27.5  ARV treatment options for PMTCT

27.5.1  General considerations

Though at this time you may not be allowed to prescribe drugs for PMTCT, it may soon be available for you to provide the service for HIV-positive pregnant mothers in your own community. The type of antiretroviral drug treatment offered will depend on the clinical stage of the mother. You will therefore have to differentiate between HIV-positive pregnant mothers who need ARV drugs for PMTCT, and those who need ARV drugs for treatment of their own condition. The main criteria for PMTCT in HIV-infected pregnant women who still do not need ART for themselves are outlined below. You should be aware though that all options of PMTCT using ARV drugs significantly reduce HIV transmission to the child.

Pregnant mothers should take ART if they fulfil the following criteria:

  1. If their CD4 count is available:
    • WHO clinical stage 4: Regardless of the CD4 count, they have to receive ART for treatment.
    • WHO stage 3: They need treatment with ART if their CD4 count is less than 350/mm3.
    • WHO clinical stage 1 or 2: They need treatment with ART if their CD4 count is less than 200/mm3.
  2. If their CD4 count is not available:
    • All women who are in WHO clinical stage 3 or 4 need ART.
    • Women who are in WHO clinical stage 2 need ART if they do not have a CD4 count, but their total lymphocyte (white blood cells) count is less than 1200/mm3.

Remember that the CD4 count refers to the number of CD4 lymphocytes per cubic millimetre (mm3) of blood.

You should note that the above criteria are used to identify HIV-infected pregnant mothers who need ART treatment. If an HIV-positive pregnant mother is taking ART treatment, she doesn’t need to take any additional ARV drugs for PMTCT. HIV-positive pregnant mothers will be screened at health-centre and hospital level, and if they fulfil one of the above criteria they will be advised to start ART treatment. If they do not fulfil the criteria, they will be counselled for PMTCT using ARV drugs.

Therefore, if you find pregnant mothers who are HIV positive at your health post or in your community, refer them to have their CD4 count checked at the nearest health centre. If they are referred back to you from the health centre, you need to make a proper follow up of them in the community.

27.4  Steps in the HIV testing process

27.5.2  Single-dose Nevirapine, and other ARV options for PMTCT