotrimoxazole until definitely
negative
HIV- 1 DNA detected
Guidance 1 - Lab will request for fresh whole blood sample

from ART centre if result is discordant and rely on the
final whole blood test result
Breastfeed in the
6 weeks before test

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l
Follow Advisory 1.
Collect and send whole Blood
specimen for HIV-1 DNA PCR

HIV- 1 DNA detected
Send Dried Blood Spot (DBS) of child for HIV-1 DNA PCR
Rapid test positive
Follow Advisory 1
l Stop cotrimoxazole
l Discontinue ART, if
started
l Avoid putting baby
to breast
Rapid test negative - does not need HIV-1 DNA PCR
Collect blood and test for HIV antibodies using rapid test. Also prepare a Dried Blood Spot (DBS) for HIV-1 DNA PCR (Level ICTC)
A months
6 months
B>6
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.
Child of 6-18 months age born to HIV positive mother
Annex 11: Testing Algorithm for HIV-1 Exposed Infants and Children <18 Months
infant is
HIV-1
infected
HIV- 1 DNA detected

Refer to ART Centre
l Assess and encourage

breast feeding if
replacement feeding
not started
if not already started
Start contrimoxazole
l
Advisory 1

l
l
l
l
l
l
122
l
l
the child.
mmargorP TCTPP fo stnenopmoC :2 erugiF

An
nnex 12:Referral
IC
CTC- ART centr
re referral forrm
Annex 12: ICTC- ART eCentre
form
State
AmoW
Control
neAIDS
tnaSoociety
ngerP
Society
SfO
lla ot secState
ivreAIDS
S gControl
nitseT
dna gnillesnuoState
C VAIDS
IH fControl
o refSociety
Referral Form
m
Referral Form
m
Referral Form
m
Name & Addreess of

ICTC:
Name & Addrress of

ICTC:
Name & Addrress of

ICTC:
evitageN VIH
Copy-2 (to bee carried by the client to the
Copy-3 (to be sent to ART centre
c
through
n
e
m
VRA/TRA ylhtnoM)stisiv 4 tsaeART
l-tacentre
erusand
eraC latattART
anecentre)
tnA l
ane(retained
e-mail or posto
t)W tnangerP
xes efaS l
.sretPart-1
neC to
ta sbyixthahelyICTC
hporp
Part-1 to
t be filled by th
he ICTC
tTR
beAfilled
Part-1 to be filled by th
he ICTC
.gNurse
nillesnuoc
Cou
unsellor/Staff Nurse
N
Cou
unsellor/Staff Nurse
N
Counsellor/Staff
N
elpuoC l
signatu
fo sName
htn&om
3uretsofriCounsellor
f eht r/Staff
nihtinurse:
w ekatName
redn&usignatu
oture
)PofTCounsello
M( ycnr/Staff
angnurse:
erp Name & signatture of Counselloor/Staff nurse:
.gnillesnuoc
.ylno ycnangerp
.sIO PID
rehNo.
to dna BT roDate
f gnofo ineercS l PID No.
PID No.
Date of
o
.secivDate
resofgninnalp
referraal
referraal
referrral
.smodnoc eerF l
Name of the cllient (optional):
Name of the cllient (optional)::
Name of the client (optional)::
egnahc ruoivaheB l
noitSex
acx:inummoc
dnAge:
a gninnalp-htribSex:
,y reviled efas ,gAge:
nivil evitisop no gSex:
nillesnuoC l Age:
ksir hgih rof )CCB(
Ph. No.:
Ph. No.:
Ph. No.:
reh dna nemow
.rentrap
Category of the client (Tiick Mark):
Category of the client (Tiick Mark):
Categoryy of the client (T
Tick Mark):
.nGeneral/Exposed
erdlihc gndivinfant
il rehto
VIdHinfant
taepeR l
ANC/G
General/Exposedd infant
ANC/G
ANC/G
General/Exposed
,
gnitset
Name and adddress of the ARTT centre
Name and adddress of the ART
T centre
Name and adddress of the ART
T centre
g
n
i
r
e
disnoc
tnureferred
oc 4DtoC no desab nemiger citcalreferred
yhportop VRA ro TRA edivorP l referred to
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
Counsellor's siignature:
Counsellor's signature:
Counsellor's ssignature:
.ruoivaheb ksir
.restaff
htoafter
m rof sPart-2
ixalyto
hpbeorfilled
mAR
uRT
tracentre
ptsostaff
P l Part-2 to bbe filled
Part-2 to be filled
f
by the ICT
TC
fp VR
byAthe
dna by
gnthe
idART
eef centre
tnafnI l
staff@
feedback from ARTcentre
noitirtun
ART centre:
H the patient rreached ART.gce
nentre:
illesYes/No
nuoc
.sHas
tisithe
v epatien
mont
h reached
hguorh
t trcoppuYes/No
s gnidHas
eefthe
tnpatient
afnI/ttreached
nemeART
crofcnentre:
ier FYes/No
BE lHas
Copy-1 (too be retained att the ICTC)
emoh ,gnillesnuoc pu-wollof hgIfuYes

