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Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
1
07
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
MIN
ISTR
Y O
F H
EALT
H
Rep
ublic
of K
enya
Gui
delin
es fo
r
Prev
entio
n of
Mot
her t
o C
hild
Tr
ansm
issi
on (P
MTC
T) o
f HIV
AID
S
in K
enya
NA
TIO
NA
L A
IDS
amp S
TI C
ON
TRO
L PR
OG
RA
MM
E
PO
BO
X 19
361-
002
00
NA
IRO
BI
Third
Edi
tion
200
9
1
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
106
Enq
uiri
es r
egar
ding
thes
e PM
TCT
Gui
delin
es s
houl
d be
add
ress
ed to
Dire
ctor
N
atio
nal A
IDS
and
STI C
ontr
ol P
rogr
amm
e (N
ASC
OP)
M
inis
try
of H
ealth
P
O B
ox 1
9361
- 00
200
N
airo
bi K
enya
Te
leph
one
+25
4 20
272
9502
272
9549
Fa
x +
254
20 2
71 0
518
or 2
72 9
502
Em
ail
head
nasc
op
icon
nect
co
ke
Web
site
ww
wa
idsk
enya
org
Third
edi
tion
Cop
yrig
ht copy
200
9 M
inis
try o
f Hea
lth G
over
nmen
t of K
enya
105
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
A
ppen
dix
VII
I Li
st o
f Con
trib
utor
s
Dr
Ayi
si R
ober
t K
Dep
uty
Hea
d N
ASC
OP
PMTC
T Pr
grm
Mng
r
MO
H-N
ASC
OP
Dr
Abd
alla
h S
aade
H
IV T
rain
er J
HPI
EG
O
Ms
Ake
lola
Rut
h
Nut
ritio
n amp
HIV
Man
ager
MO
H-N
ASC
OP
Mr
Dey
a J
osph
at
PMTC
T Pr
ogra
m O
ffice
r M
OH
-NA
SCO
P
Dr
Die
lem
ans
Pau
l
Mat
erna
l Neo
nata
l Hea
lth (M
NH
) Adv
isor
EH
SD
RH
Ms
Gitu
to A
nnie
W
Prog
ram
Offi
cer
MO
H-D
RH
Dr
Inw
ani
Iren
e
Paed
iatr
icia
n IC
AR
T K
NH
Mr
Isav
wa
Ant
hony
D
ata
Prog
ram
Man
ager
CD
C K
enya
Dr
Kar
anja
Dom
inic
PM
TCT
Prog
ram
Man
ager
PA
THFI
ND
ER
Inte
rnat
iona
l
Dr
Kia
rie
Jam
es N
PM
TCT
Prog
ram
Man
ager
KN
HU
ON
Dr
Kig
en B
atile
l Pr
ogra
m M
anag
er M
OH
-DR
H
Ms
Koe
ch R
osel
ine
Pr
ogra
m O
ffice
r M
OH
-DR
H
Dr
Mac
hari
a S
heila
R
H S
ervi
ces
Spec
ialis
t U
SAID
K
Dr
Mat
u L
ucy
PM
TCT
Prog
ram
Man
ager
USA
IDK
Ms
Mau
a J
udith
Pr
ogra
m O
ffice
r D
RH
-MO
H
Prof
Mbo
ri-N
gach
a D
Se
nior
Tec
hnic
al A
dvis
or A
ssoc
iate
Pro
fess
or
of P
aedi
atri
cs C
DC
Ken
ya U
oN
Dr
Mud
any
Mild
red
Te
chni
cal A
dvis
or C
DC
Ken
ya
Ms
Muh
enje
Ody
lia
Beh
avio
ral S
cien
tist
CD
C K
enya
Ms
Mut
sots
o W
infr
ed
PMTC
T Te
chni
cal A
dvis
orP
rogr
am M
anag
er C
DC
Ken
ya
Ms
Mut
uku
Ter
esia
H
IV T
rain
er J
HPI
EG
O
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
104
App
endi
x V
II
103
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Ms
Mw
anga
ngi
Alic
e Pr
ogra
m O
ffice
r D
RH
-MO
H
Ms
Mw
angi
Nan
cy
PMTC
T A
dmin
istr
ativ
e A
ssis
tant
CD
C K
enya
Mr
Ndw
iga
Fra
ncis
Pr
ogra
m O
ffice
r M
OH
-NA
SCO
P
Prof
Ndu
ati
Rut
h
Ass
ocia
te P
rofe
ssor
of P
aedi
atri
cs U
oN
Dr
Nju
guna
Cha
rles
Pr
ogra
m A
ssoc
iate
MSH
RPM
Plu
s
Mr
Nya
beri
Dav
id
Prog
ram
Offi
cer
MO
H-D
RH
Mr
Ode
ra J
W
Prog
ram
Coo
rdin
ator
GTZ
Ms
Olu
och
Pat
rici
a Te
chni
cal A
dvis
or C
DC
Ken
ya
Mr
Olu
och
Tom
Te
chni
cal A
dvis
or C
DC
Ken
ya
Dr
Onrsquo
gech
Joh
n
Prog
ram
Coo
rdin
ator
KN
H
Dr
Otie
no-N
yuny
a B
Se
nior
Lec
ture
rH
ead
of D
epar
tmen
t PM
TCT
Dir
ecto
rM
oi U
nive
rsity
AM
PATH
Dr
Oum
a C
hris
PM
TCT
Prog
ram
Offi
cer
UN
ICE
F
Dr
Saw
e F
redr
ick
K
Dep
uty
Dir
ecto
r W
RP
Mr
Soo
Leo
nard
Pr
ogra
m M
anag
er W
RP
Dr
Vak
il S
obha
N
Tech
nica
l Adv
isor
AR
T Pr
ogra
m N
ASC
OP
Ms
Way
ua R
uth
Prog
ram
Offi
cer
MO
H-D
RH
Dr
Yon
ga I
sabe
lla
PMTC
T Te
chni
cal A
dvis
or E
GPA
F
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
Tabl
e of
Con
tent
s Li
st o
f con
trib
utor
s 3
Tabl
e of
con
tent
s 5
Ack
now
ledg
emen
ts
10
Fore
wor
d 11
Abb
revi
atio
ns a
nd A
cron
yms
12
Exe
cutiv
e Su
mm
ary
16
Cha
pter
1
Bac
kgro
und
20
11T
he G
loba
l Pan
dem
ic
20
12
Mag
nitu
de o
f HIV
in P
regn
ancy
in
22
13
Ris
ks o
f Tra
nsm
issi
on o
f MTC
T at
Diff
eren
t Tim
e Pe
riod
s 23
14
Ris
k Fa
ctor
s of
MTC
T of
HIV
24
15
Ben
efits
of P
MTC
T of
HIV
25
16
Ben
efits
of H
IV C
ouns
ellin
g amp
Tes
ting
25
17
The
Four
-pro
nged
App
roac
h to
PM
TCT
26
18
Ove
rvie
w o
f the
New
PM
TCT
Gui
delin
es
28
19
Obj
ectiv
es amp
Org
anis
atio
n of
the
Gui
delin
es
28
110
U
sing
the
Gui
delin
es
29
Cha
pter
2 A
nten
atal
Car
e an
d Pr
even
tion
of M
TCT
of H
IV
32
21
Intr
oduc
tion
32
5
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4 B
acte
riolo
gica
l con
firm
atio
n
App
ropr
iate
clin
ical
sam
ples
incl
ude
sput
um
gast
ric
aspi
rate
s an
d ce
rtai
n ot
her
mat
eria
ls
Sin
ce m
ost
TB
in c
hild
ren
is in
infa
nts
and
youn
g ch
ildre
n s
putu
m
indu
ctio
n m
ay b
e do
ne fi
rst
or g
astr
ic a
spira
tions
and
exp
ecto
ratio
ns
a S
putu
m In
duct
ion
Spu
tum
indu
ctio
n is
saf
e an
d ef
fect
ive
in c
hild
ren
of a
ll ag
es a
nd t
he b
acte
rial
yi
elds
a]r
e as
goo
d or
bet
ter
that
for
gas
tric
asp
irate
s
b G
astr
ic a
spira
tion
Thi
s is
per
form
ed in
you
ng c
hild
ren
who
are
una
ble
or u
nwill
ing
to
expe
ctor
ate
sput
um
A g
astr
ic a
spir
ate
shou
ld b
e ob
tain
ed o
n ea
ch o
f th
e th
ree
cons
ecut
ive
mor
ning
s
c E
xpec
tora
tions
S
putu
m s
houl
d al
way
s be
obt
aine
d in
adu
lts a
nd o
lder
chi
ldre
n gt1
0 ye
ars
of
age
susp
ecte
d of
hav
ing
pulm
onar
y T
B
Bac
teri
al y
ield
s ar
e hi
gher
in o
lder
chi
ldre
n
Thr
ee s
putu
m s
peci
men
s sh
ould
be
obta
ined
an
on-
the
ndashspo
t sp
ecim
en (
at t
he
first
eva
luat
ion)
an
ear
ly m
orni
ng s
peci
men
and
a s
econ
d on
-the
-spo
t sp
ecim
en
Spu
tum
indu
ctio
n is
saf
e an
d ef
fect
ive
in c
hild
ren
of a
ll ag
es a
nd t
he b
acte
rial
yi
elds
are
as
good
or
bett
er t
han
for
gast
ric a
spira
tes
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
102
NO
TES
1 H
isto
ry
bull A
sk f
or s
ympt
oms
cons
iste
nt w
ith T
B in
clud
ing
chro
nic
coug
hgt 2
wee
ks
feve
r- b
ody
tem
pera
ture
of
38 o C
for
14 d
ays
afte
r co
mm
on c
ause
s su
ch a
s m
alar
ia a
nd p
neum
onia
hav
e be
en e
xclu
ded
wei
ght
loss
or
failu
re t
o th
rive
(
also
look
at
the
grow
th c
hart
) a
nd o
r ni
ght
swea
ts
Enq
uire
whe
ther
the
pat
ient
has
bee
n in
clo
se c
onta
ct w
ith s
mea
r-po
sitiv
e pu
lshym
onar
y T
B (
usua
lly a
par
ent
or o
ther
mem
ber
of th
e fa
mily
)
2 C
linic
al e
xam
inat
ion
a P
hysi
cal s
igns
hig
hly
sugg
estiv
e of
ext
ra p
ulm
onar
y T
B
bull O
ften
the
mai
n cl
inic
al f
indi
ng is
just
fai
lure
to
thriv
e
bull G
ibus
es
peci
ally
of
rece
nt o
nset
(re
sulti
ng f
rom
ver
tebr
al T
B)
bull N
on-p
ainf
ul e
nlar
ged
cerv
ical
lym
phad
enop
athy
with
fis
tula
for
mat
ion
b P
hysi
cal s
igns
req
uiri
ng in
vest
igat
ions
to
excl
ude
extr
a pu
lmon
ary
TB
bull M
enin
gitis
not
res
pond
ing
to a
ntib
iotic
s tr
eatm
ent
bull P
leur
al e
ffus
ion
bull P
eric
ardi
al e
ffus
ion
bull D
iste
nded
abd
omen
with
asc
itis
bull N
on-p
ainf
ul e
nlar
ged
lym
ph n
odes
with
out
fistu
la f
orm
atio
n
bull N
on-p
ainf
ul e
nlar
ged
join
t
Sig
ns o
f tu
berc
ulin
hyp
erse
nsiti
vity
3 M
anto
ux te
st
A m
anto
ux t
est
shou
ld b
e re
gard
ed p
ositi
ve a
s fo
llow
s
bull I
n hi
gh-r
isk
child
ren
(inc
lude
s H
IV-i
nfec
ted
child
ren
and
seve
rely
mal
shyno
uris
hed
child
ren
) gt
5mm
dia
met
er o
f in
dura
tion
bull I
n al
l oth
er c
hild
ren(
whe
ther
the
y ha
ve r
ecei
ved
BC
G o
r no
t)
gt10m
m d
ishyam
eter
of i
ndur
atio
n
101
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
22
Ope
ratio
nal G
uide
lines
32
23
Job
Aid
s 34
24
App
endi
ces
13
Cha
pter
3 I
ntra
part
um C
are
38
31
Intr
oduc
tion
38
32
Ope
ratio
nal G
uide
lines
38
Cha
pter
4
Use
of A
RVs
in P
regn
ancy
for T
reat
men
t amp P
MTC
T of
HIV
infe
ctio
n 42
41
Intr
oduc
tion
42
42
Ope
ratio
nal G
uide
lines
43
Cha
pter
5 I
mm
edia
te P
ostn
atal
and
Neo
nata
l Car
e
51
51
Intr
oduc
tion
51
52
Ope
ratio
nal G
uide
lines
51
Cha
pter
6 L
ate
Post
nata
l Car
e an
d Fa
mily
Pla
nnin
g
54
61
Intr
oduc
tion
54
62
Ope
ratio
nal G
uide
lines
54
Cha
pter
7 H
IV D
iagn
osis
in C
hild
ren
58
71
Intr
oduc
tion
58
72
Ope
ratio
nal G
uide
lines
59
72
0 G
uide
lines
for
HIV
Dia
gnos
is in
Chi
ldre
n
59
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
72
1 H
IV N
egat
ive
Infa
nt a
t 6 w
eeks
or
Firs
t Con
tact
59
72
2 H
IV P
ositi
ve In
fant
by
DN
A P
CR
60
72
3 C
ompr
ehen
sive
Car
e fo
r H
IV-e
xpos
ed In
fant
61
D
IAG
NO
STIC
ALG
OR
ITH
MFO
R P
ULM
ON
AR
Y T
B IN
CH
ILD
REN
Cha
pter
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
Bor
n to
HIV
infe
cted
mot
hers
62
81
Intr
oduc
tion
62
82
Ope
ratio
nal G
uide
lines
on
Infa
nt F
eedi
ng (0
-6 m
onth
s)
63
83
Ope
ratio
nal G
uide
lines
on
Feed
ing
Chi
ldre
n 6
mon
ths
and
olde
r 64
84
Nut
ritio
nal C
are
and
Supp
ort o
f HIV
infe
cted
Chi
ldre
n 64
85
Ext
ract
s fr
om R
esea
rch
on In
fant
Fee
ding
and
HIV
AID
S 65
Cha
pter
9
Car
e an
d Fo
llow
up
of C
hild
ren
of H
IV-in
fect
ed m
othe
rs 7
3
91
Intr
oduc
tion
73
92
Ope
ratio
nal G
uide
lines
74
Cha
pter
10
Mon
itorin
g an
d Ev
alua
tion
of P
MTC
T se
rvic
es
83
101
In
trod
uctio
n 83
102
O
pera
tiona
l Gui
delin
es
85
Bib
liogr
aphy
91
Job
Aid
sR
efer
ence
s
91
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
App
endi
x V
I
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
100
App
endi
x V
C
OM
MO
N A
DV
ERSE
EFF
ECTS
OF
AR
V U
SE D
UR
ING
PR
EGN
AN
CY
Cla
ss
Adv
erse
effe
cts
Nuc
leos
ide
Nuc
leot
ide
Rev
erse
Tra
nscr
ipta
se In
hibi
tors
( NR
TIs)
Zido
vudi
ne(A
ZT)
Nau
seau
La
miv
idin
e (3
TC)
Dia
rhoe
a
Stav
udin
e (d
4T)
Hyp
erse
nsiti
vity
(AB
C)
Aba
cavi
r(A
BC
) A
naem
ia(A
ZT)
Teno
fovi
r(TF
VTD
F)
Emitr
icita
bine
(FTC
)
Non
- Nuc
leos
ide
Rev
erse
Tra
nscr
ipta
se In
hibi
tors
(NN
RTI
s)
Nev
irapi
ne(N
VP)
Del
avird
in
Efav
irenz
(EFV
)
Pro
teas
e In
hibi
tors
(PIs
)
Saqu
inav
ir(SQ
V)
Indi
navi
r(ID
V)
Rito
navi
r(R
TV)
Nel
finav
ir(N
LF)
Lopi
navi
rrito
navi
r(LP
Vr)
A
taza
navi
r(A
TV)
Fose
mpr
enav
ir Ti
pana
vir(
TPV)
D
arun
avir(
DR
V)
Ras
h
Elev
ated
live
r enz
ymes
(c
omm
on w
ith N
VP in
hig
h C
D4
co
unt)
EFV
CN
S ef
fect
s(se
datio
n in
-so
mni
a v
ivid
dre
ams
diz
zine
ss
conf
usio
n fe
elin
g of
lsquod
isen
gage
men
trsquo
Tera
toge
nici
ty
GI i
ntol
eran
ce
Hep
atot
oxic
ity
Lipo
dyst
roph
y
Dys
lipid
emia
s
Insu
lin re
sist
ance
Hyp
ergl
ycae
mia
La
ctic
aci
dosi
s an
d he
patic
ste
a-to
sis
Cou
nsel
ing
and
Follo
w-u
p Ti
ps
May
not
be
wel
l-tol
erat
ed in
ear
l pr
egna
ncy
whe
n
mor
ning
sic
knes
s is
com
mon
M
ay in
crea
se ri
sk o
f non
-ad
here
nce
May
hav
e in
adeq
uate
blo
od le
vels
A
ll A
RVs
sho
uld
be d
isco
ntin
ued
and
rest
arte
d w
hen
Namp
V is
gon
e or
effe
ctiv
ely
trea
ted
Fo
llow
-up
labs
CB
C L
FTs
If ra
sh in
1st
2 w
ks d
o no
t inc
reas
e N
VP d
ose
and
cont
act c
linic
ian
Mild
rash
may
be
man
aged
with
an
tihis
tam
ines
A
void
cor
ticos
tero
ids
durin
g N
VP
dose
esc
alat
ion
EFV
shou
ld b
e ta
ken
initi
ally
at
bed
time
Avo
id E
FV in
wom
en o
f hig
h ch
ild-b
earin
g po
tent
ial
Do
not o
pera
te h
eavy
mac
hine
ry
Mon
itor g
luco
se le
vels
A
sk re
gula
rly fo
r sym
ptom
s of
hy
perg
lyca
emia
M
onito
r hep
atic
tran
sam
inas
es
(ALT
and
AST
) par
ticul
arly
dur
ing
the
first
18
wee
ks o
f the
rapy
w
hen
this
toxi
city
is m
ost l
ikel
y Ta
ke w
ith fo
od
Ant
iem
etic
s A
ntim
otili
ty
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
App
endi
ces
92
App
endi
x I
WH
O C
linic
al S
tagi
ng o
f HIV
AID
S fo
r A
dults
and
A
dole
scen
ts w
ith C
onfir
med
HIV
infe
ctio
n 92
App
endi
x II
C
ontr
acep
tive
Opt
ions
for
Peop
le L
ivin
g w
ith H
IV
95
App
endi
x II
I U
se o
f AR
Vs
for
Trea
tmen
t and
PM
TCT
of H
IV in
AN
C
97
App
endi
x IV
Use
Of A
RV
s fo
r PM
TCT
of H
IV in
Lab
our
And
Del
iver
y U
nit
98
App
endi
x V
Com
mon
Adv
erse
Effe
cts
of A
RV
Use
Dur
ing
Preg
nanc
y 99
App
endi
x V
I D
iagn
ostic
alg
orith
m fo
r pu
lmon
ary
TB in
Chi
ldre
n 10
0
App
endi
x V
II I
nteg
rate
d M
onito
ring
and
Eval
uatio
n Re
port
For
m M
OH
726
10
3
App
endi
x V
III
Rep
rodu
ctiv
e H
ealth
HIV
AID
S R
epor
t For
m M
OH
711
10
4
Lis
t of T
able
s
Tabl
e 1
1 A
dult
HIV
-pre
vale
nce
Est
imat
e by
Pro
vinc
e in
200
6 21
Tabl
e 1
2 E
stim
ated
Mag
nitu
de o
f MTC
T in
Ken
ya 2
007
22
Tabl
e 1
3 Tr
ansm
ission
Pat
tern
s in
Brea
stfee
ding
and
Non
bre
astfe
edin
g Pop
ulat
ions
23
Tabl
e 1
4 R
isk
Fact
ors
for
MTC
T of
HIV
24
Tabl
e 1
5 Th
e Fo
ur-p
rong
ed A
ppro
ach
App
lied
to th
e PM
TCT
Gui
delin
es
30
Tabl
e 2
1 E
ssen
tial P
acka
ge o
f Int
egra
ted
Ant
enat
al C
are
Serv
ices
33
Tabl
e 4
1 R
ecom
men
datio
ns fo
r In
itiat
ing
AR
V T
reat
men
t in
Preg
nant
Wom
en B
ased
on
Clin
ical
Sta
ge a
nd A
vaila
bilit
y of
CD
4 co
unt
44
Tabl
e 4
2 R
ecom
men
ded
Firs
t Lin
e A
RT
Reg
imen
for
Trea
ting
Preg
nant
Wom
en a
nd P
roph
ylac
tic R
egim
en fo
r In
fant
s 45
Tabl
e 4
3a R
ecom
men
ded
Firs
t Lin
e A
RV
Pro
phyl
axis
to P
reve
nt H
IV
46
Infe
ctio
n in
Infa
nts
Am
ong
preg
nant
Wom
en P
rese
ntin
gB
efor
e 38
Wee
ks
Tabl
e 4
3b A
ltern
ativ
e A
RV
Pro
phyl
axis
to P
reve
nt H
IV In
fect
ion
in In
fant
s 4
6 A
mon
g Pr
