Prevention of Mother to Child Transmission of HIV and Paediatric HIV Care Guidelines (Second Edition)

Malawi's national prevention of mother to child transmission (PMTCT) guidelines document was published in 2008. This document presents a national approach that integrates the principles of ART for pregnant women and ARV prophylaxis for newborn care. The HIV counseling and testing is provided as a routine procedure in the context of provider-initiated approach. The treatment criteria for pregnant women include CD4 counts below 250 or clinical stage 3 or 4.  When CD4 counts are above 250, ZVD twice daily from 28th week and single dose NVP at the onset of labor and 3TC plus ZDV in postpartum are recommended. Single dose NVP though not recommended may be provided if facility is not able to offer the preferred regimen. Newborns should receive single NVP at birth followed by AZT twice daily for four weeks. In addition, these guidelines provide indication for infant feeding, malaria prophylaxis for the mother and cotrimozaxole prophylaxis for the infant that is given from 6th week of age. The guidelines also discuss the issues of replacement feeding affordability, feasibility, acceptability, sustainability and early infant HIV diagnosis; extensively infant feeding, and monitoring and evaluation of the program.