orht troppus laicos-ohcysP
If Yes
Pre ART
Regn No.
Baseline
CD4
Count
ART Innitiated (Yes/No)
.spuorgBaseline
troppus dART
na stisiv
Pre ART
A Initiated
Regn No.
CD4
Count
(Yes/No)
l If
Yes
Pre ART
Regn No.
Baseline
CD4
Count
ART Initiated
(Yes/No)

Ifro
ART
f rnot
aey 1 otpu shtnom 6 retfa sIfdART
eenot
f tnemelpmoc ot noitidda nIfi ART
sdenot
eftsaerb deunitnoc dna
initiate
initiated
initiated
reason
.TRA cirtaideaP eviecer ohw seireason
bab evitisop DIE rof sraey 2 otpreason
u dna seibab evitagen DIE
ART
Counsello
r
Name
&
Sign
nature
ART
Counsello
or
Counsello
skeew 6 & shtnom 21 ,shtnom 6 ta gnitset taeName
per ;&egSign
a nature
fo skeew 6 tART
a )D
IE( siorsoName
ngai&dSign
tnnature
afni ylraE l
.
s
d
e
e
f
t
s
a
e
r
b
f
o
n
o
i
t
a
s
eccentre/LAC
retfaplus.
To be filled for
f all patients detected ppositive at ICTC and sent tos
ART
@
bssent
refferring
ccentre/LAC
.eCopy
ga3ftoobe
keeback
wto6them
orf sICTC
ixabylART
yhp
orp eplus
lozthrou
axghoemail/post/patient
mirt-oC l
.dlihc eht
Figure 2: Components
of PPTCT Programme
Annex 13: OM for Laboratory
Investigations
T-11020/36/2005-NACO (ART)
Goverment of India
National AIDS Control Organisation
(Care,
Support &Pregnant
Treatment
Divison)
HIV Negative
HIV Infected
Women
Pregnant Women
l
l
Safe sex
6th Floor, Chanderlok Building
counselling.
New Delhi110001
36 Janpath,
l
Counselling on choices of continuation
or medical
termination
of
l
Couple
2012
pregnancy (MTP)to undertake within theDate-January,
first 3 months
of
counselling.
pregnancy only.
l
Linkages to family
OFFICE MEMORANDUM
l
planning services.
Subject:
Revised
Technical Guidelines
Laboratory
forSTIs.
patients at ART centres/LAC/LAC plus
l on
Screening
andMonitoring
treatment for
l
Free
condoms.
centres change
l
Behaviour
l
communication
Counselling
on positive
delivery,
and
1. Essential/Mandatory Tests for all lPatients
Registering
in HIVliving,
Care safe
at Art
Centre/birth-planning
LAC Plus
(BCC) for high risk
women
Haemogram/CBC,
Urine for routine and microscopic examination, fasting blood sugar, blood
and her
l
Couple Gene-xpert
and safe sexincounselling
and
HIV testing
of X-ray
spouseChest
and PA
urea, ALT (SGPT), VDRL, CD4
count,
institutions
where
located
partner.
view. Pregnancy
test if required.other living children.
l
Repeat
HIV
testing,
l
Symptoms and signs directed investigations for ruling out Ols.
considering
l
window,Tests
period
2. Additional
forifall Patients to be
Started
on ART
and/or
clinical
staging.
spouse is positive
Nutritionsputum
counselling
linkagesetc.toasGovernment/other
for AFB, and
CSF analysis
per the physicians
orOther
s/he investigation
have high like USG labdomen,
Nutrition
programmes.
decision
depending on clinical presentation. Efforts to be made to fast track these investigations
risk
behaviour.
l
so
that
ART
is not delayed.
l
Infant feedinginitiation
and
l
nutrition
Serum creatinine is essential when considering TDF.
counselling.
l
PAP smear, fundus examination
also to be done
but through
ART initiation
not counselling,
to be delayed
for these
l
Psycho-social
support
follow-up
home
tests.
3. Tests for Special Situation
HBs Ag-for all patients if facility is available but mandatorily for those with history of IDU, multiple
& blood
products
HIVblood
Exposed
Infant
(HEI) transfusion, ALT > 2 times of ULN, on strong clinical suspicion. But
ART not tobreastfeeds
be withheld
if HBsAg
testing
is not available.
Exclusive
upto
6 months
(preferred
Option-I WHO/NACO Guidelines 2010-'11)
l
continued
breastfeeds
in addition
to complement
feeds after
upto 1 year
for
and
Anti-HCV
antibody
only for those
with history
of IDU, multiple
blood6&months
blood products
transfusion,
EID
negative
babies
andon
upto
2 years
for EID
positive babies who receive Paediatric ART.
ALT>
2 times
of ULN,
strong
clinical
suspicion.
l
For patients with Hepatitis B or C co-infection, further tests may be required to assess for chronic
l
Early
infant diagnosis (EID) at 6 weeks of age; repeat testing at 6 months, 12 months & 6 weeks
active hepatitis.