egna
nt W
omen
Pre
sent
ing
Bef
ore
38 W
eeks
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
9
9
47
IV
Wom
en w
ho h
ave
not r
ecei
ved
Intr
apar
tum
AR
T or
A
RV
Pro
phyl
axis
with
H
IV
Infe
ctio
n
Tabl
e 4
4 A
RV
Pro
phyl
axis
for
PMTC
T am
ong
Preg
nant
Wom
en w
ho h
ave
not r
ecei
ved
Ant
enat
al A
RT
or P
roph
ylax
is
App
endi
x Ta
ble
45
Cho
ice
of H
AA
RT
for
Preg
nant
Wom
en b
ased
on
CD
4 co
unt
47
Tabl
e 4
6 A
RV
Pro
phyl
actic
Reg
imen
s fo
r In
fant
s B
orn
to H
IV-p
ositi
ve
49
Tabl
e 9
1 D
ose
of C
o-tr
imox
azol
e fo
r PC
P pr
ophy
laxi
s 76
Tabl
e 9
2 W
HO
Rec
omm
enda
tions
for
Follo
w-u
p of
an
HIV
-exp
osed
Chi
ld
79
Tabl
e 10
1 C
ontr
acep
tive
Met
hods
for
Use
in C
oupl
es a
nd W
omen
Liv
ing
96
Figu
re 2
1 R
apid
HIV
Ser
ial T
estin
g A
lgor
ithm
35
Figu
re 8
1 G
uide
lines
for
Cou
nsel
ling
on H
IV a
nd In
fant
feed
ing
66
Job
Aid
s an
d IE
C M
ater
ials
on
Infa
nt a
nd Y
oung
Chi
ld F
eedi
ng
67
List
of F
igur
es
Figu
re 1
01
Mon
itori
ng a
nd E
valu
atio
n D
ata
Flow
in K
enya
84
September 0 8
USE OF ARVs FOR PMTCT OF HIV IN LABOUR AND DELIVERY UNITSALL MOTHERS
1 History 2 Examination3 Establish motherrsquos HIV status4 Offer HIV counseling and testing for mother with unknown HIV status5 Provide standard obstetrical management and care
HIV NEGATIVECounsel on risk reduction
HIV POSITIVE
Establish Motherrsquos use of ARVs in pregnancy and give appropriate ARVs as shown in boxesbelow
Regardless of Duration received HAART
Action
i Give mother ARV dose as per regimen
ii Post partu m Infant Give Infant sd Nevi rapine 2mgkg with in 72 hours of birthPL US 3T C 4mgkg BD for 1 w eek an d AZT syrup 4 m gkg BD for 6 w eeks
iii Post partum mother Continue w ith AR Vs as per regimen
MOTHE R RECEIVED HAART IN PREGNANCY
F OR MORE INFORMAT ION CONT ACT THE NATIONAL AIDSSTD CONTROL PROGRAMME (NASCOP)PO BO X 19361-00202 NAIROBI TEL 0202729502 FAX 020 2710518
MINISTRY OF HEALTH
bull G ive mo ther sd Nevirap ine 200m g AZT 600mg and 3TC 150 mg stat
bull Post partum Infant Give Infant sd Nevirapine 2mgkg within 72 ho urs of birth PL US
3TC syrup 4mg kg BD for 1 week and AZT syrup 4 mg kg BD fo r 6 w eeks
bull Post partum mother Give moth er AZT 300mg amp 3TC 150 mg BID for 7 d ays
MO THER RECEIVED AZT IN PREGNANCY OR NO ARVs TAKE N IN PREGNANCY
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
98
MINISTRY OF HEALTH
USE OF ARVs FOR TREATMENT AND PMTCT OF HIV IN ANC
App
endi
x II
I
Ack
now
ledg
emen
ts
ALL M O THERS1 History 2 Health Information3 Examination4 In vestigations (with informed consent for HIV test)
HIV NEGATIVE1 P rov id e pos t-te s t HIV pr ev e nti v e
i nter ve ntion s defi ned i n na tion alHT C gui de li nes
2 Re fe r for othe r p os t-te st HIVp re ve ntive inte rv e nti ons no tavai lable in the cli nic b ut avail ab le w ithi n the fa c ili ty
HIV PO SI TI VE1 C ounsel on risk reduction2 Per form WH O clinical staging for H IV disease3 D etermine CD 4 level (if testing facilities available)4 D etermine Gestation age and HB level5 Give ARVrsquos as shown below6 Provide or refer for other post-test HIV interventions defined in national HTC
guidelines
1 WHO clin ica l stage I o r II w ith CD4 cell co unt gt 350mm3 OR 2 WHO clin ica l stage I o r II no CD4 cell co unt do ne3 HB =8 gdl OR n o clinical feat ures of anaemia
bull Initiate AZT 30 0mg BD daily at 28 weeks gestation or any time periodimmediately there after
bull Monitor for clinical featur es of anemia and treatbull Dispense ANC Nev ir apine 200mg PLUS AZT 600mg + 3TC 1 50mg for
moth er to tak e at onset of labourbull Dispense NVP syrup to give infant at birth
bull At on set o f l abo uro Administer Nevirapine 20 0mg AZT 600mg 3TC 150 mg
stat to moth erbull Post p artum
o Give Infa nt sd Nevirapine 2mgk g within 72 hours ofbirth PLUS 3TC 4mg BD for 1 w eek and AZT syrup 4 mgkg BD for 6 w eeks
o Give mother AZT30 0 mg 3 TC 150 BID for 7 day s
1 WHO clinical stag e I or II with CD4 c ell count gt 35 0 mm3 OR 2 WHO clinical stag e I or II w ith no C D4 c ell c ount done
bull Dispense ANC Nevirapine 2 00mg PLUS AZ T 600 mg + 3TC 150mgfo r mo ther to take at onse t of labour
bull Dispense NVP sy rup to give infant at birthbull At Onset of lab our
o Administe r sd Nevirapine AZT 6 00 mg and 3TC1 50mg stat
bull Po st Par tu mo G iv e Infant sd Nev ir apine 2mg kg w ithin 72
h ours of bir th PLUS 3T C 4mgkg BD fo r 1 week a nd AZT syrup 4mgkg BD for 6 we eks
o G iv e mother AZ T300 mg 3TC 1 50 mg BID for 7d ays
1 Any gest ational age2 WHO clin ica l stage III or IV of HIV dis ease regardles s of CD4 cell count OR3 WHO clin ica l stages I or II of HIV d is ease with CD4 cell count =350mm3 ()
bull Refer to Clinician for Evaluation and initiation of NNRTI based ART as pernation al ART guidelines
bull At O nset of Lab ou ro G ive mo ther ARV dos e as per r egimen
bull Post par tumo G ive Infan t sd Nev ira pine 2mgkg within 72 hours of b irth PLUS
3TC 4mgkg and AZT syr up 4 mgkg BD for 6 weeks o G ive mo ther ARVs as per regimen
4 If no HAART av ailable man age the wo man as ind icated in box no2 a nd refer to ARTsite appro priately
F O R M OR E IN FOR M AT IO N CO N T AC T T H E N ATI ON A L A IDS STD C O NTR O L PR O G RAM ME ( N ASC O P)P O B OX 19361-00202 N AIR OBI TEL 0202729502 FAX 020 2710518
EL IGIBL E FO R T R EATMEN T
N O T E LIG IBLE FO R TR EA TM ET AN D PR ESE NTING B ELO W 3 8 W EE KSGESTA TIO N N OT ELIGIB LE FOR TREA TMEN T AN D PR ESE NTING gt 3 8 W EEK S
GE STATIO N
Plea se notebull Pregnan t w omen with WHO clinical stag e I or II plus CD4 cell co unt gt250 mm3 and = 350 mm3 can be initiated on ART wher e a PI based HAART re gimen is av ailable NVP hypersen sitivity h as been previously r eported amon g women in this gr oup initiated on N NRT I based
ART re gimens Where PI ba sed ART reg imen is not av ailab le r efer the patient to a site whe re th e regimen is availab le or c ontinue to ma nage th e w oman a s is indicated in box No 2bull The grading of ana emia in pregna ncy is gt 8-10 Milda nemia gt 6 -8 Moderate anem ia lt 6 Sever e anemiabull Treatment if common p ath ologies ruled out Mild anae mia haematinics irrespectiv e of gestatio n Moder ate a naemia tr ansfusion if close to term gt36 weeks otherwise give haema tinics Severe an aemia transfus ion irr espe ctive of ge statio n Do not stop AZT if Hb dr op s but
would manage it as above and only stop if continues to fall or fails to res pon d des pite transfusion
The
thir
d ed
ition
of
Gui
delin
es f
or P
reve
ntio
n of
Mot
her-
to-C
hild
Tra
nsm
issi
on o
f H
IV A
IDS
in K
enya
is a
res
ult o
f effo
rts
of m
any
indi
vidu
als
and
orga
niza
tions
in th
eco
untr
y T
he T
echn
ical
Wor
king
Gro
up o
n PM
TCT
led
thes
e ef
fort
s M
embe
rs o
f the
te
am r
evie
wed
all
the
mod
ules
rev
ised
and
in s
ome
case
s re
-wro
te th
e m
odul
es b
ased
on
the
seco
nd e
ditio
n to
mak
e th
em u
p to
dat
e an
d in
line
with
cur
rent
sci
entif
ic e
vishy
denc
e an
d ex
peri
ence
We
ackn
owle
dge
the
cont
ribu
tors
and
rev
iew
ers
of t
he c
urre
ntan
d pr
evio
us e
ditio
ns O
f sp
ecia
l m
entio
n ar
e th
e fo
llow
ing
Ken
ya O
bste
tric
al a
nd
Gyn
aeco
logi
cal S
ocie
ty (K
OG
S) t
he U
nive
rsity
of N
airo
bi a
nd M
oi U
nive
rsity
We
wou
ld l
ike
to t
hank
the
fol
low
ing
inst
itutio
ns f
or t
echn
ical
as
wel
l as
fin
anci
al
supp
ort
duri
ng t
he r
evis
ion
of t
he g
uide
lines
N
atio
nal A
IDS
and
STD
Con
trol
Pro
shygr
amm
e (N
ASC
OP)
the
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
Cen
ters
for
Dis
ease
Con
trol
and
Prev
entio
n (C
DC
) It
is n
ot p
ossi
ble
to m
entio
n al
l ind
ivid
uals
and
org
aniz
atio
ns
that
par
ticip
ated
in th
is im
port
ant e
xerc
ise
To
all o
f you
Asa
nte
Sana
Min
istr
y of
Hea
lth
September 2008
97
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
10
Fore
wor
d
The
Min
istr
y of
Hea
lth (
MoH
) is
com
mitt
ed t
o de
velo
pmen
t of
effe
ctiv
e PM
TCT
proshy
gram
mes
Gui
delin
es a
re a
n im
port
ant
part
of t
he G
over
nmen
t st
rate
gy t
o re
duce
MTC
Tan
d is
in
line
with
the
Nat
iona
l H
ealth
Sec
tor
Stra
tegi
c Pl
an I
I (N
HSS
PII)
and
Ken
yaN
atio
nal A
IDS
Stra
tegi
c Pl
an (K
NA
SP) 2
000-
2010
whi
ch fo
cuse
s on
pri
ority
are
as o
f pre
shyve
ntio
n of
new
infe
ctio
ns i
mpr
ovin
g qu
ality
of l
ife o
f tho
se in
fect
ed a
nd a
ffect
ed a
nd m
itishy
gatio
n of
soc
ial a
nd e
cono
mic
impa
ct o
f the
infe
ctio
n
MTC
T is
the
pre
dom
inan
t m
ode
of t
rans
mis
sion
of
HIV
in
infa
nts
and
youn
g ch
ildre
n
This
tra
nsm
issi
on o
ccur
s du
ring
pre
gnan
cy
labo
ur a
nd d
eliv
ery
and
am
ong
brea
stfe
d ba
bies
in
the
post
-par
tum
per
iod
Mem
bers
of t
he T
echn
ical
Wor
king
Gro
up (T
WG
) on
PMTC
T re
view
ed t
he m
odul
es o
f the
se
cond
edi
tion
rev
ised
and
in s
ome
case
s re
-wro
te th
e m
odul
es b
ased
on
up to
dat
e kn
owlshy
edge
and
in
line
with
cur
rent
sci
entif
ic e
vide
nce
and
expe
rien
ce T
he T
WG
con
sist
s of
agr
oup
of p
rofe
ssio
nals
dra
wn
from
var
ious
dis
cipl
ines
tha
t ar
e im
plem
entin
g an
dor
man
shyag
ing
PMTC
T T
he g
roup
ado
pted
and
ada
pted
the
late
st r
ecom
men
datio
ns o
f the
WH
O o
nPM
TCT
as w
ell a
s va
riou
s na
tiona
l gui
delin
es o
n H
IV p
reve
ntio
n tr
eatm
ent a
nd c
are
A f
our-
pron
ged
appr
oach
thr
ough
the
var
ious
rep
rodu
ctiv
e lif
e cy
cles
as
prop
osed
by
the
Inte
r-A
genc
y Ta
sk T
eam
(IA
TT)
on c
hild
ren
and
HIV
and
AID
S w
as a
dopt
ed i
n th
ese
guid
elin
es w
ith e
mph
asis
bei
ng p
lace
on
all t
he fo
ur p
rong
s
For
any
of t
he P
MTC
T in
terv
entio
ns t
o be
suc
cess
fully
impl
emen
ted
coun
selin
g an
d te
stshy
ing
(CT)
mus
t fir
st b
e do
ne R
outin
e H
IV te
stin
g w
ith o
pt-o
ut o
ptio
n is
rec
omm
ende
d T
his
is fo
llow
ed b
y ap
prop
riat
e m
edic
al s
urgi
cal i
nter
vent
ions
incl
udin
g an
tiret
rovi
ral p
roph
yshyla
xis
saf
er o
bste
tric
pra
ctic
es a
s w
ell a
s in
fant
feed
ing
coun
selin
g an
d pr
ovis
ion
of a
ppro
shypr
iate
infa
nt fe
edin
g H
IV-p
ositi
ve w
omen
are
ass
esse
d cl
inic
ally
usi
ng W
HO
sta
ging
and
whe
re f
easi
ble
imm
unol
ogic
al a
sses
smen
t us
ing
CD
4 ce
ll co
unt
HIV
exp
osed
infa
nts
are
test
ed th
roug
h ea
rly
infa
nt d
iagn
osis
(EID
)
In th
ese
guid
elin
es m
ore
effic
acio
us r
egim
ens
are
intr
oduc
ed fo
r th
e fir
st ti
me
whi
le in
forshy
mat
ion
and
coun
selin
g on
inf
ant
feed
ing
follo
ws
the
AFA
SS (
Ava
ilabl
e f
easi
ble
acc
eptshy
able
saf
e an
d su
stai
nabl
e) c
rite
ria
The
mod
ule
on m
onito
ring
and
eva
luat
ion
addr
esse
s is
sues
of d
ata
colle
ctio
n c
olla
tion
and
repo
rtin
g as
wel
l as
use
of d
ata
for
deci
sion
-mak
ing
at th
e fa
cilit
y-le
vel
We
hope
that
app
ropr
iate
impl
emen
tatio
n in
stru
men
ts w
ill b
e us
ed to
ope
ratio
naliz
e th
ese
guid
elin
es
Tabl
e 11
1
Con
trac
eptiv
e M
etho
ds fo
r Use
in
Cou
ples
and
Wom
en L
ivin
g w
ith H
IV In
fect
ion
MET
HO
D
CO
MM
ENTS
Con
dom
s bull
M
ale
amp f
emal
e co
ndom
s av
aila
ble
bull
P
rovi
de d
ual p
rote
ctio
n ag
ains
t STI
sH
IV
amp p
regn
ancy
bull
R
equi
re a
ttent
ion
amp ca
re
for c
orre
ct u
se e
ach
time
bull
M
ay re
quire
co-
oper
atio
n of
par
tner
Hor
mon
al
bull V
ery
effe
ctiv
e an
d ea
sy to
use
M
etho
ds
bull S
uita
ble
for s
hort-
or lo
ng-
term
use
bull
Rev
ersi
ble
bull A
ssoc
iate
d w
ith n
on-
cont
race
ptiv
e he
alth
ben
efits
bull
Ser
ious
com
plic
atio
ns
extre
mel
y ra
re
Intra
uter
ine
bull
H
ighl
y ef
fect
ive
long
-term
C
ontra
cept
ive
reve
rsib
le m
etho
d
Dev
ice
bull
Rem
ains
in p
lace
up
to 1
2 ye
ars
bull
A
lmos
t 100
per
cent
ef
fect
ive
bull
H
as n
o ef
fect
on
ferti
lity
whe
n us
ed b
y nu
llipar
ous
wom
en
bull
Sho
uld
not b
e pr
ovid
ed to
w
omen
with
hig
h ris
k se
xual
life
styl
e bull
B
acte
rial S
TIs
shou
ld b
e sc
reen
ed fo
r and
or
treat
ed a
s a
prec
autio
n pr
ior t
o in
serti
on o
f IU
CD
Ste
riliz
atio
n bull
Goo
d v
ery
effe
ctiv
e fo
r co
uple
s or
indi
vidu
als
who
w
ant n
o m
ore
child
ren
bull S
afe
sim
ple
surg
ical
pr
oced
ure
Con
side
red
perm
anen
t
US
E IN
HIV
PO
SITI
VE
PA
TIE
NTS
bull
Can
and
sho
uld
be u
sed
at a
ll st
ages
of H
IV
infe
ctio
n bull
C
an a
nd s
houl
d be
use
d by
pat
ient
s on
AR
T
bull
Cor
rect
and
con
sist
ent u
se b
y H
IV in
fect
ed p
atie
nts
is
reco
mm
ende
d re
gard
less
of t
he u
se o
f oth
er m
etho
ds
of c
ontra
cept
ion
(dua
l con
trace
ptio
n)
bull C
an b
e us
ed w
ithou
t res
trict
ion
in H
IV+
wom
en n
ot o
n AR
T bull
Can
be
used
with
out r
estri
ctio
n in
all
HIV
+ w
omen
for
emer
genc
y co
ntra
cept
ion
bull S
ome
AR
V dr
ugs
may
redu
ce m
etho
d ef
fect
iven
ess
bull
DM
PA
Im
plan
ts c
an h
owev
er b
e us
ed w
ith A
RT
reshy
inje
ctio
n of
DM
PA
sho
uld
be d
one
at 1
0-12
wee
ks
bull If
horm
onal
met
hod
is c
hose
n c
ondo
ms
shou
ld s
till b
e us
ed c