For patients to prophylaxis
be switchedfrom
to a6Pl
basedofregimen,
Blood Sugar, LFT and Lipid profile to be done
l
Co-trimoxazole
weeks
age.
at baseline.
l
l
124
l
l
the child.
4. Tests for Monitoring Purpose emmargorP TCTPP fo stnenopmoC :2 erugiF

Essential - CD4,Hb, TLC, DLC, ALT(SGPT)/creatinine clearance (if on TDF), every 6 months or
oW tnan
gepatients
rP lla otstarted
secivreon
S AZT
gnitBased
seT dnregimen,
a gnillesHb
nuoatC15
VIH
fo rethen
ffO every, month
required.
For
days,
earlierneifm
for initial 3 months, 6 months and then every 6 months/as & when indicated. For patients started
on EFV based regimen, lipid profile should also done yearly. For patients started on ATV, LFT to be
done at 15 days, 1 month, 3 months, 6 months and then every 6 months. Blood sugar and Lipid
evitageN VIH
profile every 6 months for patients on Pl based regimen. All the above tests can be done earlier
n
e
m
oW tnangerP
based on clinicians assessment/discretion.
xes efaS l
.
g
n
i
llesnuoc
fo noiOther
tanimrinvestigations
et lacidem ro nduring
oitaunifollowtnoc fo up
secas
iohper
c norequirement/availability.
gnillesnuoC l
elpuoC l
o shtninvestigations
om 3 tsrif ehother
t nihtthan
iw ekCD4
atredand
nu oviral
t)Pload
TM( estimations
ycnangerp (when required), shall be done from
All fabove
.gnillesnuoc
lno ycnanfrom
gerpState Health Department.
the health facility where the centre is located with.ysupport
.seciv res gninnalp
.smodnoc eerF l
egnahc ruYours
oivahefaithfully
B l
noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
(Dr.
Mohammad
,gnitShaukat)
set
ADG
g
n
i
r
e
d
i
s
n
oc (CST)
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
Copy to:
.ruoivaheb ksir
d
n
a
gnideef tnafnI l
1. Project Director, All State AIDS control Society
noitirtun
ART
centres
2. Nodal
Officers
of
all
.gnillesnuoc
oh ,Services),
gnillesnuocNACO
pu-wollof hguorht troppus laicos-ohcysP
3. ADGem
(Lab

.dlihc eht
Components of PPTCT Programme

Annex 14: List of ItemsFigure
that2: can
be Procured under Universal Work
Precautions
1) Disposable latex Gloves2 Boxes (100 per Box)
2) Disposable Laboratory gownsAs per Number of positive deliveries in years.