orre
ctly
and
con
sist
ently
bull
Attr
activ
e m
etho
d fo
r wom
en w
ith H
IV w
ho d
esire
ver
y re
liabl
e pr
egna
ncy
prot
ectio
n bull
C
an b
e in
serte
d in
HIV
+ w
omen
who
do
not h
ave
WH
O
Sta
ge 4
dis
ease
AID
S d
efin
ing
illne
ss
bull
For w
omen
with
sta
ge 4
dis
ease
IUD
can
be
inse
rted
once
they
are
on
ART
and
have
con
trolle
d sy
mpt
oms
of s
ever
e ill
ness
bull N
o m
edic
al re
ason
s to
den
y st
eriliz
atio
n to
clie
nts
w
ith H
IV
bull P
roce
dure
may
be
dela
yed
in e
vent
of a
cute
HIV
-rel
ated
in
fect
ion
or s
tage
4 d
isea
se p
endi
ng im
mun
e re
cons
titut
ion
bull E
ncou
rage
con
dom
use
as
wel
l
DM
PA =
Dep
ot M
edro
xypr
oges
tero
ne A
ceta
te (D
epo-
Prov
era)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
1
96
App
endi
x II
CO
NTR
AC
EPTI
VE
OPT
ION
SFO
R P
EOPL
E L I
VIN
G W
ITH
HIV
It
has
bee
n sh
own
in a
num
ber
of s
tudi
es o
f coh
orts
of H
IV p
ositi
ve w
omen
tha
t so
me
choo
se t
o co
ntin
ue s
exua
l act
ivity
des
pite
kno
wle
dge
of t
heir
sta
tus
Evi
denc
e of
con
shyce
ptio
n ha
s de
mon
stra
ted
that
fert
ility
in H
IV p
ositi
ve w
omen
for
the
mos
t pa
rt is
unshy
affe
cted
H
owev
er c
erta
in c
ondi
tions
may
affe
ct fe
rtili
ty s
uch
as lo
w b
ody
mas
s in
dex
A
IDS
and
inte
rcur
rent
illn
ess
esp
ecia
lly t
uber
culo
sis
Put
ting
wom
en w
ho a
re H
IV
infe
cted
on
cont
race
ptiv
es is
one
of t
he m
eans
of p
reve
ntin
g m
othe
r to
chi
ld t
rans
mis
shysi
on o
f HIV
(PM
TCT)
It is
the
rig
ht o
f HIV
infe
cted
wom
en t
o m
ake
thei
r ow
n de
cisi
ons
rega
rdin
g re
prod
ucshy
tion
The
y m
ay w
ish
to h
ave
mor
e ba
bies
lim
it th
eir
fam
ilies
or
avoi
d pr
egna
ncy
alto
shyge
ther
The
hea
lth c
are
prov
ider
s th
ey c
onsu
lt sh
ould
ena
ble
them
to
mak
e in
form
edch
oice
s by
them
selv
es
The
follo
win
g co
ntra
cept
ive
met
hods
are
ava
ilabl
e in
Ken
ya -
pro
gest
eron
e on
ly p
ills
lo
w d
ose
com
bine
d or
al c
ontr
acep
tives
de
pot
med
roxy
prog
este
rone
ace
tate
(D
MPA
shyde
po)
levo
norg
estr
el a
nd e
tono
gest
rel i
mpl
ants
Em
erge
ncy
cont
race
ptiv
e pi
lls c
oppe
rin
trau
teri
ne c
ontr
acep
tive
devi
ces
bar
rier
met
hods
fem
ale
and
mal
e st
erili
satio
n ar
e al
so a
vaila
ble
Som
e dr
ugs
inte
ract
with
hor
mon
al c
ontr
acep
tives
A
nd c
oncu
rren
t us
e sh
ould
be
avoi
ded
The
se d
rugs
incl
ude
bull P
rote
ase
inhi
bito
rs ndash
Rito
navi
r N
elfin
avir
Lop
inav
ir w
ith R
itona
vir
bull N
on-n
ucle
otid
e re
vers
e tr
ansc
ript
ase
inhi
bito
rs (
NN
RT
Is)
ndash N
evir
apin
e
bull E
favi
renz
bull A
nti-T
B d
rugs
ndash R
ifam
pici
n an
d R
ifabu
tin
bull O
ther
dru
gs ndash
Gris
eofu
lvin
P
heno
barb
itone
C
arba
maz
epin
e P
heny
toin
All
the
abov
e do
not
app
ly i
n th
e fa
ce o
f ot
her
med
ical
con
ditio
ns t
hat
are
cont
ra-
indi
catio
ns f
or t
he v
ario
us m
etho
ds e
g k
now
n ca
rdio
vasc
ular
dis
ease
hep
atic
con
dishy
tions
sm
okin
g h
igh
bloo
d pr
essu
re a
nd th
rom
boem
bolic
dis
orde
rs
The
follo
win
g ta
ble
sum
mar
ises
maj
or is
sues
reg
ardi
ng u
se o
f diff
eren
t co
ntra
cept
ives
by H
IV-p
ositi
ve w
omen
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Abb
revi
atio
ns a
nd A
cron
yms
AFA
SS
Acc
epta
ble
Fea
sibl
e A
fford
able
Sus
tain
able
and
Saf
e
Ab
Ant
i-bod
y
AID
S A
cqui
red
Imm
une
Def
icie
ncy
Synd
rom
e
ALT
Ala
nine
Tra
nsfe
rase
AN
C
Ant
enat
al C
are
AR
M
Art
ifici
al R
uptu
re o
f Mem
bran
es
AR
T
Ant
iret
rovi
ral T
hera
py
A
RV
A
ntir
etro
vira
l
AZT
A
zido
thym
idin
e (Z
idov
udin
e or
ZD
V)
AZT
3TC
Com
bivi
r
3TC
Lam
ivud
ine
BC
C
Beh
avio
ur C
hang
e C
omm
unic
atio
n
BC
G
Bac
ille
Cal
met
te G
ueri
ne v
acci
ne
BFH
I B
aby
Frie
ndly
Hos
pita
l Ini
tiativ
e
BID
BD
ldquoT
wic
e a
dayrdquo
CD
C (K
) C
entr
es fo
r D
isea
se C
ontr
ol a
nd P
reve
ntio
n K
enya
CN
S C
entr
al N
ervo
us S
yste
m
CS
Cae
sare
an S
ectio
n
CT
Cou
nsel
ling
and
Test
ing
CTX
CTZ
Cot
rim
oxaz
ole
d4T
Stav
udin
e
D
ASC
O
Dis
tric
t AID
SST
I Coo
rdin
ator
G
uid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
5
12
DB
S D
ried
Blo
od S
pot s
peci
men
DN
A
Deo
xyri
bonu
clei
c A
cid
DR
H
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
EC
V
Ext
erna
l Cep
halic
Ver
sion
EFV
Efa
vire
nz
EID
E
arly
Infa
nt D
iagn
osis
ELI
SA
Enz
yme
Link
ed Im
mun
osor
bent
Ass
ay
FBC
Fu
ll B
lood
Cou
nt
GTZ
G
erm
an T
echn
ical
Coo
pera
tion
HA
AR
T
Hig
hly
Act
ive
Ant
iret
rovi
ral T
hera
py
Hb
Hae
mog
lobi
n
HIV
H
uman
Imm
unod
efic
ienc
y Vi
rus
IATT
Inte
r-A
genc
y Ta
sk T
eam
IMC
I In
tegr
ated
Man
agem
ent o
f Chi
ldho
od Il
lnes
s
IPPT
Inte
rmitt
ent P
resu
mpt
ive
Trea
tmen
t for
Mal
aria
ITN
s In
sect
icid
es T
reat
ed N
ets
IUC
D
Intr
a U
teri
ne C
ontr
acep
tive
Dev
ice
KD
HS
Ken
ya D
emog
raph
ic a
nd H
ealth
Sur
vey
KE
PI
Ken
ya E
xpan
ded
Prog
ram
me
on Im
mun
izat
ion
KO
GS
Ken
ya O
bste
tric
al a
nd G
ynae
colo
gica
l Soc
iety
KN
H
Ken
yatt
a N
atio
nal H
ospi
tal
LAM
Lact
atio
nal A
men
orrh
oea
Met
hod
Mamp
E
Mon
itori
ng a
nd E
valu
atio
n
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
Cyt
omeg
alov
irus
infe
ctio
n (r
etin
itis
or in
fect
ion
of o
ther
org
ans)
9
Cen
tral
ner
vous
sys
tem
tox
opla
smos
is
10
HIV
enc
epha
lopa
thy
11
Ext
rapu
lmon
ary
cryp
toco
ccos
is in
clud
ing
men
ingi
tis
12
Dis
sem
inat
ed n
on-t
uber
culo
us m
ycob
acte
rial
infe
ctio
n
13
Pro
gres
sive
mul
tifoc
al le
ukoe
ncep
halo
path
y
14
Chr
onic
cry
ptos
pori
dios
is
15
Chr
onic
isos
poria
sis
16
Dis
sem
inat
ed m
ycos
is (
extr
apul
mon
ary
hist
opla
smos
is
or c
occi
diom
ycos
is)
17
Rec
urre
nt s
eptic
aem
ia (
incl
udin
g no
n-ty
phoi
dal S
alm
onel
la)
18
Lym
phom
a (c
ereb
ral o
r B
-cel
l non
-Hod
gkin
s)
19
Inv
asiv
e ce
rvic
al c
arci
nom
a
20
Aty
pica
l dis
sem
inat
ed le
ishm
ania
sis
21
Sym
ptom
atic
HIV
-ass
ocia
ted
neph
ropa
thy
or s
ympt
omat
ic H
IV-
asso
ciat
ed
22
Car
diom
yopa
thy
Ple
ase
note
S
igns
and s
ympto
ms
of
HIV
was
ting s
yndro
me
incl
ude
Unex
pla
ined
invo
lunta
ry w
eight
loss
(gt
10
base
line
body
wei
ght)
with o
bvi
ous
was
ting o
f body
mas
s in
dex
lt185
PLU
S
unex
pla
ined
chro
nic
dia
rrhoea
(lo
ose
or
wat
ery
stools
thre
e or
more
tim
es d
aily
) re
port
ed
for
longer
than
one
month
OR r
eport
s of
feve
r or
nig
ht
swea
ts f
or
more
than
one
month
w
ithout
oth
er c
ause
and lack
of
resp
onse
to a
ntibio
tics
or
antim
ala
rial ag
ents
M
ala
ria
must
be
excl
uded
in m
ala
ria
pro
ne
area
s
Fo
r th
e purp
ose
of
the
WH
O s
tagin
g s
yste
m
adole
sents
and a
dults
are
def
ined
as
adults
aged
ge15 y
ears
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
3
94
CLI
NIC
AL
STA
GE
3 1
Une
xpla
ined
sev
ere
wei
ght
loss
(gt1
0 o
f pr
esum
ed o
r m
easu
red
bo
dy w
eigh
t)
2
Une
xpla
ined
chr
onic
dia
rrho
ea fo
r lo
nger
tha
n on
e m
onth
3
Une
xpla
ined
per
sist
ent
feve
r (a
bove
37
5degC
inte
rmitt
ent
or c
onst
ant
for
long
er t
han
one
mon
th)
4
Per
sist
ent
oral
can
didi
asis
5
Ora
l hai
ry le
ukop
laki
a
6
Pul
mon
ary
tube
rcul
osis
7
Tub
ercu
lous
Lym
phad
enop
athy
8
Sev
ere
bact
eria
l inf
ectio
ns (
such
as
pneu
mon
ia
empy
ema
pyo
myo
sitis
bo
ne o
r jo
int
infe
ctio
n m
enin
gitis
or
bact
erae
mia
)
9
Acu
te n
ecro
tizin
g ul
cera
tive
stom
atiti
s g
ingi
vitis
or
perio
dont
itis
10
Une
xpla
ined
ana
emia
(lt8
gdl
) n
eutr
opae
nia
(lt0
5 times1
09 pe
rlitr
e) a
ndo
r ch
roni
c th
rom
bocy
topa
enia
(lt5
0times10
9 per
litr
e)
CLI
NIC
AL
STA
GE
4 1
HIV
was
ting
synd
rom
e
2
Pne
umoc
ystis
pne
umon
ia
3
Rec
urre
nt s
ever
e ba
cter
ial p
neum
onia
4
Chr
onic
her
pes
sim
plex
infe
ctio
n (o
rola
bial
ge
nita
l or
anor
ecta
l of
mor
e th
an o
ne
mon
thrsquos
dur
atio
n or
vis
cera
l at
any
site
)
5
Oes
opha
geal
can
didi
asis
(or
can
didi
asis
of
trac
hea
bro
nchi
or
lung
s)
6
Ext
rapu
lmon
ary
tube
rcul
osis
exc
ept
Tub
ercu
lous
Lym
ph a
deno
path
y
7
Kap
osirsquos
sar
com
a
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
MC
H
Mat
erna
l and
Chi
ld H
ealth
MoH
M
inis
try
of H
ealth
MSF
M
edic
ins
Sans
Fro
ntie
rs
M
TCT
Mot
her-
To-C
hild
Tra
nsm
issi
on
NA
SCO
P N
atio
nal A
IDS
and
STD
Con
trol
Pro
gram
me
NV
P
Nev
irap
ine
OD
ldquoO
nce
a D
ayrdquo
OI
Opp
ortu
nist
ic In
fect
ion
OPV
O
ral P
olio
Vac
cine
PASC
O
Prov
inci
al A
IDS
STI C
oord
inat
or
PCP
Pneu
moc
ystis
jiro
veci
i pne
umon
ia
PCR
Po
lym
eras
e C
hain
Rea
ctio
n
PI
Prot
ease
Inhi
bito
r
PLW
HA
Pe
rson
sPe
ople
Liv
ing
With
HIV
AID
S
PMTC
T
Prev
entio
n of
Mot
her
To C
hild
Tra
nsm
issi
on
RD
A
Rec
omm
ende
d D
aily
Allo
wan
ce
RH
Rep
rodu
ctiv
e H
ealth
RN
A
Rib
onuc
leic
Aci
d
SdN
VP
Si
ngle
dos
e N
evir
apin
e
SRH
Se
xual
and
Rep
rodu
ctiv
e H
ealth
STD
Se
xual
ly T
rans
mitt
ed D
isea
se
STI
Sexu
ally
Tra
nsm
itted
Infe
ctio
n
TB
Tube
rcul
osis
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
3
14
TBA
s Tr
aditi
onal
Bir
th A
tten
dant
s
TLC
To
tal L
ymph
ocyt
e C
ount
TT
Teta
nus
Toxo
id v
acci
ne
UN
ICE
F U
nite
d N
atio
ns C
hild
renrsquo
s Fu
nd
UN
GA
SS
Uni
ted
Nat
ions
Gen
eral
Ass
embl
y Sp
ecia
l Ses
sion
on
HIV
AID
S
UoN
Uni
vers
ity o
f Nai
robi
VC
T V
olun
tary
Cou
nsel
ling
and
Test
ing
VIA
V
isua
l Ins
pect
ion
usin
g A
ceto
ne
VD
RL
Ven
erea
l Dis
ease
Res
earc
h La
bora
tory
(tes
t for
syp
hilis
)
WH
O
Wor
ld H
ealth
Org
anis
atio
n
WR
P W
alte
r R
eed
Prog
ram
App
endi
x I
WH
O C
LIN
ICA
L S T
AG
ING
OF
HIV
AID
S FO
R A
DU
LTS
AN
D A
DO
LES-
CEN
TSW
ITH
CO
NFI
RM
ED H
IV IN
FEC
TIO
N
CLI
NIC
AL
STA
GE
1
bull
Asy
mpt
omat
ic
bull
Per
sist
ent
gene
raliz
ed ly
mph
aden
opat
hy
CLI
NIC
AL
STA
GE
2 1
Une
xpla
ined
mod
erat
e w
eigh
t lo
ss (
lt10
of
pres
umed
or
mea
sure
d bo
dy w
eigh
t)
2
Rec
urre
nt u
pper
res
pira
tory
tra
ct in
fect
ions
(si
nusi
tis
tons
illiti
s
otiti
s m
edia
and
pha
ryng
itis)
3
Her
pes
Zos
ter
4
Ang
ular
Che
ilitis
5
Rec
urre
nt o
ral u
lcer
atio
n
6
Pap
ular
pru
ritic
eru
ptio
ns
7
Seb
orrh
oeic
der
mat
itis
8
Fun
gal n
ail i
nfec
tions
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
5
92
Bib
liog
raph
y 1
Offic
e of
the
Pres
iden
t N
ational
AID
S C
ontr
ol Counci
l K
enya
Nat
ional H
IVA
IDS
Str
ate
gic
pla
n 2
0056
-20091
0
2
Rep
ublic
of
Ken
ya
Nat
ional AID
S C
ontr
ol C
ounci
l N
atio
nal H
IVA
IDS M
onitori
ng
and E
valu
atio
n F
ram
ework
3
Rep
ublic
of
Ken
ya
Nat
ional AID
S C
ontr
ol C
ounci
l N
atio
nal H
IVA
IDS M
onitori
ng
and E
valu
atio
n I
mple
men
tation M
anual
Job
Aid
sR
efer
ence
s 1
MoH
AN
C R
egis
ters
2
MoH
Mat
ernity
Reg
iste
rs
3
MoH
Post
-nata
l Reg
iste
rs
4
Mat
ernal
and C
hild
Wel
fare
Han
dbook
5
Rep
roduct
ive
Hea
lth S
ervi
ces
month
ly r
eport
6
MoH
Form
726
(Appen
dix
IV)
7
MoH
Form
727
8
MO
H F
orm
711
Exec
utiv
e Su
mm
ary
The
Rev
ised
Gui
delin
es (3
rd
editi
on) f
or P
reve
ntio
n of
Mot
her
to C
hild
Tra
nsm
issi
on(P
MTC
T) o
f H
IV a
nd A
IDS
addr
esse
s th
e ri
sks
of m
othe
r-to
-chi
ld t
rans
mis
sion
(MTC
T) o
f H
IV a
nd A
IDS
usin
g m
ore
effic
acio
us in
terv
entio
ns t
han
in t
he p
revi
ous
editi
ons
The
Gui
delin
es a
re i
n lin
e w
ith K
enya
rsquos N
atio
nal
Hea
lth S
ecto
r St
rate
gic
Plan
II
(NH
SSP
II)
and
are
anch
ored
on
the
Ken
ya N
atio
nal
AID
S St
rate
gic
Plan
(KN
ASP
) 20
00-2
010
whi
ch f
ocus
es o
n th
e pr
iori
ty a
reas
of
prev
entio
n of
new
inf
ecshy
tions
im
prov
ing
the
qual
ity o
f life
of p
eopl
e in
fect
ed a
nd a
ffect
ed b
y H
IV a
nd A
IDS
and
miti
gatio
n of
the
soc
ial a
nd e
cono
mic
impa
ct o
f the
infe
ctio
n O
ne o
f the
pri
ority
ar
eas
of N
HSS
P II
is
adhe
renc
e to
set
clin
ical
and
pub
lic h
ealth
sta
ndar
ds
The
Gui
delin
es w
ere
deve
lope
d th
roug
h a
part
icip
ator
y an
d co
nsul
tativ
e pr
oces
s th
at
drew
par
ticip
ants
fro
m p
ublic
hea
lth i
nstit
utio
ns
NG
Os
FB
Os
aca
dem
ic a
nd r
eshyse
arch
ins
titut
ions
and
dev
elop
men
t pa
rtne
rs
The
proc
ess
was
co-
ordi
nate
d by
N
ASC
OP
with
tech
nica
l and
fina
ncia
l sup
port
from
CD
C (K
)
HIV
infe
ctio
n ha
s re
vers
ed g
ains
rea
lised
in c
hild
hea
lth a
nd s
urvi
val i
n th
e la
st d
ecshy
ade
in K
enya
The
infe
ctio
n ha
s al
so c
ontr
ibut
ed s
igni
fican
tly t
o th
e co
mm
on c
ompl
ishyca
tions
of
preg
nanc
y in
man
y co
untr
ies
Glo
bally
mor
e th
an 6
300
00 c
hild
ren
wer
ein
fect
ed w
ith H
IV t
hrou
gh M
TCT
in 2
003
In
2007
K
enya
had
a p
opul
atio
n es
tishym
ated
at
34 m
illio
n t
he n
umbe
r of
bir
ths
per
annu
m w
as 1
73
mill
ion
the
HIV
prev
alen
ce a
mon
g pr
egna
nt m
othe
rs w
as 6
7 p
er c
ent
and
the
tota
l num
ber
of b
irth
s to
HIV
-infe
cted
mot
hers
exp
osed
to
MTC
T w
as 1
638
00
Ass
umin
g a
tran
smis
sion
rate
of 4
0 pe
r ce
nt a
nd in
the
abs
ence
of a
ny in
terv
entio
n t
he n
umbe
r of
HIV
pos
ishytiv
e in
fant
s pe
r an
num
wou
ld b
e 65
520
Ken
ya A
IDS
Indi
cato
r su
rvey
(KA
IS) 2
007
HIV
ser
opre
vale
nce
amon
g ad
ults
age
d 15
-49
year
s is
78
Var
ious
inte
rven
tions
hav
e be
en p
ut in
pla
ce t
o re
spon
d to
the
em
ergi
ng c
halle
nges
an
d co
nstr
aint
s to
MTC
T ac
ross
the
cou
ntry
Ana
lysi
s of
effe
ctiv
enes
s of
the
var
ious
ap
proa
ches
nee
ded
to m
anag
e ri
sks
of M
TCT
prov
ides
val
uabl
e in
sigh
ts th
at n
eces
sishy
tate
the
ado
ptio
n of
mor
e ef
ficac
ious
car
e an
d tr
eatm
ent
regi
men
s T
hese
ins
ight
s ha
ve in
form
ed t
he d
evel
opm
ent
of n
ew G
uide
lines
The
Gui
delin
es in
corp
orat
e th
ese
chan
ges
and
are
reco
mm
ende
d fo
r us
e by
hea
lth p
rofe
ssio
nals
and
hea
lth in
stitu
tions
at a
ll le
vels
of c
are
The
Gui
delin
es w
ill e
nhan
ce th
e ca
paci
ty o
f hea
lth c
are
prov
ider
sto
giv
e m
ore
effic
ient
and
effe
ctiv
e se
rvic
es t
o H
IV p
ositi
ve e
xpec
tant
mot
hers
and
ne
wbo
rns
The
Gui
delin
es h
ave
ten
chap
ters
and
cov
er th
e fo
llow
ing
just
ifyin
g th
e ne
ed fo
r sp
eshyci
fic m
anag
emen
t of
HIV
pos
itive
wom
en c
are
befo
re d
urin
g an
d af
ter
preg
nanc
yus
e of
ant
iret
rovi
ral t
hera
py in
pre
gnan
cy p
ostn
atal
car
e fa
mily
pla
nnin
g e
arly
inshy
fant
dia
gnos
is
feed
ing
car
e an
d fo
llow
-up
of H
IV-in
fect
ed i
nfan
ts
and
mon
itori
ng
and
eval
uatio
n A
dditi
onal
inf
orm
atio
n on
WH
O s
tagi
ng
cont
race
ptiv
e op
tions
for
PLW
As
and
a su
mm
ary
of A
RV
use
in P
MTC
T is
giv
en in
the
appe
ndic
es
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
1
16
The
Gui
delin
es h
ave
also
inc
orpo
rate
d ba
sic
info
rmat
ion
that
pro
gram
man
ager
sne
ed in
ord
er to
mak
e th
eir
inst
itutio
ns P
MTC
T-fr
iend
ly T
his
info
rmat
ion
is fo
und
in
the
boxe
s an
d ap
pend
ices
Sum
mar
ies
of t
he i
nfor
mat
ion
cont
aine
d in
the
tex
t ar
e fo
und
in th
e ta
bles
The
Gui
delin
es p
rovi
de a
bac
kgro
und
to t
he P
MTC
T pr
oble
m in
the
wor
ld i
n A
fric
a an
d in
Ken
ya T
hey
also
giv
e de
tails
on
HIV
in p
regn
ancy
the
tran
smis
sion
pat
tern
sof
MTC
T an
d de
scri
be t
he b
enef
its o
f pr
even
ting
mot
her-
to-c
hild
tra
nsm
issi
on(P
MTC
T) T
hey
also
pro
vide
info
rmat
ion
on in
terv
entio
ns n
eces
sary
to
redu
ce M
TCT
that
incl
ude
coun
selli
ng a
nd te
stin
g la
bora
tory
inve
stig
atio
ns o
bste
tric
inte
rven
tions
and
trea
tmen
tpro
phyl
axis
The
ante
nata
l man
agem
ent
for
HIV
pos
itive
wom
en i
nclu
ding
pol
icy
guid
e jo
b ai
dsw
ith s
umm
aris
ed e
ssen
tial p
acka
ge o
f int
egra
ted
ante
nata
l car
e se
rvic
es a
re d
etai
led
in C
hapt
er 2
Cha
pter
3 p
rovi
des
info
rmat
ion
on i
ntra
part
um c
are
Thi
s is
the
man
agem
ent
ofw
omen
from
the
onse
t of l
abou
r to
del
iver
y A
t thi
s st
age
it is
impo
rtan
t to
esta
blis
hth
e H
IV s
tatu
s of
wom
en p
rior
to d
eliv
ery
or d
urin
g la
bour
Gui
delin
es s
houl
d be
folshy
low
ed fo
r al
l wom
en a
dmitt
ed to
labo
ur a
nd d
eliv
ery
To
cond
uct v
agin
al d
eliv
erie
s fo
r H
IV p
ositi
ve w
omen
m
odifi
ed r
outin
e ca
re i
s gi
ven
The
gui
delin
es p
rovi
de a
reshy
min
der
on th
e ac
tiviti
es e
ssen
tial t
o ca
rry
out f
or s
afe
vagi
nal d
eliv
ery
for
all w
omen
no
t ju
st fo
r th
ose
infe
cted
with
HIV
It
is r
ecom
men
ded
that
the
re s
houl
d be
no
disshy
crim
inat
ion
or is
olat
ion
of H
IV p
ositi
ve w
omen
dur
ing
labo
ur a
nd d
eliv
ery
Del
iver
y th
roug
h el
ectiv
e ca
esar
ean
sect
ion
redu
ces
the
risk
of
HIV
MTC
T as
com
pare
d to
vagi
nal d
eliv
ery
amon
g H
IV p
ositi
ve w
omen
Whe
re C
S is
per
form
ed a
s an
em
erge
ncy
or e
lect
ivel
y a
ntib
iotic
s sh
ould
be
give
n
Ant
iret
rovi
ral (
AR
V) t
hera
py is
dis
cuss
ed in
det
ail i
n C
hapt
er 4
Thi
s in
clud
es t
hershy
apy
for
the
mot
her
befo
re la
bour
dur
ing
labo
ur a
nd a
fter
del
iver
y a
nd fo
r th
e in
fant
afte
r de
liver
y C
urre
ntly
N
evir
apin
e is
the
rec
omm
ende
d re
gim
en H
owev
er
shor
tco
urse
effi
caci
ous
AR
V d
rug
regi
men
s ca
n be
im
plem
ente
d in
res
ourc
e lim
ited
setshy
tings
AR
Vs
are
used
bot
h fo
r tr
eatm
ent
and
for
PMTC
T in
HIV
inf
ecte
d pr
egna
ntw
omen
and
thei
r ne
onat
es
Gui
delin
es f
or t
he p
ostp
artu
m c
are
of t
he m
othe
r an
d ca
re f
or H
IV e
xpos
ed in
fant
s ar
e de
taile
d in
Cha
pter
5 I
n C
hapt
er 6
the
Gui
de p
rovi
des
deta
iled
info
rmat
ion
on
late
pos
tnat
al c
are
and
fam
ily p
lann
ing
HIV
pos
itive
wom
en c
an u
se a
ll ty
pes
of fa
mshy
ily p
lann
ing
base
d on
sta
ndar
d el
igib
ility
cri
teri
a as
exp
licitl
y ou
tline
d in
the
text
Gui
delin
es fo
r in
fant
dia
gnos
is c
are
and
trea
tmen
t ar
e di
scus
sed
in C
hapt
er 7
Cur
shyre
ntly
the
re is
no
test
to
diffe
rent
iate
bet
wee
n an
tibod
ies
from
the
mot
her
and
thos
e pr
oduc
ed b
y th
e ba
by T
o id
entif
y H
IV in
fect
ed in
fant
s le
ss t
han
18 m
onth
s D
NA
or
RN
A ndash
PC
R te
st is
cur
rent
ly r
ecom
men
ded
HIV
exp
osed
infa
nts
at 6
wee
ks a
nd s
ick
infa
nts
at 1
2 m
onth
s sh
ould
hav
e ac
cess
to
DB
S fo
r D
NA
PC
R H
IV e
xpos
ed in
fant
ssh
ould
be
star
ted
on c
otri
mox
azol
e fr
om 6
wee
ks A
ll m
othe
rs w
ith 6
wee
k ol
d in
fant
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
E
Upt
ake
of c
ouns
ellin
g an
d te
stin
g in
Mat
erni
ty c
linic
Rat
io o
f m
ater
nity
clie
nts
with
unk
now
n H
IV s
tatu
s w
ho a
re c
ouns
elle
d an
d te
sted
for H
IV in
mat
erni
ty
Num
erat
or
Num
ber o
f pre
gnan
t wom
en a
dmitt
ed in
to m
ater
nity
with
un
know
n H
IV s
tatu
s th
at a
re c
ouns
elle
d an
d te
sted
for H
IV
durin
g la
bour
or a
fter d
eliv
ery
Den
omin
ator
N
umbe
r of p
regn
ant w
omen
adm
itted
into
mat
erni
ty
with
unk
now
n H
IV s
tatu
s
F
Mat
erni
ty m
othe
r AR
V pr
ophy
laxi
s up
take
R
atio
of H
IV in
fect
ed m
othe
rs in
mat
erni
ty c
linic
rece
ivin
g pr
even
tive
A
RV
pro
phyl
axis
Num
erat
or
Num
ber o
f HIV
-infe
cted
mot
hers
adm
itted
in m
ater
nity
takshy
ing
or re
porte
d to
hav
e ta
ken
the
mot
her d
ose(
s) o
f pre
venshy
tive
AR
V p
roph
ylax
is
Den
omin
ator
N
umbe
r of p
regn
ant w
omen
adm
itted
into
mat
erni
ty w
ho
are
HIV
-infe
cted
G
Infa
nt A
RV
prop
hyla
xis
upta
ke
Rat
io o
f inf
ants
bor
n to
HIV
-infe
cted
mot
hers
in m
ater
nity
clin
ic
rece
ivin
g pr
even
tive
AR
V p
roph
ylax
is
Num
erat
or
Num
ber o
f inf
ants
bor
n to
HIV
-infe
cted
mot
hers
who
rece
ive
prev
entiv
e
Den
omin
ator
N
umbe
r of i
nfan
ts b
orn
to H
IV-in
fect
ed m
othe
rs
Num
ber o
f pre
gnan
t wom
en a
dmitt
ed in
to m
ater
nity
who
are
H
IV-in
fect
ed is
use
d to
app
roxi
mat
e th
is n
umbe
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
7
90
With
the
mea
sure
men
ts li
sted
abo
ve t
he fo
llow
ing
perf
orm
ance
indi
cato
rs
for m
onito
ring
PMTC
T ac
tiviti
es a
re c
alcu
late
d
A
Upt
ake
of c
ouns
ellin
g an
d te
stin
g in
Ant
enat
al c
linic
R
atio
of a
nten
atal
clie
nts
who
wer
e co
unse
lled
and
test
ed fo
r HIV
Num
erat
or
This
is n
umbe
r of p
regn
ant w
omen
atte
ndin
g th
eir f
irst
ante
nata
l clin
ic v
isit
who
are
test
ed fo
r HIV
Den
omin
ator
N
umbe
r of n
ew v
isits
to th
e an
tena
tal c
linic
B
Ant
enat
al H
IV s
erop
reva
lenc
e
Rat
io o
f Ant
enat
al p
regn
ant w
omen
test
ed fo
r HIV
that
are
HIV
infe
cted
Num
erat
or
Num
ber o
f clie
nts
who
test
HIV
pos
itive
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
test
ed fo
r HIV
in a
nten
ashyta
l clin
ic
C
Ant
enat
al m
othe
r AR
V pr
ophy
laxi
s up
take
R
atio
of k
now
n H
IV in
fect
ed p
regn
ant w
omen
in a
nten
atal
clin
ic
rece
ivin
g A
RV
pre
vent
ive
prop
hyla
xis
Num
erat
or
Tota
l num
ber o
f HIV
-infe
cted
pre
gnan
t wom
en in
ant
enat
al
clin
ic re
ceiv
ing
mot
her p
reve
ntiv
e A
RV
pro
phyl
axis
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
who
are
HIV
-infe
cted
in
the
ante
nata
l clin
ic
D
Ant
enat
al in
fant
AR
V pr
ophy
laxi
s up
take
R
atio
of k
now
n H
IV-in
fect
ed p
regn
ant w
omen
in a
nten
atal
clin
ic w
ho
rece
ive
infa
nt d
ose(
s) o
f pre
vent
ive
AR
V p
roph
ylax
is
Num
erat
or
Tota
l num
ber o
f HIV
infe
cted
pre
gnan
t wom
en in
an
tena
tal c
linic
rece
ivin
g in
fant
dos
e(s)
pre
vent
ive
A
RV
pro
phyl
axis
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
who
are
HIV
-infe
cted
in
the
ante
nata
l clin
ic
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
shou
ld h
ave
rout
ine
HIV
ant
ibod
y te
st
Gui
delin
es f
or f
eedi
ng in
fant
s an
d yo
ung
child
ren
born
to
HIV
infe
cted
mot
hers
are
di
scus
sed
in C
hapt
er 8
The
Min
istr
y of
Hea
lth r
ecom
men
ds p
rom
otio
n of
exc
lusi
vebr
east
feed
ing
for
the
first
6 m
onth
s of
life
Whe
re r
epla
cem
ent f
eedi
ng is
acc
epta
ble
feas
ible
af
ford
able
su
stai
nabl
e an
d sa
fe (
AFA
SS)
avoi
danc
e of
bre
astf
eedi
ng b
yH
IV-in
fect
ed w
omen
is
reco
mm
ende
d (W
HO
200
6) D
iscu
ssio
n on
diff
eren
t ty
pes
offe
edin
g al
tern
ativ
es t
o br
east
feed
ing
is c
aptu
red
in t
he t
ext
Thes
e op
tions
exi
st f
orth
e m
othe
r to
cho
ose
with
the
aid
of
coun
selli
ng I
deal
ly c
oupl
e de
cisi
on-m
akin
g is
enco
urag
ed f
or t
he H
IV p
ositi
ve m
othe
r F
or t
he H
IV n
egat
ive
mot
her
exc
lusi
ve
brea
stfe
edin
g is
rec
omm
ende
d fo
r 6
mon
ths
or le
ss fo
llow
ed b
y w
eani
ng
Car
e an
d fo
llow
-up
of c
hild
ren
of H
IV-in
fect
ed m
othe
rs is
dis
cuss
ed in
det
ail i
n C
hapshy
ter
9 A
ll ch
ildre
n bo
rn t
o H
IV i
nfec
ted
mot
hers
sho
uld
be f
ollo
wed
up
clos
ely
from
birt
h th
roug
h 2
year
s T
able
92
pro
vide
s th
e W
HO
rec
omm
ende
d fo
llow
up
deta
ils
Sim
ilarl
y t
he m
othe
rs s
houl
d be
sup
port
ed t
o pr
ovid
e op
timal
infa
nt fe
edin
g an
d to
av
oid
mix
ed fe
edin
g w
ithin
6 m
onth
s
In C
hapt
er 1
0 t
he G
uide
lines
exp
lain
the
ben
efits
of
mon
itori
ng a
nd e
valu
atio
n of
PMTC
T pr
ogra
ms
Mamp
E p
rovi
des
an o
ppor
tuni
ty t
o m
easu
re a
nd a
ppra
ise
perf
orm
shyan
ce w
ithin
def
ined
tim
e fr
ame
to e
nsur
e ac
com
plis
hmen
t of s
et g
oals
and
obj
ectiv
es
PMTC
T se
rvic
es m
ust
be g
uide
d by
tim
ely
and
accu
rate
dat
a re
port
ed f
rom
the
heal
th f
acili
ties
thr
ough
the
dis
tric
t an
d pr
ovin
cial
lev
els
to
the
natio
nal
leve
l at
NA
SCO
P
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
9
18
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
(xiii
) H
IV in
fect
ed in
mat
erni
ty w
ard
Num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to
mat
erni
ty c
linic
who
are
HIV
infe
cted
In
clud
es b
oth
thos
e w
ho w
ere
adm
itted
al
read
y kn
owin
g th
ey a
re H
IV-i
nfec
ted
and
thos
e w
ho w
ere
test
ed a
nd r
ecei
ved
thei
r re
sults
in m
ater
nity
clin
ic T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(xiv
) P
reve
ntiv
e A
RV
pro
phyl
axis
in m
ater
nity
war
d (m
othe
r do
se)
Num
ber
of
preg
nant
wom
en a
dmitt
ed in
mat
erni
ty t
akin
g or
rep
orte
d to
hav
e ta
ken
the
mot
her
dose
(s)
of p
reve
ntiv
e A
RV
pro
phyl
axis
T
his
is o
btai
ned
from
the
m
ater
nity
reg
iste
r
(xv)
Inf
ant
prev
entiv
e A
RV
pro
phyl
axis
in m
ater
nity
clin
ic
war
d N
umbe
r of
inshy
fant
s bo
rn in
mat
erni
ty r
ecei
ving
the
infa
nt p
reve
ntiv
e A
RV
pro
phyl
axis
in t
he
mat
erni
ty c
linic
T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(xvi
) D
eliv
erie
s T
otal
num
ber
of p
regn
ant
wom
en d
eliv
erin
g at
the
hea
lth fa
cilit
y
(xvi
i) C
ouns
ellin
g on
infa
nt f
eedi
ng o
ptio
ns
Num
ber
of m
othe
rs d
eliv
erin
g at
the
he
alth
fac
ility
cou
nsel
led
on in
fant
fee
ding
opt
ions
T
his
is o
btai
ned
from
the
m
ater
nity
reg
iste
r
(xvi
ii) I
nfan
t te
stin
g at
6 w
eeks
bull N
umbe
r of
infa
nts
test
ed f
or H
IV a
t 6
wee
ks o
ld
bull N
umbe
r of
infa
nts
test
ing
HIV
-pos
itive
T
his
is o
btai
ned
from
labo
rato
ry
regi
ster
(xix
) R
efer
red
for
care
and
tre
atm
ent
bull N
umbe
r of
HIV
infe
cted
wom
en a
ttend
ing
ante
nata
l clin
ic t
hat
is r
efer
red
for
HIV
car
e an
d tr
eatm
ent
bull N
umbe
r of
HIV
infe
cted
wom
en in
mat
erni
ty t
hat
is r
efer
red
for
HIV
car
e an
d tr
eatm
ent
bull N
umbe
r H
IV in
fect
ed in
fant
s re
ferr
ed f
or H
IV c
are
and
trea
tmen
t T
his
is
ob
tain
ed f
rom
ant
enat
al a
nd m
ater
nity
reg
iste
rs
(xx)
Ini
tiate
d on
Cot
rim
oxaz
ole
Num
ber
of H
IV in
fect
ed p
regn
ant
wom
en a
ttend
ing
ante
nata
l clin
ic th
at h
as
been
initi
ated
on
Cot
rimox
azol
e T
his
is o
btai
ned
from
the
ant
enat
al r
egis
ter
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
9
88
Th
e da
ta is
pre
sent
ed u
sing
def
ined
per
form
ance
indi
cato
rs th
at in
clud
e th
e fo
llow
ing
(i)
New
clie
nts
first
ant
enat
al c
linic
vis
its
Num
ber
of p
regn
ant
wom
en a
ttend
ing
thei
r fir
st a
nten
atal
vis
it fo
r th
e cu
rren
t pr
egna
ncy
at t
he h
ealth
fac
ility
T
his
is
obta
ined
fro
m t
he a
nten
atal
reg
iste
r
(ii)
Ret
urn
visi
tsr
evis
its
Num
ber
of r
etur
n an
tena
tal c
linic
vis
itsr
evis
its
atte
nded
by
the
preg
nant
wom
en a
t th
e fa
cilit
y T
his
is o
btai
ned
from
the
an
tena
tal r
egis
ter
(iii)
C
ouns
ellin
g an
d te
stin
g fo
r H
IV in
ant
enat
al c
linic
Tot
al n
umbe
r of
pre
gnan
t w
omen
cou
nsel
led
and
test
ed f