3)
Disposable
Number
HIV
Negative Plastic aprons24
HIV
Infected Pregnant Women
Pregnant
Women
l
Antenatal
4)
Disposable
Face Mask2 Boxes
(100 per Care
Box) (ensure at-least 4 visits)Monthly ART/ARV
l
Safe sex
5) counselling.
Disposable Caps4 Boxes (25 per box)
l
l
6)
Couple
Shoe covers2 Boxes (25 pairs pregnancy
per box) (MTP)to undertake within the first 3 months of
counselling.
pregnancy only.
7)
Rubber boots2
l Linkages
to familypairs
l
planning services.
8) Hand rubs/disinfectant solution
for hand wash6 bottles.for STIs.
l
Screening
and treatment
l
Free condoms.
l Behaviour
change Number l WHO clinical staging and CD4 testing.
9)
Needle destroyer1
communication
l
10) (BCC)
Sharpfor
disposal
containers2 Numbers
high risk
and her
11)women
1% Sodium
hypochlorite24lcans
per year
(5 litres
canister of and
45%)
Couple
and safe
sex counselling
HIV testing of spouse and
partner.
living(5
children.
12)
10% Sodium
per year
litres canister of 40% solution)
l
Repeat
HIV hypochlorite1canother
testing,
Referral
to ART Center.
13) Spirit/70% alcohol6 bottlesl(500
ml/bottle)
considering
l
if (large 500 gm/pack)
14)window,
Cotton-6period
Bundles
spouse is positive
l
15)or Tissue
paperhigh
rolls24 Numbers
s/he have
Nutrition
programmes.
behaviour.
16)risk
Cloth
Aprons/Laboratory coats4
Numbers
l
l
Infant feeding and
17)nutrition
Colour coded waste disposallbags4
FamilyDozen
Planning Services.
counselling.
18) Colour coded waste disposallbins8
Numbers
l
19) Biohazard labels2 Dozen
20) Bandaids 100 Numbers
21) Needles/Syringes3 Boxes (100 per box)
22)
Rubber gloves
for dirty
washing
and waste
handling-8
Exclusive
breastfeeds
upto
6 months
(preferred
Option-INumbers
WHO/NACO Guidelines 2010-'11)
l
continued
breastfeeds
addition
to complement feeds after 6 months upto 1 year for
23) and
Measuring
cylinder
glass 1inlitre
2 Number
24) Covered discard jars/discard buckets with lid4 Number
l
25)
Hepatitis
vaccination
andatantibody
forrepeat
staff employed
NACO4
vials of& 6 weeks
l
Early
infantBdiagnosis
(EID)
6 weeks titres
of age;
testing at 6under
months,
12 months
6
doses
each
l
Co-trimoxazole
from 6 weeks
of age.
26)
Any other itemprophylaxis
with prior approval
of NACO
l
l
126
l
l
the child.