or H
IV a
t th
e an
tena
tal c
linic
w
heth
er t
his
is d
one
on th
e fir
st a
nten
atal
vis
it or
a la
ter
visi
t T
his
is o
btai
ned
from
the
an
tena
tal r
egis
ter
(iv)
H
IV c
ouns
ellin
g an
d te
stin
g at
fir
st a
nten
atal
clin
ic v
isit
Num
ber
of p
regn
ant
wom
en a
tten
ding
the
ir fir
st a
nten
atal
clin
ic v
isit
for
curr
ent
preg
nanc
y w
ho a
re
test
ed f
or H
IV
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(v)
Lear
ning
HIV
sta
tus
in a
nten
atal
clin
ic
Num
ber
of a
nten
atal
clin
ic p
regn
ant
wom
en t
este
d fo
r H
IV w
ho r
ecei
ve t
heir
HIV
res
ults
w
heth
er t
his
is d
one
on t
he
first
ant
enat
al c
linic
vis
it or
at
a la
ter
visi
t T
his
is o
btai
ned
from
the
ant
enat
al
regi
ster
(vi)
HIV
infe
cted
in a
nten
atal
clin
ic
Num
ber
of a
nten
atal
clin
ic p
regn
ant
wom
en
who
are
HIV
-inf
ecte
d on
the
late
st t
est
durin
g th
e pr
egna
ncy
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(vii)
Pre
vent
ive
AR
V p
roph
ylax
is in
ant
enat
al c
linic
(m
othe
r do
se)
Num
ber
of
preg
nant
wom
en in
the
ant
enat
al c
linic
rec
eivi
ng t
he m
othe
r do
se(s
) of
pre
venshy
tive
AR
V p
roph
ylax
is
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(viii
) P
reve
ntiv
e A
RV
pro
phyl
axis
in a
nten
atal
clin
ic (
infa
nt d
ose)
N
umbe
r of
pr
egna
nt w
omen
in t
he A
nten
atal
clin
ic is
sued
with
the
infa
nt d
ose(
s) o
f pr
even
shytiv
e A
RV
pro
phyl
axis
T
his
is o
btai
ned
from
the
ant
enat
al r
egis
ter
(ix)
New
clie
nts
in m
ater
nity
clin
ic
Num
ber
of p
regn
ant
wom
en a
tten
ding
the
Mashy
tern
ity c
linic
for
the
firs
t tim
e T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(x)
Unk
now
n H
IV s
tatu
s at
mat
erni
ty
Num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to
the
mat
erni
ty w
ith u
nkno
wn
HIV
sta
tus
Thi
s is
obt
aine
d fr
om t
he m
ater
nity
reg
isshy
ter
(xi)
Cou
nsel
ling
and
test
ing
for
HIV
in m
ater
nity
war
dT
otal
num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to m
ater
nity
with
unk
now
n st
atus
tha
t ar
e co
unse
lled
and
test
ed fo
r H
IV d
urin
g la
bour
or
afte
r de
liver
y T
his
is o
btai
ned
from
the
mat
erni
ty
regi
ster
(xii)
Lea
rnin
g H
IV s
tatu
s in
mat
erni
ty w
ard
Num
ber
of p
regn
ant
wom
en a
dmitt
ed
into
mat
erni
ty a
nd t
este
d fo
r H
IV w
ho r
ecei
ved
thei
r H
IV r
esul
ts
Thi
s is
obt
aine
d fr
om t
he m
ater
nity
reg
iste
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Cha
pter
1
Bac
kgro
und
11
THE
GLO
BA
L P A
ND
EMIC
Ove
r 38
mill
ion
peop
le a
re li
ving
with
HIV
AID
S w
orld
wid
e a
nd a
bout
two-
thir
ds o
r 25
m
illio
n of
PLW
HA
liv
e in
sub
-Sah
aran
Afr
ica1
H
IVA
IDS
mai
nly
affe
cts
peop
le o
fre
prod
uctiv
e ag
e an
d in
crea
sing
ly a
ffect
s w
omen
w
ho n
ow a
ccou
nt f
or 5
7 o
f ne
win
fect
ions
in s
ub-S
ahar
an A
fric
a w
here
wom
en a
re 3
0 m
ore
likel
y to
be
livin
g w
ith
HIV
AID
S th
an m
en a
nd y
oung
wom
en a
ged
15-2
4 ar
e ne
arly
four
tim
es m
ore
likel
y to
be
inf
ecte
d th
an t
heir
mal
e co
unte
rpar
ts2
Youn
g m
arri
ed w
omen
w
ho a
re o
ften
m
onog
amou
s h
ave
beco
me
one
of t
he g
roup
s m
ost
vuln
erab
le t
o H
IV i
n th
e re
gion
Th
is r
equi
res
new
and
rap
id r
espo
nses
that
bro
aden
the
focu
s be
yond
trad
ition
al ldquoh
igh
risk
rdquo gro
ups
like
com
mer
cial
sex
wor
kers
tru
ck d
rive
rs a
nd d
rug
user
s
To r
each
you
ng m
arri
ed w
omen
w
ho m
ay n
ot b
e aw
are
of t
heir
vul
nera
bilit
y H
IV
AID
S pr
even
tion
ca
re
and
supp
ort
activ
ities
m
ust
be
inte
grat
ed
into
al
read
yes
tabl
ishe
d he
alth
ser
vice
s th
at a
re u
sed
by t
he g
ener
al p
opul
atio
n A
n es
timat
ed
630
000
child
ren
wor
ld-w
ide
beca
me
infe
cted
with
HIV
in
2003
mdash m
ost
thro
ugh
MTC
T3
The
risk
of
an H
IV-in
fect
ed m
othe
r pa
ssin
g th
e vi
rus
to h
er i
nfan
t du
ring
pr
egna
ncy
labo
ur a
nd d
eliv
ery
or in
the
post
nata
l per
iod
is 1
in 3
if n
othi
ng is
don
e to
re
duce
this
ris
k I
n ot
her
wor
ds o
ut o
f 100
infa
nts
born
to w
omen
with
HIV
AID
S an
d w
ithou
t in
terv
entio
n 6
0-75
of t
hem
will
not
be
infe
cted
Of t
he o
ne-t
hird
who
bec
ome
infe
cted
abo
ut 5
-10
babi
es w
ill b
e in
fect
ed d
urin
g pr
egna
ncy
15
will
be
infe
cted
dur
ing
labo
ur a
nd d
eliv
ery
whi
le 5
-15
will
be
infe
cted
dur
ing
brea
stfe
edin
g l
arge
ly b
eing
de
pend
ent
on b
reas
tfee
ding
pra
ctic
es a
nd o
n th
e du
ratio
n of
bre
astfe
edin
g4 I
n 20
03
near
ly 5
000
00 c
hild
ren
died
of A
IDS-
rela
ted
caus
es M
ost
child
ren
born
with
HIV
die
befo
re th
ey r
each
thei
r fif
th b
irth
day
with
mos
t not
sur
vivi
ng b
eyon
d tw
o ye
ars5
The
high
rat
es o
f M
TCT
in d
evel
opin
g co
untr
ies
com
pare
d to
muc
h lo
wer
rat
es i
nri
cher
cou
ntri
es
illus
trat
e gr
owin
g in
equa
litie
s in
glo
bal
heal
th
In t
he w
ealth
y co
untr
ies
the
rat
e of
MTC
T is
les
s th
an 2
b
ecau
se o
f w
ides
prea
d ac
cess
to
antishy
retr
ovir
al th
erap
y (A
RT)
pla
nned
cae
sare
an s
ectio
ns (C
S) t
he m
eans
to s
afel
y fo
rmul
afe
ed a
nd a
cces
s to
qua
lity
med
ical
ser
vice
s I
n po
orer
cou
ntri
es li
ke K
enya
the
re is
a
30-4
0 c
hanc
e th
at a
n H
IV-p
ositi
ve b
reas
tfee
ding
mot
her
will
pas
s H
IV to
her
chi
ld in
th
e ab
senc
e of
the
se s
ervi
ces
In
such
set
tings
it
is c
ritic
al t
hat
prev
entio
n pr
oced
ures
be i
nteg
rate
d in
to e
xist
ing
sexu
al a
nd r
epro
duct
ive
heal
th (
SRH
) an
d m
ater
nal
and
child
hea
lth (
MC
H)
serv
ices
re
achi
ng a
s m
any
wom
en a
s po
ssib
le a
nd l
ower
ing
tran
smis
sion
rat
es A
lthou
gh p
harm
aceu
tical
com
pany
don
atio
ns d
onor
sup
port
and
othe
r go
vern
men
t in
itiat
ives
hav
e he
lped
exp
and
acce
ss t
o H
IV t
estin
g fo
r pr
egna
ntw
omen
and
use
of a
ntir
etro
vira
l dru
gs li
ke N
evir
apin
e w
hich
red
uce
the
chan
ce o
f HIV
tr
ansm
issi
on s
till o
nly
10
of p
regn
ant w
omen
glo
bally
hav
e ac
cess
to th
ese
drug
s6
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
7
20
HIV
AID
S tr
ansm
issi
on fr
om m
othe
r to
chi
ld in
Ken
ya is
one
of t
he b
igge
st h
ealth
and
de
velo
pmen
t cha
lleng
es in
Ken
ya A
ccor
ding
to th
e 20
03 D
emog
raph
ic a
nd H
ealth
Sur
shyve
y7 6
7
or
over
12
mill
ion
Ken
yan
adul
ts w
ere
livin
g w
ith H
IVA
IDS
in 2
003
The
re
has
been
a s
tead
y de
clin
e in
HIV
ser
opre
vale
nce
in K
enya
In
2005
the
pre
vale
nce
rate
w
as e
stim
ated
at 5
9
and
as
per
the
2006
sta
tistic
s th
e pr
eval
ence
rat
e am
ong
adul
tsha
d dr
oppe
d to
51
8
Acc
ordi
ng t
o 20
07 K
enya
AID
S In
dica
tor
Surv
ey (
KA
IS)8a
the
H
IV s
erop
reva
lenc
e in
Ken
ya is
cur
rent
ly 7
8
am
ong
adul
ts a
ged
15-4
9 ye
ars
bei
nghi
gher
in
wom
en (
87
) th
an i
n m
en (
56
) Y
oung
wom
en a
re m
ore
vuln
erab
le i
n K
enya
tha
n m
en a
s ev
iden
ced
by a
nea
rly
9 p
reva
lenc
e ra
te a
mon
g w
omen
and
unshy
der
5 a
mon
g m
en9
Ther
e ar
e w
ide
vari
atio
ns b
etw
een
urba
n an
d ru
ral
area
s b
etw
een
regi
ons
bet
wee
n ad
ults
and
you
ng p
eopl
e an
d be
twee
n m
en a
nd w
omen
The
re h
as b
een
a no
tabl
e dr
op
in t
he n
umbe
r of
new
inf
ectio
ns
with
an
estim
ated
60
000
new
inf
ectio
ns i
n 20
05
drop
ping
to 5
500
0 in
200
6 In
fant
s an
d yo
ung
child
ren
unde
r 15
yea
rs a
ccou
nt fo
r 16
of
all
new
HIV
infe
ctio
ns m
ainl
y as
a r
esul
t of M
TCT
Mos
t of t
he n
ew in
fect
ions
occ
ur
amon
g yo
ung
peop
le i
n w
hom
the
mai
n m
ode
of t
rans
mis
sion
is t
hrou
gh s
exua
l int
ershy
cour
se
Tabl
e 1
1 A
dult
HIV
-Pre
vale
nce
Estim
ate
by P
rovi
nce
in 2
006
Prov
ince
N
umbe
r of H
IV +
Pre
vale
nce
()
Nai
robi
Cen
tral
Coa
st
Eas
tern
N E
aste
rn
Nya
nza
Rift
Val
ley
Wes
tern
Tota
l
197
000
960
00
930
00
720
00
900
0 18
300
0
171
000
112
000
11
milli
on
Tota
l
101
41
59
28
14
78
38
53
51
Mal
e
80
17
50
11
09
61
26
42
35
Fem
ale
123
65
69
44
18
96
49
64
67
Mal
eFe
mal
e R
atio
15
38
14
40
20
16
19
15
19
all t
he d
ata
from
the
prov
ince
s (a
nd r
efer
ral h
ospi
tals
) Th
e ag
greg
ated
dat
a is
di
ssem
inat
ed t
o th
e H
ealth
Man
agem
ent
Info
rmat
ion
Syst
em N
atio
nal A
IDS
Con
trol
Cou
ncilrsquo
s (N
AC
C)
natio
nal
data
ban
k an
d re
sour
ce c
entr
e T
he f
ocal
pe
rson
s he
re a
re t
he d
irec
tor
NA
CC
and
the
Mamp
E m
anag
er D
ata
is d
isse
mishy
nate
d ba
ck to
the
prov
ince
s an
d re
ferr
al h
ospi
tals
for
use
in d
ecis
ion-
mak
ing
7
Dat
a flo
w f
rom
fac
ility
lev
el t
o na
tiona
l le
vel
At
the
heal
th f
acili
ty P
MTC
T in
divi
dual
le
vel d
ata
reco
rded
in t
he M
oH s
tand
ardi
sed
regi
ster
s (A
NC
Mashy
tern
ity a
nd P
ostn
atal
) is
sum
mar
ised
ag
greg
ated
on
a m
onth
ly b
asis
ont
o M
oH F
orm
726
F
orm
726
is
then
for
war
ded
upw
ards
to
the
dist
rict
Lev
el
(DA
SCO
rsquos O
ffice
) for
agg
rega
tion
of th
e D
istr
ict l
evel
dat
a on
to F
orm
727
Cop
shyie
s of
For
m 7
26 a
nd F
orm
727
are
forw
arde
d to
the
Nat
iona
l Offi
ce (N
ASC
OP)
w
ith a
noth
er c
opy
of F
orm
727
bei
ng s
ent t
o th
e Pr
ovin
cial
Offi
ce (P
ASC
O)
8
Dat
a di
ssem
inat
ion
Thi
s is
car
ried
out
at
all
leve
ls s
tart
ing
from
fac
ility
to
natio
nal l
evel
It i
s th
e re
spon
sibi
lity
of N
AC
C to
coo
rdin
ate
the
diss
emin
atio
n an
d us
e of
all
HIV
AID
S da
ta a
nd in
form
atio
n fo
r na
tiona
l res
pons
e J
APR
a
join
t pro
gram
me
of a
ll st
akeh
olde
rs in
HIV
AID
S re
ceiv
es a
nd u
ses
the
data
to
disc
uss
the
chal
leng
es a
chie
vem
ents
and
les
sons
lea
rnt
from
HIV
AID
S an
d gi
ves
feed
back
for n
atio
nal r
espo
nse
9
PMTC
T in
dica
tors
and
thei
r so
urce
s H
ealth
car
e fa
cilit
ies
colle
ct th
e fo
llow
ing
data
as
a m
inim
um t
o be
use
d in
the
mon
itori
ng o
f PM
TCT
prog
ram
s T
he
data
is
to b
e ag
greg
ated
on
a m
onth
ly b
asis
ont
o th
e M
inis
try
of H
ealth
In
tegr
ated
Mon
itori
ng a
nd E
valu
atio
n R
epor
t For
m M
oH 7
26 u
sing
dat
a fr
om
the
Min
istr
y of
Hea
lth
Ken
ya A
nten
atal
and
Mat
erni
ty R
egis
ters
(D
eliv
ery
Reg
iste
r) M
oH 4
05 a
nd M
oH 3
33 r
espe
ctiv
ely
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
1
86
102
O
PER
ATI
ON
AL
GU
IDEL
INES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed in
the
mon
itorin
g an
d ev
alua
-tio
n of
PM
TCT
serv
ices
1
W
ithin
PM
TCT
prog
ram
s d
ata
is c
olle
cted
and
rep
orte
d at
the
fol
low
ing
leve
ls I
ndiv
idua
l fa
cilit
y d
istr
ict
prov
inci
al a
nd n
atio
nal
2
Indi
vidu
al l
evel
The
com
bine
d m
othe
r an
d ch
ild h
ealth
boo
klet
pro
vide
s de
shyta
iled
info
rmat
ion
on t
he w
oman
and
chi
ld i
nclu
ding
the
HIV
sta
tus
oth
er
HIV
car
e se
rvic
es d
rugs
del
iver
y in
form
atio
n im
mun
isat
ion
gro
wth
mon
itorshy
ing
and
othe
r par
amet
ers
3
Faci
lity
leve
l da
ta c
aptu
re t
ools
The
MoH
has
sta
ndar
dise
d re
gist
ers
for
reshy
cord
ing
data
at
faci
litie
s T
hese
inc
lude
the
Rev
ised
AN
C R
egis
ter
Rev
ised
M
ater
nity
Reg
iste
r an
d Po
st N
atal
Reg
iste
r an
d W
orkl
oad
MO
H 7
17 O
ther
re
gist
ers
incl
ude
Chi
ld H
ealth
and
Nut
ritio
n In
form
atio
n Sy
stem
and
Inshy
patie
nt M
orbi
dity
and
Mor
talit
y F
orm
711
and
the
Rep
rodu
ctiv
e H
ealth
Ser
shyvi
ces
mon
thly
rep
orts
are
use
d fo
r m
akin
g fa
cilit
y le
vel s
umm
arie
s on
PM
TCT
and
repr
oduc
tive
heal
th s
ervi
ces
3 F
acili
ty le
vel d
ata
capt
ure
tool
s T
he M
oH
has
stan
dard
ized
reg
iste
rs f
or r
ecor
ding
dat
a at
fac
ilitie
s T
hese
inc
lude
the
R
evis
ed A
NC
Reg
iste
r R
evis
ed M
ater
nity
Reg
iste
r an
d Po
st N
atal
Reg
iste
r an
d w
orkl
oad
MO
H 7
17 O
ther
reg
iste
rs in
clud
e C
hild
Hea
lth a
nd N
utri
tion
Info
rmat
ion
Syst
em a
nd I
n-pa
tient
mor
bidi
ty a
nd m
orta
lity
Fo
rm 7
26 a
nd
the
Rep
rodu
ctiv
e he
alth
ser
vice
s m
onth
ly r
epor
ts a
re u
sed
for
mak
ing
faci
lity
leve
l sum
mar
ies
on P
MTC
T an
d re
prod
uctiv
e he
alth
ser
vice
s
4
Dis
tric
t le
vel
data
For
m 7
27 i
s us
ed t
o su
mm
aris
e an
d re
port
dis
tric
t le
vel
data
Oth
er s
umm
ary
repo
rtin
g to
ols
are
also
use
d to
rep
ort
dist
rict
leve
l inshy
form
atio
n A
t th
e di
stri
ct le
vel
the
DAS
CO
rsquos of
fice
aggr
egat
es d
ata
from
sev
shyer
al h
ealth
faci
lity
spec
ific
Form
726
ont
o Fo
rm 7
27 th
at is
use
d to
sum
mar
ise
and
repo
rt d
istr
ict l
evel
dat
a
5
Prov
inci
al l
evel
dat
a A
t th
e pr
ovin
cial
lev
el t
he P
ASC
O r
ecei
ves
Form
727
da
ta f
rom
the
res
pect
ive
DA
SCO
rsquos of
fices
in
the
prov
ince
for
the
ir o
wn
data
us
e an
d re
cord
s A
cop
y of
the
sam
e is
sen
t to
the
Nat
iona
l Offi
ce (N
ASC
OP)
by
the
DA
SCO
rsquos of
fice
At
the
prov
inci
al le
vel
the
dist
rict
leve
l dat
a is
agg
reshy
gate
d to
giv
e th
e pr
ovin
cial
leve
l dat
a
6 N
atio
nal
leve
l da
ta
At
the
natio
nal
leve
l th
e M
ampE
Man
ager
rec
eive
s da
ta
from
the
PASC
Os
for
each
of t
he p
rovi
nces
Dat
a is
als
o re
ceiv
ed fr
om th
e R
eshyfe
rral
hos
pita
ls a
nd o
ther
fac
ilitie
s at
the
ref
erra
l ho
spita
l or
ter
tiary
lev
el
The
data
rec
eive
d at
the
nat
iona
l lev
el is
als
o co
pied
to
the
Hea
d of
NA
SCO
P an
d PM
TCT
prog
ram
me
man
ager
The
Mamp
E m
anag
er a
t NA
SCO
P ag
greg
ates
85
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
12
MA
GN
ITU
DE
OF
HIV
IN P
REG
NA
NC
YIN
KEN
YA
Ken
ya N
atio
nal
AID
SST
I C
ontr
ol P
rogr
amm
e (N
ASC
OP)
est
imat
es t
hat
ther
e w
ere
12
mill
ion
babi
es b
orn
in 2
006
in K
enya
and
that
as
man
y as
9
of p
regn
ant w
omen
inK
enya
wer
e liv
ing
with
HIV
AID
S10
At
leas
t 50
000
to
600
00 i
nfan
ts i
n K
enya
wer
e th
ough
t to
hav
e be
en i
nfec
ted
with
H
IV a
s a
resu
lt of
MTC
T th
at y
ear
With
an
estim
ated
pop
ulat
ion
of 3
72
mill
ion
in th
eye
ar 2
007
the
num
ber
of b
irth
s in
200
7 w
as 1
73
mill
ion
With
an
HIV
pre
vale
nce
of 6
7
the
num
ber
of H
IV -
expo
sed
babi
es is
114
101
and
at
leas
t 45
640
HIV
-pos
itive
bab
ies
are
born
ass
umin
g a
40
tran
smis
sion
(Tab
le 1
2)
Tabl
e 1
2 E
stim
ated
mag
nitu
de o
f MTC
T in
Ken
ya 2
007
Popu
latio
n (E
stim
ates
200
7)
372
mill
ion
Birt
hs p
er a
nnum
1
73 m
illio
n
HIV
pre
vale
nce
in m
othe
rs
67
Tota
l num
ber o
f birt
hs to
HIV
-infe
cted
mot
hers
exp
osed
14
110
1 to
MTC
T as
sum
ing
no m
ultip
le p
regn
ancy
Num
ber o
f HIV
pos
itive
infa
nts
per a
nnum
in K
enya
45
640
as
sum
ing
40
tran
smis
sion
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
22
13
RIS
KS
OF
T RA
NSM
ISSI
ON
OF
MTC
T A
T D
IFFE
REN
T
T
IME
P ER
IOD
S
In K
enya
an
estim
ated
40
000
to 5
000
0 in
fant
s ar
e in
fect
ed w
ith H
IV a
nnua
lly d
ue to
m
othe
r-to
-chi
ld t
rans
mis
sion
Th
is c
an o
ccur
in u
tero
dur
ing
labo
ur a
nd d
eliv
ery
and
thro
ugh
brea
stfe
edin
g D
urin
g pr
egna
ncy
abo
ut 5
to
8 pe
rcen
t of
HIV
-exp
osed
bab
ies
beco
me
infe
cted
thr
ough
tra
nsm
issi
on a
cros
s th
e pl
acen
ta L
abou
r an
d de
liver
y po
ses
the
grea
test
ris
k fo
r tr
ansm
issi
on w
ith 1
0 to
20
perc
ent
of e
xpos
ed i
nfan
ts b
ecom
ing
infe
cted
at t
his
time
Bre
astf
eedi
ng a
lso
expo
ses
infa
nts
to H
IV
Whe
n m
othe
rs b
reas
tfee
d fo
r 18
to
24m
onth
s an
othe
r 10
to 1
5 pe
rcen
t of i
nfan
ts b
ecom
e in
fect
ed T
hus
in n
on-b
reas
tfee
ding
po
pula
tions
with
out
antir
etro
vira
l tre
atm
ent
appr
oxim
atel
y 15
to
30 p
erce
nt in
fant
s w
ill b
ecom
e in
fect
ed
with
pro
long
ed b
reas
tfee
ding
25
to
45 p
erce
nt i
nfan
ts w
ill
beco
me
infe
cted
Tabl
e 1
3 T
rans
mis
sion
pat
tern
s in
bre
astfe
edin
g an
d no
n br
east
feed
ing
popu
latio
ns
Tran
smis
sion
rate
in
Tim
ing
No
Bre
astfe
edin
g B
reas
tfeed
ing
Bre
astfe
edin
g th
roug
h
thro
ugh
6
mon
ths
18 to
24
mon
ths
Dur
ing
preg
nanc
y 05
to 1
0 05
to 1
0 05
to 1
0
Dur
ing
labo
ur
10 to
20
10 to
20
10 to
20
Thro
ugh
brea
stfe
edin
g 10
to 2
0 05
to 1
0 05
to 1
0
Ear
ly (f
irst 2
mon
ths)
10
to 2
0 05
to 1
0 05
to 1
0
Late
(afte
r 2 m
onth
s)
10 to
20
01 to
05
05 to
10
Ove
rall
15 to
30
25 to
35
30 to
45
Sou
rce
De
Coc
k K
M (2
002)
Form
MoH
711
has
bee
n re
com
men
ded
to r
epla
ce F
orm
MoH
726
HIV
Mamp
E d
ata
flow
pip
elin
e fr
om t
he i
ndiv
idua
l he
alth
fac
ilitie
s t
o th
e di
stri
ct a
ndpr
ovin
cial
leve
ls u
p to
the
cent
ral o
r na
tiona
l lev
els
at N
ASC
OP
and
NA
CC
is s
umm
ashyri
sed
in F
igur
e 1
01
Figu
re 1
01
HIV
Mon
itorin
g an
d Ev
alua
tion
data
flow
pip
elin
e in
Ken
ya
HM
IS
NA
SC
OP
N
ACC
H
ead
Nat
iona
l Dat
a B
ank
amp
Res
ourc
e C
entre
M
E M
anag
er
The
Dire
ctor
P
rogr
amm
e M
anag
er
ME
Man
ager
Ref
erra
l Hos
pita
ls
CE
Os
Spe
cial
ists
The
Prov
ince
P
MO
P
AS
CO
P
AR
TO
PH
RIO
P
CO
The
Dis
trict
D
MO
D
AS
CO
Dat
a en
try
cler
k D
AR
TO
DH
RIO
Hea
lth F
acilit
y P
ublic
Sec
tor
FBO
etc
23
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
84
Cha
pter
10
Mon
itorin
g an
d Ev
alua
tion
of P
MTC
T Se
rvic
es
101
IN
TRO
DU
CTI
ON
PMTC
T pr
ogra
m m
onito
ring
and
eva
luat
ion
activ
ities
pro
vide
the
oppo
rtun
ity to
mea
sshyur
e an
d ap
prai
se p
erfo
rman
ce w
ithin
def
ined
par
amet
ers
that
ens
ure
acco
mpl
ishm
ent
of g
oals
and
obj
ectiv
es
Ken
ya is
com
mitt
ed to
the
ldquoThr
ee-o
nesrdquo
pri
ncip
les
whi
ch a
re
bull O
ne a
gree
d A
IDS
Act
ion
Fra
mew
ork
that
pro
vide
s th
e ba
sis
for
coor
dina
ting
the
wor
k pl
an o
f al
l par
tner
s
bull O
ne N
atio
nal A
IDS
Coo
rdin
atin
g A
utho
rity
with
a b
road
-bas
ed
mul
tisec
tora
l man
date
bull O
ne a
gree
d co
untr
y-le
vel M
onito
ring
and
Eva
luat
ion
(M
ampE
) sy
stem
In l
ine
with
thi
s t
he c
ount
ry h
as d
evel
oped
the
Nat
iona
l H
IVA
IDS
Mon
itori
ng a
ndE
valu
atio
n Fr
amew
ork
that
pro
vide
s st
akeh
olde
rs w
ith a
too
l fo
r w
ell
coor
dina
ted
in
terl
inke
d an
d fu
nctio
nal H
IVA
IDS
Mamp
E s
yste
m t
hat
allo
ws
for
effic
ient
mon
itori
ngof
int
erve
ntio
ns i
n ac
hiev
ing
the
natio
nal
prog
ram
mat
ic g
oals
usi
ng d
efin
ed t
arge
ts
This
pro
vide
s th
e fr
amew
ork
for M
ampE
act
iviti
es w
ithin
PM
TCT
prog
ram
s
Nat
iona
l PM
TCT
data
is
repo
rted
usi
ng M
oH I
nteg
rate
d M
onito
ring
and
Eva
luat
ion
Rep
ortin
g Fo
rms
For
m M
oH 7
11 o
r Fo
rm M
oH 7
27
Indi
vidu
al P
MTC
T da
ta is
col
shyle
cted
at
the
heal
th f
acili
ties
offe
ring
PM
TCT
serv
ices
usi
ng s
tand
ard
MoH
reg
iste
rs(A
NC
Mat
erni
ty a
nd P
ostn
atal
Reg
iste
rs)
On
mon
thly
bas
is t
he h
ealth
faci
litie
s w
ill a
ggre
gate
the
dat
a fr
om t
he r
egis
ters
on
to
Form
MoH
711
or
MO
H 7
26 w
hich
is th
en fo
rwar
ded
upw
ards
to th
e D
ASC
Orsquos
offic
e A
copy
is
left
at
the
heal
th f
acili
ty f
or t
heir
ow
n da
ta u
se
At
the
dist
rict
lev
el
the
DA
SCO
rsquos of
fice
aggr
egat
es d
ata
from
sev
eral
hea
lth f
acili
ty s
peci
fic F
orm
726
ont
o Fo
rm M
oH 7
27 (o
r Fo
rm 7
11) t
hat
is u
sed
to s
umm
aris
e an
d re
port
dis
tric
t le
vel d
ata
B
oth
Form
726
and
For
m M
oH 7
27 a
re th
en s
ent t
o N
ASC
OP
A c
opy
of th
e Fo
rm 7
27
or F
orm
711
is s
ent t
o th
e PA
SCO
and
ano
ther
to th
e he
alth
faci
litie
s in
the
dist
rict
for
thei
r ow
n da
ta u
se
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
14
RIS
K F
AC
TOR
SFO
R M
TCT
OF
HIV
M
any
fact
ors
are
know
n or
sus
pect
ed t
o in
crea
se t
he r
isk
of a
n H
IV in
fect
ed m
othe
r tr
ansm
ittin
g th
e vi
rus
to h
er i
nfan
t Th
ese
fact
ors
incl
ude
the
HIV
vir
al l
oad
in t
he
mot
her
as
wel
l as
othe
r m
ater
nal
obst
etri
cal
vira
l and
infa
nt fa
ctor
s (T
able
14
)
The
mos
t sig
nific
ant r
isk
fact
or a
ppea
rs to
be
the
HIV
vir
al lo
ad in
the
mot
her
thou
gh
the
othe
r fa
ctor
s m
ay a
lso
cont
ribu
te t
o in
crea
sing
an
infa
ntrsquos
expo
sure
or
susc
eptib
ilshyity
to
acqu
irin
g H
IV S
ome
fact
ors
may
cau
se a
bre
akdo
wn
in t
he p
rote
ctio
n of
fere
d to
the
foet
us b
y th
e pl
acen
ta w
hich
in n
orm
al c
ircu
mst
ance
s w
ould
not
allo
w H
IV to
cro
ssth
e pl
acen
ta fr
om m
othe
r to
foet
us
Tran
smis
sion
dur
ing
labo
ur a
nd d
eliv
ery
occu
rs w
hen
the
infa
nt s
ucks
im
bibe
s or
asshy
pira
tes
mat
erna
l bl
ood
or c
ervi
cal
secr
etio
ns t
hat
cont
ain
HIV
or
whe
n it
has
othe
r m
ucou
s m
embr
ane
expo
sure
Tab
le 1
4
Ris
k fa
ctor
s fo
r M
TCT
of H
IV
Stro
ng e
vide
nce
Lim
ited
evid
ence
VIR
AL
MA
TER
NA
L
OB
STE
TRIC
AL
FETA
LIN
FAN
T
BR
EA
ST-
FEE
DIN
G
Hig
h vi
ral l
oad
Imm
une
defic
ienc
y (lo
w
CD
4 co
unt)
HIV
infe
ctio
n ac
quire
d du
ring
preg
nanc
y o
r br
east
feed
ing
perio
d
Vagi
nal d
eliv
ery
(com
pare
d to
ele
ctiv
e ca
esar
ean
sect
ion)
ru
ptur
e of
the
mem
bran
es
for m
ore
than
4 h
ours
Prem
atur
ity
Dur
atio
n of
bre
astfe
edin
g
mix
ed fe
edin
g b
reas
t di
seas
e (m
astit
isc
rack
ed
nipp
les)
Vira
l res
ista
nce
(theo
retic
al p
ossi
bilit
y)
Vira
l gen
otyp
e an
d ph
enot
ype
Vita
min
A d
efic
ienc
y a
naem
ia s
exua
lly
trans
mitt
ed d
isea
ses
ch
orio
amni
oniti
s fr
eque
nt u
npro
tect
ed
sexu
al in
terc
ours
e m
ultip
le s
exua
l pa
rtner
s s
mok
ing
inje
ctin
g dr
ug a
buse
Inva
sive
or t
raum
atic
pro
cedu
res
in
stru
men
tal d
eliv
erie
s a
mni
ocen
tesi
s
epis
ioto
my
ext
erna
l cep
halic
ver
sion
(E
CV
) et
c i
ntra
partu
m h
aem
orrh
age
Lesi
ons
of s
kin
and
or m
ucou
s m
embr
anes
Ora
l thr
ush
(bab
y)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
3
24
15
BEN
EFIT
SO
F P R
EVEN
TIN
G M
OTH
ER-T
O-C
HIL
D
T
RA
NSM
ISSI
ON
OF
HIV
A
IDS
rela
ted
deat
hs a
re r
ever
sing
gai
ns m
ade
in c
hild
hea
lth a
nd s
urvi
val i
n K
enya
C
arin
g fo
r H
IV-in
fect
ed c
hild
ren
has
maj
or e
cono
mic
and
soc
ial
impa
cts
on f
amili
es
and
heal
th s
yste
ms
Thu
s at
the
nat
iona
l lev
el p
reve
ntin
g M
TCT
has
the
pote
ntia
l to
incr
ease
the
unde
rsta
ndin
g an
d ac
cept
ance
of t
he H
IVA
IDS
epid
emic
and
thos
e liv
ing
with
HIV
AID
S C
ouns
ellin
g t
estin
g an
d co
mm
unity
sen
sitis
atio
n ca
n co
ntri
bute
to
redu
cing
stig
ma
Red
uctio
n of
MTC
T of
HIV
bull
Dec
reas
es n
umbe
rs o
f H
IV in
fect
ed c
hild
ren
bull
Incr
ease
s ch
ild h
ealth
and
sur
viva
l
bull
Dec
reas
es t
he lo
ad o
n th
e he
alth
sys
tem
bull
Giv
es a
n op
port
unity
to im
prov
e an
d ex
pand
hea
lth s
ervi
ces
as w
ell a
s to
str
engt
hen
the
exis
ting
heal
th in
fras
truc
ture
16
BEN
EFIT
SO
F H
IV C
OU
NSE
LLIN
GA
ND T
ESTI
NG
(CT)
(a) I
t pro
mot
es b
ehav
iour
cha
nge
by
bull R
educ
ing
high
ris
k be
havi
our
for
HIV
bull Id
entif
ying
HIV
dis
cord
ant
coup
les
bull In
crea
sing
the
use
of
dual
met
hods
of f
amily
pla
nnin
g an
d S
TI
prev
entio
n
bull Im
prov
ing
ante
nata
l car
e
bull G
uidi
ng in
fant
fee
ding
(b) I
t ena
bles
pre
vent
ive
ther
apy
for
bull
Mal
aria
bull O
ppor
tuni
stic
infe
ctio
ns (
eg
Pne
umoc
ystis
jiro
veci
i pn
eum
onia
)
bull T
B
25
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
82
Foo
tnot
es
9
Use
oth
er o
ptions
for
child
ren o
ver
9 k
ilogra
ms
10
Use
reg
ula
r or
double
-str
ength
tab
lets
for
child
ren o
ver
16 k
ilogra
ms
NO
T A
PP
LIC
AB
LE
bullPsp
sm
ear
The
fram
ewor
k be
low
illu
stra
tes
poin
ts o
f int
egra
tion
of c
ompr
ehen
sive
HIV
ca
re p
acka
ge in
to e
xist
ing
child
hea
lth s
ervi
ces
Fram
ewor
k for
integ
ratio
n F
rom
Ped
iatr
ic H
IV P
reve
nti
on
to C
are
A
Co
nce
ptu
al F
ram
ewo
rk N
ewb
orn
In
fan
t W
om
an
H
IV e
duca
tion
Pre
gn
an
cy
prev
entio
n C
T
bull F
ocus
ed A
NC
incl
udin
g
AR
V p
roph
ylax
is s
tagi
ng
STI
syph
ilis
CT
Z p
roph
ylax
isA
RT
M
alar
ia tr
eatm
ent amp
pre
vent
ion
CD
4 w
here
ava
ilabl
e in
clud
ing
IPT
amp I
TNs
Infa
nt f
eedi
ng c
ouns
elin
g (I
FC)
Lab
ou
r an
d D
eliv
ery
U
nive
rsal
pre
caut
ions
CT
for
unt
este
d m
othe
rs in
clud
ing
bull D
eliv
ery
care
bull E
OC
-Em
erge
ncy
obst
etri
c ca
re
part
ner
bull R
efer
ral s
yste
m
AR
V p
roph
ylax
is
(mot
her
and
infa
nt)
AR
T C
TZ
pro
phyl
axis
Exc
lusi
ve b
reas
t fe
edin
g or
rep
lace
men
t fe
edin
g
Post
Na
tal
Ca
re
Infa
nt fe
edin
g co
unse
ling
bull B
reas
t hea
lth
Dia
gnos
is (
antib
ody)
if
bull Se
xual
hea
lth
expo
sure
unk
now
n bull
Fam
ily
plan
ning
D
NA
PC
R if
exp
osed
CT
Z p
roph
ylax
is I
FC-
infa
nt f
eedi
ng c
ouns
elin
g
CT
for
unt
este
d m
othe
rs
CT
for
par
tner
D
BS
resu
lt I
FC
IFC
Wea
ning
Bf
eedi
ng
cess
atio
n s
uppo
rt
bullBre
ast e
xam
D
iagn
osis
(an
tibod
y
bullPap
sm
ear
test
) C
T f
or n
egat
ive
wom
en a
nd p
artn
ers
Dia
gnos
is (
antib
ody
test
)
New
born
Ca
re
bull B
CG
bull P
olio
0
bull Is
sue
child
hea
th c
ard
bullEnt
er b
irth
wei
ght
HIV
an
d A
RV
Exp
osur
e st
atus
on
chi
ld h
ealth
car
d Tw
o w
eeks
Infa
nt fe
edin
g co
unse
ling
Six
wee
ks
Imm
uniz
atio
ngr
owth
mon
itori
ng
Ten
wee
ks
im
mun
izat
ion
GM
Fou
rtee
n w
eeks
Im
mun
izat
ion
grow
th m
onito
ring
Si
x m
onth
s
Com
plem
enta
ry fe
eds
Vita
min
A S
uppl
emen
tatio
n
9 m
onth
s
imm
uniz
atio
nG
M
12 amp
18
mon
ths
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
17
(c) I
t pro
mot
es a
cces
s to
ear
ly m
edic
al c
are
bull
Obs
tetr
ical
car
e
bull T
B th
erap
y
bull M
alar
ia t
reat
men
t
bull S
TI t
reat
men
t
bull A
RV
the
rapy
for
mot
her
and
fam
ily
(d) I
t hel
ps to
pla
n fo
r the
futu
re
bull In
fant
fee
ding
sup
port
sys
tem
s
bull F
amily
pla
nnin
g
bull P
erso
nal a
nd f
inan
cial
dec
isio
ns
(e) I
t ena
bles
pre
vent
ive
ther
apy
of m
alar
ia a
nd
othe
r opp
ortu
nist
ic in
fect
ions
suc
h a
PCP
(f) It
giv
es ti
me
to p
lan
for t
he fu
ture
eg
inf
ant
feed
ing
supp
ort s
yste
ms
TH
E F O
UR-P
RO
NG
ED A
PPR
OA
CH
TO P
MTC
T Th
e In
ter
Age
ncy
Task
Tea
m o
n Pr
even
tion
of H
IV T
rans
mis
sion
in p
regn
ant
wom
en
mot
hers
and
the
ir c
hild
ren
(IA
TT)
has
prop
osed
a f
our-
pron
ged
appr
oach
for
the
pre
shyve
ntio
n of
HIV
tra
nsm
issi
on t
hat
targ
ets
non-
preg
nant
and
pre
gnan
t w
omen
mot
hers
and
thei
r ch
ildre
n
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
1
26
The
four
pro
ngs
are
1 P
rimar
y pr
even
tion
of H
IV in
fect
ion
in w
omen
2 P
reve
ntio
n of
uni
nten
ded
preg
nanc
y am
ong
HIV
-inf
ecte
d w
omen
3 I
nter
vent
ions
to
redu
ce t
rans
mis
sion
fro
m H
IV-i
nfec
ted
preg