Annex 15: CF- Consentemform
for Patients Registering into HIV Care &
Starting ART
I, (name)........................................, (address).........................
CONSENT to share all information pertaining to my health and HIV/AIDS status with the service providers
who will be part of the management of my condition.
evitageN VIH
And
n
e
m
oW tnangerP
xes efaS l
I AGREE to receive Antiretroviral Therapy
programme.
.sretprovided
neC TRA under
ta sixalthe
yhpNational
orp
.gnillesnuoc
fo nounderstand
itanimret lathe
cideinformation
m ro noitaunthat
itnochas
fo sbeen
eciohprovided
c no gnilleby
snu
oChealth
l
I fully
the
care staff in the following:
elpuoC l
.gnillesnuoc
.ylnowill
ycnbe
angstarted
erp
That the ART is not an emergency and thus
as per theyldecision
imaf ot sofegthe
aknidoctor.
L l I
.
s
I
O
r
e
h
t
o
d
n
a
B
T
r
o
f
g
n
i
n
e
e
r
c
S
l
shall attend the ART centre as per appointment for timely initiation of ART
.seand
civ rregular
es gninnfollowalp up.
.smodnoc eerF l
That receiving ART involves shared confidentiality with other service providers such as CBO/
egnahc ruoivaheB l
NGO/CCC/positive network who may support my treatment and other welfare measures through
noitacinummoc
dnaoutreach
gninnalp-and
htribhome-based
,y reviled efascare
,gniactivities
vil evitisopatnhome.
o gnillesnuoC l
ksir hgih rof )CCB(
reh dna nemow
dnaThat
by the same.
esuoART
ps forequires
gnitset V100%
IH dnaadherence
gnillesnuoctoxedrugs
s efas and
dna Ielshall
puoCabide
l
.rentrap
VIH taepeR l
That I understand the side effects of ART.
,gnitset
That I shall not stop the drugs on my own and will return to the centre if there is
any
In
g
n
i
r
e
diproblem.
snoc
fi doinot
rep hold
,wodthe
niw health
case I stop the drugs on my own accord/do
.gnigats lnot
acinadhere
ilc ro/dntoa the regimen, I shall
e
v
i
t
i
s
o
p
s
i
e
s
u
care staff of the ART Centre responsible for any complication arising out of the same. ops
hgih evah eh/s ro
emamdifferent
argorp noregimen,
itirtuN I agree to receive
In case, I am on ART from outside.son
.ruothe
ivahdrugs/regimen
eb ksir
.
r
e
h
t
o
m
r
o
f
s
i
x
a
l
y
h
p
o
r
p
V
R
A
m
u
t
r
a
p
t
s
o
P
l
provided under the national programme.
noitirtun
In case, I want to take ART from other centre or to go other city for livelihood .or
other
I
gnillesnureasons,
oc
will inform my ART Centre and get a transfer out letter before leaving.
.......................................
Signature of patient with date

......................................
Signature
.TRofA witness
cirtaideaP eviecer ohw seibab evitisop DIE rof sraey 2 otpu dna seibab evitagen DIE
(Doctor/nurse/counsellor)
(This should be translated in local language &/or explained to patient.sbefore
deeftsataking
erb fo npatients
oitassec rsignature)
etfa
.dlihc eht
of PPTCT Programme
Annex 16: Transfer outFigure
form2: Components
(Form for
Transfer of PLHIV to Other ART
Centre)
Name and address of the transferring ART Centre ___________________________________________

Name and address of ART Centre where patient is being transferred ____________________________
Name
Patient: ________________________________________________________________________
HIVofNegative
Pregnant Women
l
HIV lCare
(Pre-ART)
Registration No. _________________________________________________________
Safe
sex
counselling.
Address
and contact details: _____________________________________________________________
l
_ l Couple
counselling.
pregnancy only.
l
Linkages
to family
Reason
for transfer
(Specify) 1. Patient Choice 2. Provision of second line ART/ Alt First line
l
planning services.
Date
transfer:_____________________
l
l of
Free
condoms.
l
Behaviour change
l
ART regimen (pls. specify): _________________________________
communication
l
for ART:___________/______________/
high risk
Date of(BCC)
starting
(Date/Month/Year); Latest CD4________________
women and her
l
Next date
for dispensing drug is ___________/______________/
partner.
l
Repeat HIV
Please testing,
find the following original documents handed over to the patient:
l
considering
1. Patient Treatment Record (White Card)
l
window, period if
spouse
is positive
2. Patient
Booklet
(Green Booklet)
l
or s/he have high
Nutrition
programmes.
3. Others,
any (Mention)
risk ifbehaviour.
l
l
Infant feeding and
Name and Signature of SMO/MO Phone no. and e-mail of SMO/MO:
l
nutrition
counselling.
l
EBF
feeding
home visits.
(To be filled by the receiving ART Centre
and
sent to the transferring
ARTsupport
Centre through
by post/email)
l
(Name of Patient), referred by you on date ____________/_____/__________has reported and been
registered with us on_____________/______/_____________along with the documents sent by you. Her/
His HIV Care (Pre- ART) registration no. is ___________________ and ART registration no. (if applicable)
is _____________________________
Exclusive
breastfeeds
upto 6
months
WHO/NACO Guidelines 2010-'11)
l
Name
and
Signature
of SMO/MO
Phone
no (preferred
with e-mailOption-I
of SMO/MO
Address
of the
ART Centre,
transferring
out the
_____________________________________
EID
negative
babies and
upto 2 years
for patient:
EID positive
babies who receive Paediatric ART.
l
l
l
l
l
128
l
l
the child.