nant
and
la
ctat
ing
wom
en t
o th
eir
child
ren
4 C
are
and
supp
ort
of w
omen
ch
ildre
n an
d fa
mili
es in
fect
ed a
nd
affe
cted
by
HIV
and
AID
S (
The
PM
TC
T-p
lus)
Ove
rall
the
cov
erag
e of
PM
TCT
prog
ram
mes
and
the
upt
ake
of s
ervi
ces
prov
ided
thro
ugh
thes
e pr
ogra
mm
es
incl
udin
g H
IV
test
ing
and
coun
selli
ng
and
AR
V
prop
hyla
xis
are
still
ver
y lo
w I
n 20
06 w
orld
wid
e le
ss t
han
10
of
preg
nant
wom
ente
stin
g H
IV-p
ositi
ve r
ecei
ved
AR
V d
rugs
for
PMTC
T11
In K
enya
acc
ordi
ng to
the
2007
Ken
ya A
IDS
Indi
cato
r Su
rvey
(KA
IS) 7
the
re h
as b
een
a sm
all i
ncre
ase
in H
IV te
stin
g am
ong
wom
en a
nd m
en c
ompa
red
to th
e 20
03 K
DH
S
KA
IS s
how
s th
at t
houg
h a
vast
maj
ority
(83
)
of H
IV-in
fect
ed w
omen
and
men
in
Ken
ya d
o no
t kn
ow t
heir
HIV
sta
tus
the
re h
as b
een
a cl
ear
and
dram
atic
incr
ease
inco
vera
ge o
f HIV
-tes
ting
amon
g A
NC
clin
ic a
tten
dees
PMTC
T se
rvic
es a
re t
here
fore
im
port
ant
entr
y po
ints
for
HIV
pre
vent
ion
and
trea
tshym
ent
Ove
rall
AR
V c
over
age
for
HIV
infe
cted
peo
ple
who
nee
d tr
eatm
ent
in K
enya
ison
ly 3
5
bull 9
0
of K
enya
n w
omen
who
del
iver
ed in
the
last
4 y
ears
att
end
AN
C
bull 5
7 o
f th
ose
atte
ndin
g A
NC
tes
ted
for
HIV
bull A
mon
g H
IV in
fect
ed w
omen
with
rec
ent
birt
hs
47
wer
e te
sted
in
AN
C
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
(8)
HIV
dis
ease
sta
ging
in H
IV-in
fect
ed c
hild
ren
Dis
ease
sta
ging
with
or
with
out
labo
rato
ry s
uppo
rt f
ollo
ws
HIV
dia
gshyno
sis
Sta
ging
HIV
dis
ease
pro
vide
s a
guid
e to
the
prog
nosi
s an
d in
tershy
vent
ions
nee
ded
at th
e di
ffere
nt s
tage
s (R
efer
to C
hapt
er 5
and
8)
(9)
AR
V th
erap
y
Chi
ldre
n w
ho a
re e
ligib
le fo
r A
RT
shou
ld b
e lin
ked
with
the
AR
T pr
oshygr
am a
nd p
rovi
ded
with
trea
tmen
t acc
ordi
ng to
Nat
iona
l Gui
delin
es a
sso
on a
s an
HIV
dia
gnos
is i
s m
ade
Ear
ly t
reat
men
t si
gnifi
cant
ly r
eshydu
ces
mor
talit
y in
HIV
infe
cted
chi
ldre
n
(10)
C
omm
unic
atio
n
Com
mun
icat
ing
with
car
e-pr
ovid
ers
and
prov
idin
g ps
ycho
soci
al s
upshy
port
for
the
child
mot
her
care
give
r an
d fa
mily
are
a c
ruci
al c
ompo
nent
of
car
e
Pare
nts
care
give
rs a
ndo
r th
e ch
ild n
eed
to p
artic
ipat
e in
mak
ing
deci
shysi
ons
and
plan
ning
app
ropr
iate
car
e fo
r th
e ch
ild i
nclu
ding
dec
isio
nsab
out t
hera
py a
nd w
here
the
child
sho
uld
rece
ive
care
In
this
res
pect
he
alth
wor
kers
mus
t en
sure
tha
t th
e fa
mily
con
side
rs t
he s
ocia
l nee
ds
of H
IV in
fect
ed a
nd a
ffect
ed c
hild
ren
Hea
lth c
are
wor
kers
sho
uld
ensu
re th
at th
ey p
rovi
de a
dequ
ate
time
for
care
give
rs to
ask
que
stio
ns s
o th
at th
ey c
an fu
lly u
nder
stan
d th
e im
plishy
catio
ns o
f HIV
and
HIV
tes
ting
for
them
selv
es a
nd fo
r th
eir
child
ren
H
ealth
car
e w
orke
rs s
houl
d co
unse
l car
egiv
ers
on d
iscl
osur
e in
clud
ing
disc
losu
re to
the
child
(11)
R
efer
rals
Ref
erra
ls a
re a
n im
port
ant p
art o
f man
agin
g an
HIV
exp
osed
or
infe
cted
chi
ld
Thes
e in
clud
e re
ferr
als
to
bull H
ighe
r le
vels
of s
peci
alis
ed c
are
for
furt
her
inve
stig
atio
ns a
nd
trea
tmen
t
bull S
ocia
l sup
port
pro
gram
mes
bull C
omm
unity
-bas
ed c
are
prog
ram
mes
bull P
ITC
site
s fo
r pa
rent
s an
d si
blin
gs
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
7
80
Tabl
e 9
2 W
HO
Rec
omm
enda
tions
for
Follo
w-u
p of
an
HIV
-Exp
osed
Chi
ld
bull A
t birt
h (f
or in
fant
s de
liver
ed a
t ho
me)
bull A
t age
1 t
o 2
wee
ks (
mai
nly
for
infa
nt f
eedi
ng c
ouns
elin
g)
bull A
t ag
e 6
10
and
14
wee
ks (
for
imm
uniz
atio
n an
d in
fant
fee
ding
co
unse
ling)
bull A
fter
age
14
wee
ks
mon
thly
thr
ough
age
12
mon
ths
bull A
fter
age
12 m
onth
s e
very
3 m
onth
s th
roug
h 24
mon
ths
bull A
t 18
mon
ths
do
conf
irm
ator
y H
IV la
bora
tory
test
(if
ther
e ar
e no
re
sour
ces
for
an e
arlie
r an
tigen
-bas
ed t
est)
bull A
fter
2 ye
ars
a m
inim
um o
f ye
arly
vis
its
For t
he H
IV-in
fect
ed f
ollo
w th
ese
guid
elin
es
From
M
onito
r
6 w
eeks
ndash12
mon
ths
Mon
thly
12 ndash
24 m
onth
s Ev
ery
3 m
onth
s
24 m
onth
s an
d on
war
ds
Yea
rly i
f not
sym
ptom
atic
If sy
mpt
omat
ic f
ollo
w u
p as
nee
ded
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
18
OV
ERV
IEW
OF
THE
NEW
PM
TCT
GU
IDEL
INES
Ken
yarsquos
Min
istr
y of
Hea
lth (
MO
H)
thro
ugh
NA
SCO
P h
as t
aken
sev
eral
act
ions
to
expa
nd a
nd s
tren
gthe
n PM
TCT
inte
rven
tions
in
the
coun
try
In
2000
a
Nat
iona
lTe
chni
cal
Wor
king
Gro
up (
TWG
) on
PM
TCT
was
for
med
Th
e TW
G
co-c
hair
ed b
yN
ASC
OP
and
the
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
co
ordi
nate
s im
plem
enta
tion
and
prov
ides
tec
hnic
al s
uppo
rt t
o th
e N
atio
nal
PMTC
T Pr
ogra
m
The
TWG
ser
ves
as a
foru
m t
o up
date
sta
keho
lder
s an
d di
scus
s ch
alle
nges
and
upc
omin
g ac
tiviti
es
The
TWG
is
also
res
pons
ible
for
upd
atin
g na
tiona
l gu
idel
ines
for
PM
TCT
The
nat
iona
l PM
TCT
prog
ram
was
offi
cial
ly l
aunc
hed
in 2
002
NA
SCO
P al
so e
stab
lishe
d se
vera
lpi
lot P
MTC
T si
tes
thro
ugho
ut th
e co
untr
y an
d pr
epar
ed n
atio
nal P
MTC
T gu
idel
ines
The
goal
of t
he n
atio
nal P
MTC
T pr
ogra
m is
in li
ne w
ith th
e go
al s
et o
ut a
t the
Uni
ted
Nat
ions
Gen
eral
Ass
embl
y Sp
ecia
l Ses
sion
on
HIV
AID
S (U
NG
ASS
) in
2001
to
redu
ceth
e pr
opor
tion
of in
fant
s in
fect
ed w
ith H
IV b
y 20
b
y th
e ye
ar 2
005
and
50
by
2010
In
Ken
ya t
he n
atio
nal P
MTC
T pr
ogra
m p
lann
ed t
o ex
tend
its
serv
ices
to
at le
ast
80
of
all
heal
th f
acili
ties
by 2
0071
2 A
ccor
ding
to
the
2003
PM
TCT
serv
ice
stat
istic
sap
prox
imat
ely
9 o
f al
l pr
egna
nt w
omen
rec
eive
d PM
TCT
serv
ices
in
that
yea
rC
urre
ntly
mor
e th
an 5
0 o
f al
l pr
egna
nt w
omen
in
Ken
ya r
ecei
ve P
MTC
T se
rvic
es
Thes
e gu
idel
ines
are
bas
ed o
n a
publ
ic h
ealth
app
roac
h to
car
e t
akin
g in
to c
onsi
dera
shytio
n is
sues
of
feas
ibili
ty a
nd a
ccep
tabi
lity
in
addi
tion
to e
ffica
cy a
nd c
ost-
bene
fit i
ndi
ffere
nt s
ettin
gs
The
guid
elin
es a
re e
xpec
ted
to i
mpr
ove
the
upta
ke
qual
ity a
nd
effe
ctiv
enes
s of
PM
TCT
serv
ices
in th
e co
untr
y
19
OB
JEC
TIV
ESA
ND O
RG
AN
ISA
TIO
NO
FTH
E G
UID
ELIN
ES
The
PMTC
T gu
idel
ines
are
par
t of
the
impl
emen
tatio
n in
stru
men
ts t
owar
ds u
nive
rsal
ac
cess
to
PMTC
T se
rvic
es a
nd a
res
pons
e to
the
cal
l to
actio
n to
war
ds H
IV-fr
ee a
ndA
IDS-
free
gen
erat
ion
Tog
ethe
r w
ith tw
o ot
her
guid
elin
es (A
RV
Ther
apy
in A
dults
and
Ad
oles
cent
s an
d AR
V Th
erap
y in
Inf
ants
and
You
ng C
hild
ren)
th
ey f
orm
a t
rilo
gy
aim
ed a
t co
ntex
tual
isin
g an
d m
ains
trea
min
g th
e W
HO
tri
logy
of
guid
elin
es o
n H
IVA
IDS
prev
entio
n an
d tr
eatm
ent
The
cont
ext
reso
urce
s an
d de
man
ds o
f PM
TCT
prog
ram
mes
diff
er g
reat
ly a
cros
s co
unshy
trie
s an
d ev
en a
cros
s pr
ogra
mm
es w
ithin
the
sam
e co
untr
y C
onsi
deri
ng t
his
vari
abilshy
ity t
hese
gui
delin
es in
clud
e th
e cu
rren
t con
sens
us o
n be
st p
ract
ices
as
wel
l as
alte
rnashy
tives
whi
ch m
ight
be
mor
e ap
prop
riat
e in
par
ticul
ar s
ettin
gs E
xper
ts a
gree
tha
t th
e ldquos
tate
of
the
artrdquo
in
PMTC
T is
cha
ngin
g ra
pidl
y an
d th
at r
ecom
men
datio
ns w
ill c
ershy
tain
ly a
lter
with
adv
ance
s in
med
ical
sci
ence
and
as
mor
e pr
ogra
mm
e ex
peri
ence
is
docu
men
ted
and
diss
emin
ated
The
are
as o
f A
RV
pro
phyl
axis
and
inf
ant
feed
ing
are
part
icul
arly
sub
ject
to r
apid
cha
nge
In 2
005
the
WH
O is
sued
pro
pose
d re
visi
ons
to it
s re
com
men
datio
ns o
n th
e us
e of
ant
ishyre
trov
iral
dru
gs f
or P
MTC
T T
he r
ecom
men
datio
ns w
ere
the
prod
uct
of e
xper
ts w
ho
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
9
28
conv
ened
to
disc
uss
impo
rtan
t ne
w i
nfor
mat
ion
conc
erni
ng t
he d
evel
opm
ent
of r
esis
shyta
nce
in w
omen
and
chi
ldre
n us
ing
sing
le d
ose
nevi
rapi
ne (S
dNV
P) fo
r PM
TCT
as w
ell
as n
ew c
linic
al fi
ndin
gs o
n st
rate
gies
that
mig
ht r
educ
e th
e de
velo
pmen
t of r
esis
tanc
e
Bas
ed o
n th
e ne
w W
HO
gui
delin
es K
enya
rsquos TW
G h
as d
evel
oped
sim
ple
pra
ctic
al a
nd
evid
ence
-bas
ed r
ecom
men
datio
ns o
n PM
TCT
that
wou
ld w
ork
in a
var
iety
of r
esou
rce-
limite
d en
viro
nmen
ts a
nd c
linic
al s
ituat
ions
that
con
fron
t hea
lthca
re w
orke
rs n
ot o
nly
in K
enya
but
als
o in
oth
er d
evel
opin
g co
untr
ies
110
U
SIN
GTH
E G
UID
ELIN
ES
Thes
e gu
idel
ines
are
inte
nded
prim
arily
for u
se b
y PM
TCT
prov
ider
s Th
ese
inclu
de n
urse
sm
idw
ives
clin
ical o
ffice
rs d
octo
rs c
ouns
ello
rs n
utrit
ioni
sts
and
othe
r he
alth
care
pro
fesshy
sion
als
They
will
als
o be
use
ful a
s a re
fere
nce
for p
rogr
amm
e m
anag
ers a
t fac
ility
dis
trict
pr
ovin
cial
and
nat
iona
l lev
els
thro
ugho
ut th
e he
alth
sec
tor
The
guid
elin
es a
re d
ivid
ed in
tote
n ch
apte
rs a
s out
lined
in T
able
15
The
spec
ific
obje
ctiv
es o
f the
new
PM
TCT
guid
elin
es a
re to
bull O
utlin
e th
e po
licy
issu
es in
pro
vidi
ng P
MT
CT
serv
ices
bull R
ecom
men
d op
erat
iona
l gui
delin
es to
be
follo
wed
by
heal
th c
are
prov
ider
s of
PM
TC
T se
rvic
es
bull E
nabl
e pr
ovid
ers
of P
MT
CT
to s
elec
t an
d pr
escr
ibe
AR
Vs
for
prop
hyla
xis
agai
nst
MT
CT
and
for
trea
tmen
t of
pre
gnan
t w
omen
in
fant
s an
d yo
ung
child
ren
bull S
tand
ardi
se t
he c
are
and
coun
selli
ng g
iven
by
PM
TC
T s
ervi
ce
prov
ider
s re
gard
ing
risk
of
MT
CT
and
on
PM
TC
T
bull I
mpr
ove
PM
TC
T se
rvic
es u
sing
eas
y-to
-use
job
aids
and
a
stan
dard
ised
Mamp
E s
yste
m
Prev
entin
g TB
Fo
r chi
ldre
n ex
pose
d to
sm
ear p
ositi
ve tu
berc
ulos
is
bull E
xclu
de a
ctiv
e T
B th
roug
h ca
refu
l his
tory
ph
ysic
al e
xam
and
in
vest
igat
ions
bull
If
ther
e is
no
evid
ence
of
activ
e T
B
star
t on
IN
H f
or p
roph
ylax
is f
or 6
m
onth
s (I
PT
) bull
If
TB
is p
rese
nt
star
t on
TB
tre
atm
ent
as p
er N
atio
nal T
B g
uide
lines
If
a ch
ild is
bor
n to
a m
othe
r with
act
ive
TB
bull S
tart
on
INH
pro
phyl
axis
(IP
T)
and
give
for
3 m
onth
s bull
Afte
r 3
mon
ths
do a
man
toux
bull
If
man
toux
is n
egat
ive
sto
p IN
H a
nd g
ive
BC
G
bull I
f man
toux
is p
ositi
ve a
t 3
mon
ths
con
tinue
for
a f
urth
er 3
mon
ths
bull A
t the
end
of
prop
hyla
xis
re-v
alua
te f
or a
ctiv
e T
B
|
If no
evi
denc
e of
act
ive
TB d
o no
t tre
at fo
r TB
|
If th
ere
is e
vide
nce
of a
ctiv
e TB
tre
at fo
r TB
as
per N
atio
nal
TB g
uide
lines
(6)
Trea
tmen
t of a
cute
infe
ctio
ns a
nd o
ther
HIV
-rel
ated
con
ditio
ns
HIV
-exp
osed
chi
ldre
n ar
e su
scep
tible
to c
omm
on in
fect
ions
as
wel
l as
OIs
for
the
HIV
infe
cted
and
HIV
may
alte
r th
e in
cide
nce
pre
senshy
tatio
n an
d re
spon
se t
o co
nven
tiona
l th
erap
y I
n so
me
case
s m
ore
aggr
essi
ve a
nd lo
nger
tre
atm
ent
cour
ses
may
be
nece
ssar
y a
s tr
eatshy
men
t fai
lure
s ar
e m
ore
freq
uent
(7)
Reg
ular
follo
w-u
p ca
re amp
refe
rral
s
Reg
ular
follo
w-u
p is
the
back
bone
to c
arin
g fo
r th
e H
IV e
xpos
ed c
hilshy
dren
and
ens
ures
opt
imal
hea
lthca
re a
nd p
sych
osoc
ial s
uppo
rt to
the
fam
ily W
HO
has
mad
e re
com
men
datio
ns o
n fr
eque
ncy
of fo
llow
-up
as s
how
n in
Tab
le 9
2 T
his
is t
he m
inim
um a
nd m
ore
freq
uent
con
shyta
ct w
ith t
he h
ealth
car
e sy
stem
may
be
indi
cate
d fo
r H
IV in
fect
ed
child
ren
and
espe
cial
ly if
they
are
on
anti-
retr
ovir
al tr
eatm
ent
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
9
78
Pro
phyl
axis
aga
inst
Pne
umoc
ysti
s ji
rove
cii
Pne
umon
ia (
PC
P)
in c
hild
ren
whe
re C
otri
mox
azol
e is
con
trai
ndic
ated
Ta
ble
15
The
Fou
r-Pr
onge
d A
ppro
ach
App
lied
to th
e PM
TCT
Gui
delin
e
Alte
rnat
ive
drug
s to
use
if C
TX is
con
train
dica
ted
are
give
n be
low
A s
econ
d ch
oice
wou
ld b
e ei
ther
dap
sone
or
atov
aqui
ne
Dap
sone
bull C
hild
ren
gt 1
mon
th
2 m
gkg
24
hour
s or
ally
onc
e da
ily
bull I
f bot
h C
TX
and
Dap
sone
are
con
trai
ndic
ated
(e
g
in c
hilshy
dren
with
G6P
D d
efic
ienc
y w
ho g
et h
aem
olys
is w
ith C
TX
and
D
apso
ne)
the
n us
e ei
ther
Ato
vaqu
one
bull
30m
gkg
day
for
age
1-3
mon
ths
bull H
ighe
r do
se 4
5mg
kgd
ay f
or a
ge 4
-24
mon
ths
OR
Aer
osol
ized
Pen
tam
idin
e
bull 3
00 m
g in
6 m
l wat
er v
ia in
hala
tion
nebu
lizer
onc
e m
onth
ly
bull c
hild
ren
gt 5
year
s
Cha
pter
CH
AP
TER
1
Bac
kgro
und
CH
AP
TER
2
Ant
enat
al C
are
and
Pre
vent
ion
of M
TCT
of H
IV
CH
AP
TER
3
Intra
partu
m C
are
Pron
g 1
Prim
ary
prev
entio
n of
HIV
in
fect
ion
in w
omen
Pron
g 2
Prev
entio
n of
un
inte
nded
pr
egna
ncy
amon
g H
IV in
fect
ed w
omen
Pron
g 3
Inte
rven
tions
to
redu
ce
tran
smis
sion
from
H
IV in
fect
ed
preg
nant
and
la
ctat
ing
wom
en to
th
eir c
hild
ren
Pron
g 4
Car
e an
d su
ppor
t of
wom
en c
hild
ren
and
fam
ilies