Annex 17: OM Regarding
Provision of ART/ ARV Prophylactic Drugs at
ART Centre to HIV Infected Pregnant Women
Government of India
Ministry of Health and Family Welfare
Department
evitageN VIH
nemoW tof
naAIDS
ngerPControl
detcefnNational
I VIH
n
e
m
oW tnangerP
AIDS
Control
Organization
xes efaS l
(Care,
.sreSupport
tneC TR&A Treatment
ta sixalyhpoDivison)
rp
.gnillesnuoc
elpuoBuilding
C l
6th Floor, Chanderlok
.gnillesnuoc
.ylno ycnangerp
36 Janpath, New Delhi-110001
Date
.sec- i28th
v res gAugust,
ninnalp 2012
.smodnoc eerF l
OFFICE MEMORANDUM
egnahc ruoivaheB l
women noitacinummoc
dna gninnalp-htribSubject:
,y reviled eART/ARV
fas ,gnivProyhylaxis
il evitisop nofor
gnipregnant
llesnuoC positive
l
ksir hgih rof )CCB(
.snoitpfor
o gnpregnant
ideef tnafpositive
ni
It has been decided that ART/ARV prophylaxis
women will
rehbedninitiated
a nemowonly at
dna ecentres.
suops foAfter
gnitse6t Vmonths
IH dna gof
nillpregnancy,
esnuoc xes einfascase
dna ethe
lpuopregnant
C l
the ART
woman is not able
to
.rentotracome
p
erdauthorized
lihc gnivil remember
hto
ART centre, the ARV drugs may be given to.nan
of her family. This
VIHdrug
taepsupply
eR l to
,
g
n
i
t
s
et to the
authorized member can continue till 2 months
.retneafter
C TRAdelivery.
ot larrefeAfter
R l that drugs will be dispensed
g
n
i
r
e
d
i
s
n
o
c
women
tnuoconly
4DCon
noher
desattending
ab nemigethe
r ciART
tcalyhcentre.
porp VRA ro TRA edivorP l
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
(Dr. Mohammed
noitirtShaukat)
un
ADG
.gnillesnuoc (CST)
Ph: 011- 23731805
To,
1. Project Director, State AIDS Control Society, Andhra Pradesh & Karnataka
2. Regional Coordinator (CST), Andhra Pradesh & Karnataka

3. )1Programme
1'-0102 senDirector,
ilediuG OCoE,
CAN/Gandhi
OHW I-Hospital,
noitpO deSecunderabad
rreferp( shtnom &6Bowring
otpu sdeHospital,
eftsaerb eBangalore
visulcxE l
4. roNodal
f raey Officer,
1 otpu All
shtART
nomCentres
6 retfa in
sdAndhra
eef tnemPradesh
elpmoc &otKarnataka
noitidda n(To
i sdebe
eftcoordinated
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dna
Copy to,
1. DDG (BSD), NACO
2. NPD (ICTC), NACO
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Annex 18: List of Reference
Doctors for Advice on PPTCT Services
Including Care of HIV Exposed Child
S. No.
Name of Centre
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.
Contact Person
E-mail
Mobile
Other Contact No.

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l

l
l
l
l
l
l
130
l
l
the child.

Annex 19: National Coordination
Committee for PPTCT-NRHM
Integration Activities

.ylno ycnangerp
evitageN VIH
nemoW tnangerP
xes efaS l
.gnillesnuoc
elpuoC l
.gnillesnuoc
.seciv res gninnalp
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
gniredisnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
HIV Negative
Pregnant Women
l
Safe sex
counselling.
l
Couple
counselling.
l
Linkages to family
planning services.
l
Free condoms.
l
Behaviour change
communication
(BCC) for high risk
women and her
partner.
l
Repeat HIV
testing,
considering
window, period if
spouse is positive
or s/he have high
risk behaviour.
l
Infant feeding and
nutrition
counselling.

l
l
pregnancy only.
l
l
l
l
l
l
l
l
l
l
l
l

l
l
l
l
l
l
132
l
l
the child.

Annex 20: OM from DDG(BSD)
for Roll-out of PPTCT Multi-Drug
Regimen in India from 1st January 2014

.ylno ycnangerp
evitageN VIH
nemoW tnangerP
xes efaS l
.gnillesnuoc
elpuoC l
.gnillesnuoc
.seciv res gninnalp
.smodnoc eerF l
egnahc ruoivaheB l
noitacinummoc
ksir hgih rof )CCB(
reh dna nemow
.rentrap
VIH taepeR l
,gnitset
gniredisnoc
fi doirep ,wodniw
evitisop si esuops
hgih evah eh/s ro
.ruoivaheb ksir
noitirtun
.gnillesnuoc

.dlihc eht
Back Inner
State / UT wise Number of HIV Counseling and Tes ng Centers (ICTCs) In India (December, 2013)
SA ICTC / F- ICTC/ PPP-ICTC

15539
State / UT wise Number of HIV / AIDS Treatment Centers In India (December, 2013)
ART/ LAC
1278
The HIV Counseling & Tes ng and Treatment Facli es are being rapidly further scaled up during NACP- IV (2012-17)

December, 2013
Government of India

New Delhi - 110001

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Updated Guidelines for

Prevention of Parent to Child

Department of AIDS Control

Updated Guidelines for

Prevention of Parent to Child

Department of AIDS Control

Geetanjali Kumari, (ex) National Programme Officer/ PPTCT, DAC

Ashok Kumar, Dy. DG/ BSD, DAC

PPTCT Policy, Essential Package and Guiding Principles

The Overall Goals of the PPTCT Programme

The Essential Package of Services under the PPTCT Programme

Sexually Transmitted Infections and Reproductive Tract Infections

HIVTB Collaborative Activities

Guiding Principles for Use of ARV Drugs (ART) in PPTCT

PPTCT Services Under NACP

Continuum of Care under PPTCT

Care and Assessment of HIV Infected Pregnant Women

Care during the Antenatal Period

Criteria for ART Initiation

Indications for Co-trimozaxole Prophylactic Therapy (CPT) in Pregnancy

HIV Infected Pregnant Women being Newly Initiated on ART

Choice of ART Regimen for HIV-infected Pregnant Women

Safety of Efavirenz (EFV) in Pregnant Women

ART Regimen for Pregnant Women having Prior Exposure to

Figure 2: Components of PPTCT Programme

Pregnant Women Already Receiving ART

Clinical and Laboratory Monitoring of Pregnant Women Receiving ART

emmargorP TCTPP fo stnenopmoC :2 erugiF

: ART for Pregnant Women

OM Regarding Provision of ART/ARV Prophylactic Drugs at ART Centre to

Intra-uterine contraceptive device

emoh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP

)IEH( tnafnI desopxE VIH

mmargorP TCTPP fo stnenopmoC :2 erugiF

Figure 2: Components of PPTCT Programme

Exclusive breastfeeds upto 6 months (preferred Option-I WHO/NACO Guidelines 2010-'11)

nemoW tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO

HIV Infected Pregnant Women

Ante-natal Care (ensure at least 4 visits)

nemoW tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO

emoh ,gnillesnuoc pu-wollof hguorht troppus laicos-ohcysP l

Refer to ICTC for

HIV rapid test and RPR test

HIV Exposed Infant (HEI)

Tab. Azithromycin 1 G (1) and Disposable

Genital Ulcer Disease- Non Herpetic

STI/ RTI Service Package

emmargorP TCTPP fo stnenopmoC :2 erugiF

Minimal laboratory testing

HIV testing of presumptive TB cases

nemoW tnangerP lla ot secivreS gnitseT dna gnillesnuoC VIH fo reffO

HIV testing of diagnosed TB patients

Figure 2: Components of PPTCT Programme

Stand Alone ICTC

Sub-centre level Whole Blood Finger

Three Rapid test for

Syphilis confirmation using

Screening of Ante-natal cases

Psycho-social support through follow-up counselling, home

2.4 Guiding Principles for Use

ART Centre: Initiate ART to HIV positive pregnant mother

Labour & Delivery