in
fect
ed a
nd
affe
cted
by
HIV
A
IDS
C
HA
PTE
R 4
U
se o
f Ant
iretro
vira
l D
rugs
in P
regn
ancy
fo
r Tre
atm
ent a
nd
Pre
vent
ion
of M
othe
r to
Chi
ld
Tran
smis
sion
of H
IV
Infe
ctio
n
CH
AP
TER
5
Imm
edia
te P
ostn
atal
an
d N
eona
tal C
are
CH
AP
TER
6
Late
Pos
tnat
al C
are
and
Fam
ily P
lann
ing
CH
AP
TER
7
HIV
Dia
gnos
is in
C
hild
ren
CH
AP
TER
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
born
to
HIV
infe
cted
m
othe
rs
CH
AP
TER
9
Car
e an
d Fo
llow
-up
of C
hild
ren
of H
IV
infe
cted
mot
hers
C
HA
PTE
R 1
0
Mon
itorin
g an
d E
valu
atio
n of
PM
TCT
se
rvic
es
77
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
30
For
each
of t
hese
cha
pter
s (e
xcep
t ch
apte
r on
e on
bac
kgro
und)
the
gui
delin
es g
ive
anin
trod
uctio
n fo
llow
ed b
y po
licy
stat
emen
ts t
hen
oper
atio
nal g
uide
lines
of w
hat p
rovi
dshyer
s sh
ould
do
to r
educ
e m
othe
r-to
-chi
ld t
rans
mis
sion
of
HIV
and
or
to i
mpr
ove
thei
r pe
rfor
man
ce a
nd th
e ef
fect
iven
ess
of th
eir s
ervi
ces
A li
st o
f job
aid
s fo
r us
e by
the
hea
lthca
re p
rovi
der
follo
ws
the
oper
atio
nal g
uide
lines
and
whe
re n
eces
sary
a li
st o
f ap
pend
ices
and
add
ition
al d
ocum
ents
tha
t m
ay b
e re
shyfe
rred
to
but
are
cons
ider
ed t
oo b
ig o
r de
taile
d to
be
incl
uded
with
in t
he m
ain
body
of
the
guid
elin
es
Foo
tnot
es
1
UN
AID
S (
2004)
Rep
ort
on t
he
Glo
bal AID
S E
pid
emic
Ava
ilable
at
ww
wu
nai
ds
org
2
Ibid
2004
3
It
is
import
ant
to r
ecognis
e th
at t
he
use
of
the
phra
se M
TC
T in n
o w
ay is
inte
nded
to
pla
ce b
lam
e on t
he
moth
er
who m
ay o
r m
ay n
ot
know
her
HIV
sta
tus
who t
ransm
its
the
viru
s to
her
child
Pa
thfinder
ack
now
ledges
that
man
y tim
es p
regnant
wom
en
may
hav
e bee
n infe
cted
by
thei
r m
ale
par
tner
and d
o n
ot
hav
e th
e ab
ility
to n
egoti-
ate
safe
r se
x o
r to
see
k M
TC
T s
ervi
ces
for
fear
of
viole
nce
st
igm
a o
r ab
andonm
ent
if t
hei
r st
atu
s is
rev
eale
d
Path
finder
uphold
s th
e re
pro
duct
ive
rights
of
all w
om
en t
o
choose
if
and w
hen
to h
ave
child
ren
regar
dle
ss o
f H
IV-s
tatu
s
4
W
HO
CD
C
Dep
artm
ent
of
Hea
lth a
nd H
um
an S
ervi
ces
(2004)
Pre
vention o
f M
oth
er-t
o-C
hild
Tra
nsm
issi
on o
f H
IV
Gen
eric
Tra
inin
g P
acka
ge
Gen
eva
Sw
itze
r-la
nd
WH
O
5
U
NAID
S (
2004)
Rep
ort
on t
he
Glo
bal AID
S E
pid
emic
Ava
ilable
at
ww
wu
nai
ds
org
6
Polic
y Pro
ject
(2004)
Cove
rage
of
sele
cted
ser
vice
s fo
r H
IVA
IDS p
reve
ntion a
nd
care
in low
and m
iddle
-inco
me
countr
ies
in 2
003
Ava
ilable
at
ww
wp
olia
pro
ject
com
7
Cen
tral Bure
au o
f Sta
tist
ics
(CBS)
[Ken
ya]
Min
istr
y of
Hea
lth (
MO
H)
[Ken
ya]
and
ORC M
acro
(2004)
Ken
ya D
emogra
phic
and H
ealth S
urv
ey 2
003
Cal
vert
on
Mar
y-la
nd
CBSM
OH
an
d O
RC M
acr
o
8
Nat
ional AID
S C
ontr
ol Counci
l 2
007
8a
Ken
ya A
IDS I
ndic
ato
r Surv
ey 2
007
9
Ibid
2004
10
NASCO
P (
2002)
Surv
eilla
nce
data
as
cite
d in N
ASCO
PM
OH
(2
003)
Nat
ional
PM
CT
Str
ate
gic
Managem
ent
Pla
n 2
003-2
007
111
2 A
IDS in K
enya
Tre
nds
Inte
rven
tions
and I
mpact
7th
editio
n
(2005)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Who
Nee
ds P
CP
Prop
hyla
xis
bull A
ll in
fant
s bo
rn t
o H
IV-i
nfec
ted
mot
hers
irr
espe
ctiv
e of
any
ant
iret
rovi
ral
ther
apy
duri
ng p
regn
ancy
and
labo
ur
Pro
phyl
axis
con
tinue
s un
til th
e in
fant
is 1
2 m
onth
s or
is P
CR
neg
ativ
e or
ant
ibod
y ne
gativ
e w
hich
ever
co
mes
ear
lier
bull A
ll in
fant
s id
entif
ied
as H
IV-i
nfec
ted
duri
ng th
e fir
st y
ear
of li
fe b
y a
PC
R
test
or
by a
clin
ical
dia
gnos
is o
f H
IV in
fect
ion
and
a po
sitiv
e an
tibod
y te
st
bull C
hild
ren
olde
r th
an 1
2 m
onth
s w
ith s
ympt
omat
ic H
IV d
isea
se o
r an
A
IDS
-def
inin
g ill
ness
(W
HO
sta
ge I
I an
d III
se
e ch
apte
r 5)
or
with
CD
4 lt
15
or
TLC
150
0m
m3
bull A
ny c
hild
with
a h
isto
ry o
f P
CP
sho
uld
cont
inue
with
sec
onda
ry
prop
hyla
xis
(dai
ly C
T)
for
life
Clin
icia
ns s
houl
d cl
earl
y in
form
HIV
inf
ecte
d m
othe
rs a
t de
liver
y th
at t
heir
chi
ldre
n ne
ed p
roph
ylax
is a
gain
st P
CP
star
ting
at 6
wee
ks o
f age
unt
il it
is e
stab
lishe
d th
at th
e ch
ild i
s no
t H
IV i
nfec
ted
A p
ract
ical
way
to
ensu
re t
hat
mot
hers
and
oth
er h
ealth
wor
kers
are
inf
orm
ed i
s to
mak
e a
note
on
the
child
rsquos im
mun
izat
ion
card
at
birt
h st
atin
g ldquoP
leas
e gi
ve c
o-tr
imox
azol
e (5
mg
kgd
ay o
rally
dai
ly) f
rom
6 w
eeks
of a
gerdquo
Tabl
e 9
1 D
ose
of C
otrim
oxaz
ole
for P
CP
Prop
hyla
xis
Wei
ght o
f C
hild
(kg)
1ndash4
5ndash8
9ndash16
17ndash5
0
gt 50
CT
tabl
ets
20 m
g TM
P1
00
mg
SM
X p
edia
tric
stre
ngth
(120
mg)
1 ta
b
2 ta
bs
Cot
rimox
azol
e su
spen
sion
40
mg
TMP
200
mg
SM
X
5ml (
240
mg)
25
ml
5 m
l
10 m
l
CT
tabl
ets
80 m
g TM
P4
00 m
g S
MX
re
gula
r stre
ngth
(4
80 m
g)
frac14 ta
b
frac12 ta
b
1 ta
b
2 ta
bs
2 ta
bs
CT
Tabl
ets
160
mg
TMP
800
mg
SM
X
Dou
ble
stre
ngth
(9
60 m
g) -
frac14 ta
b
frac12 ta
b
1 ta
b
1 ta
b
In r
are
case
s a
s in
chi
ldre
n w
ith G
6PD
def
icie
ncy
CTX
may
be
cont
rain
dica
ted
G
uid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
1
76
(3)
Mon
itor
the
child
rsquos g
row
th a
nd d
evel
opm
ent
as a
mea
ns o
f id
entif
ying
the
ch
ild w
ho is
faili
ng to
thriv
e an
d al
so a
s a
tool
for m
onito
ring
the
effe
ct o
f int
ershy
vent
ions
(4)
Ens
ure
that
im
mun
isat
ions
are
sta
rted
and
com
plet
ed
acco
rdin
g to
the
re
com
men
datio
ns o
f the
nat
iona
l im
mun
isat
ion
sche
dule
|
Add
ition
al c
onsi
dera
tions
are
as
follo
ws
bull
Whe
n co
nsid
erin
g BC
G v
acci
natio
n at
a la
ter a
ge
(re-
vacc
inat
ion
for n
o sc
ar o
r mis
sed
earli
er v
acci
natio
n)
excl
ude
sym
ptom
atic
HIV
infe
ctio
n
bull
Do
not g
ive
yello
w fe
ver v
acci
ne to
sym
ptom
atic
HIV
-infe
cted
chi
lshydr
en H
owev
er a
sym
ptom
atic
chi
ldre
n in
end
emic
are
as s
houl
d re
shyce
ive
the
yello
w fe
ver v
acci
ne a
t 9 m
onth
s of
age
bull
Mea
sles
vac
cine
sho
uld
be g
iven
to H
IV in
fect
ed c
hild
ren
at 6
and
9
mon
ths
sinc
e H
IV in
fect
ed c
hild
ren
expe
rienc
e m
uch
mor
e se
vere
di
seas
e w
ith w
ild m
easl
es v
irus
whi
ch o
utw
eigh
s th
e ris
k of
a m
ilder
illn
ess
from
the
vacc
ine
(5)
Pro
vide
pro
phyl
axis
for o
ppor
tuni
stic
infe
ctio
ns
|
Pro
phyl
axis
aga
inst
Pne
umoc
ystis
jiro
veci
i Pne
umon
ia
bull
Pne
umoc
ystis
jiro
veci
i (fo
rmer
ly P
neum
ocys
tis c
arin
ii) p
neum
onia
(PC
P)
is a
sig
nific
ant c
ause
of m
orbi
dity
and
mor
talit
y am
ong
youn
g in
fant
s in
A
frica
Co-
trim
oxaz
ole
(CTX
) pro
phyl
axis
sig
nific
antly
redu
ces
the
inci
shyde
nce
and
seve
rity
of P
CP
Add
ition
al b
enef
its o
f co-
trim
oxaz
ole
incl
ude
prot
ectio
n ag
ains
t com
mon
bac
teria
l inf
ectio
ns t
oxop
lasm
osis
and
mashy
laria
All
child
ren
born
to H
IV in
fect
ed m
othe
rs s
houl
d re
ceiv
e pr
ophy
shyla
xis
agai
nst P
CP
at l
east
dur
ing
the
first
yea
r of l
ife o
r unt
il th
ey a
re
prov
en to
be
unin
fect
ed (s
ee b
ox b
elow
)
bull
CTX
is c
lear
ly th
e dr
ug o
f cho
ice
for p
roph
ylax
is b
ecau
se o
f its
hig
h
effic
acy
rela
tive
safe
ty l
ow c
ost a
nd b
road
ant
imic
robi
al s
pect
rum
In
cas
e of
CTX
hyp
erse
nsiti
vity
des
ensi
tizat
ion
is re
com
men
ded
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
CH
AP
TE
R 2
Ant
enat
al C
are
and
Prev
entio
n of
MTC
T of
HIV
21
INTR
OD
UC
TIO
N
HIV
inf
ectio
n ha
s em
erge
d in
Ken
ya a
s th
e m
ost
impo
rtan
t he
alth
ris
k fa
ctor
for
m
othe
rs a
nd t
heir
chi
ldre
n an
d ha
s a
grea
t im
pact
on
the
long
ter
m o
utco
me
ofpr
egna
ncy
and
child
sur
viva
l A
ll pr
egna
nt w
omen
sho
uld
be e
ncou
rage
d to
lear
n th
eir
HIV
infe
ctio
n st
atus
as
wel
l as
that
of t
heir
sex
ual p
artn
ers
O
nly
by k
now
ing
onersquos
H
IV s
tatu
s ca
n th
e he
alth
wor
kers
mak
e ap
prop
riat
e he
alth
car
e m
anag
emen
t re
com
men
datio
ns a
nd t
he c
oupl
e m
ake
appr
opri
ate
deci
sion
s ab
out
mai
ntai
ning
the
ir
heal
th a
nd t
hat
of t
heir
unb
orn
baby
Pr
e-co
ncep
tion
care
is
enco
urag
ed w
here
an
oppo
rtun
ity a
rise
s an
d a
birt
h pl
an is
dis
cuss
ed w
ith th
e pr
egna
nt w
oman
In m
ost
case
s t
he p
regn
ant
wom
an w
ill n
ot h
ave
HIV
infe
ctio
n P
regn
ancy
offe
rs a
n op
port
une
time
to d
iscu
ss p
reve
ntio
n of
HIV
inf
ectio
n as
man
y w
omen
com
e in
toco
ntac
t w
ith h
ealth
ser
vice
s fo
r th
e fir
st (
and
in s
ome
case
s th
e on
ly)
time
duri
ng
preg
nanc
y
In K
enya
50
o
f m
arri
ed H
IV p
ositi
ve p
erso
ns h
ave
an H
IV n
egat
ive
spou
se1
Ther
efor
e k
now
ing
the
HIV
inf
ectio
n st
atus
of
onersquos
par
tner
is
criti
cal
Add
ition
ally
th
is f
orm
s an
im
port
ant
entr
y po
int
for
esta
blis
hing
pre
vent
ion
with
po
sitiv
e (P
WP)
pro
gram
s am
ong
coup
les
as w
ell a
s pr
ovid
ing
acce
ss to
HIV
pre
vent
ion
ca
re a
nd tr
eatm
ent s
ervi
ces
for
the
who
le fa
mily
PMTC
T pr
ovid
es a
n op
port
unity
for
prev
entin
g ne
w p
aedi
atri
c H
IV in
fect
ions
as
wel
l as
for
reac
hing
the
10 to
20
of H
IV p
ositi
ve p
regn
ant w
omen
who
mee
t WH
O e
ligib
ilshyity
cri
teri
a fo
r in
itiat
ing
AR
T fo
r th
eir
own
heal
th N
ew in
fect
ions
and
hig
h vi
ral l
oads
duri
ng p
regn
ancy
pos
e th
e gr
eate
st r
isk
of M
TCT
to t
he u
nbor
n ba
by t
hus
prim
ary
prev
entio
n A
RV
pro
phyl
axis
as
wel
l as
trea
tmen
t at t
his
time
is c
ritic
al G
iven
that
25
perc
ent o
f wom
en in
Ken
ya h
ave
an u
nwan
ted
preg
nanc
y s
tren
gthe
ning
the
link
to F
P se
rvic
es a
nd c
ondo
m a
cces
s fo
r du
al p
rote
ctio
n of
fers
a c
hanc
e to
fur
ther
pre
vent
MTC
T2
22
OPE
RA
TIO
NA
L G
UID
ELIN
ES
Ant
enat
al c
are
and
prev
entio
n of
MTC
T du
ring
thi
s pe
riod
can
be
sum
mar
ised
usi
ngan
ess
entia
l pa
ckag
e of
int
egra
ted
ante
nata
l ca
re s
ervi
ces
as s
how
n in
Tab
le 2
1
This
ou
tline
s th
e pa
ckag
e of
ca
re
to
be
prov
ided
to
ev
ery
wom
an
atte
ndin
g A
NC
ser
vice
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
5
32
Tabl
e 2
1 Es
sent
ial P
acka
ge o
f Int
egra
ted
Ant
enat
al C
are
Serv
ices
Gro
up e
duca
tion
Incl
ude
info
rmat
ion
on fo
ur A
NC
vis
its b
reas
tfeed
ing
mat
erna
l and
infa
nt n
utrit
ion
per
sona
l hyg
iene
birt
h pr
epar
edne
ss d
ange
r sig
ns p
reve
ntio
n of
com
plic
atio
ns s
kille
d bi
rth a
ttend
ance
fam
ily p
lann
ing
imm
uniz
atio
n sc
hedu
le
post
-nat
al c
are
and
HIV
and
AID
S m
anag
emen
t
Clie
nt h
isto
ry O
btai
n ro
utin
e da
ta in
clud
ing
med
ical
obs
tetri
c a
nd p
sych
osoc
ial h
isto
ry D
eter
min
e dr
ug h
isto
ry k
now
n al
lerg
ies
and
use
of a
ltern
ativ
e m
edic
ines
suc
h as
her
bal p
rodu
cts
Phy
sica
l exa
min
atio
n In
clud
e vi
tal s
igns
ins
pect
ion
aus
culta
tion
and
palp
atio
n
Abd
omin
al a
nd g
enita
l exa
min
atio
n In
clud
e in
spec
tion
pal
patio
n fo
etal
aus
culta
tion
spe
culu
m a
nd b
iman
ual e
xam
inat
ions
w
here
indi
cate
d
AN
C P
rofil
e R
outin
e te
sts
for s
yphi
lis H
b b
lood
gro
up a
nd R
hesu
s fa
ctor
urin
alys
is a
nd p
rovi
de ra
pid
HIV
test
ing
to th
e pr
egna
nt w
oman
and
her
par
tner
if a
ccom
pany
ing
her
If in
dica
ted
chec
k sp
utum
for A
AFB
and
CD
4 co
unt
Cou
nsel
ing
on b
irth
prep
ared
ness
Sup
port
the
preg
nant
wom
an a
nd h
er p
artn
er to
dev
elop
an
indi
vidu
al b
irth
plan
that
in
clud
es p
lace
of d
eliv
ery
with
ski
lled
birth
atte
ndan
ce e
mer
genc
y tra
nspo
rt b
irth
com
pani
onsh
ip a
nd re
adin
ess
for i
nfan
t ca
re
Cou
nsel
ing
on p
regn
ancy
dan
ger s
igns
Pro
vide
wom
en w
ith in
form
atio
n an
d in
stru
ctio
ns o
n se
ekin
g ea
rly c
are
for p
regshy
nanc
y co
mpl
icat
ions
suc
h as
ble
edin
g fe
ver
seve
re h
eada
che
sw
olle
n fe
et f
its o
r con
vuls
ions
Cou
nsel
ing
on in
fant
feed
ing
All
wom
en re
quire
infa
nt-fe
edin
g co
unse
ling
and
supp
ort
Exc
lusi
ve b
reas
tfeed
ing
for s
ix
mon
ths
shou
ld b
e pr
omot
ed a
s th
e no
rm fo
r all
wom
en re
gard
less
of H
IV s
tatu
s W
omen
infe
cted
with
HIV
nee
d to
be
gu
ided
in th
e se
lect
ion
of s
afer
infa
nt-fe
edin
g op
tions
(ref
er to
WH
O g
uide
lines
and
MO
H c
ircul
ar o
n in
fant
and
you
ng c
hild
fe
edin
g)
Nut
ritio
nal a
sses
smen
t co
unse
ling
and
educ
atio
n In
clud
e iro
n m
ultiv
itam
in a
nd fo
late
sup
plem
enta
tion
mon
itor f
or a
naeshy
mia
ade
quat
e ca
loric
and
nut
rient
inta
ke a
nd re
com
men
d re
alis
tic d
iet a
djus
tmen
ts b
ased
on
loca
l res
ourc
es a
nd n
eeds
of
HIV
+ pr
egna
nt w
omen
(at l
east
10
mor
e of
the
RD
A)
Cou
nsel
ing
on H
IV a
nd A
IDS
Pro
vide
wom
en w
ith in
form
atio
n an
d in
stru
ctio
ns o
n se
ekin
g he
alth
car
e fo
r
sym
ptom
s of
HIV
dis
ease
pro
gres
sion
suc
h as
freq
uent
and
recu
rrent
illn
esse
s c
hron
ic p
ersi
sten
t dia
rrho
ea c
andi
dias
is
feve
r w
astin
g or
sig
ns o
f any
opp
ortu
nist
ic in
fect
ion
Lin
k w
omen
to A
IDS
trea
tmen
t and
oth
er s
uppo
rt pr
ogra
mm
es w
here
av
aila
ble
Cou
nsel
ing
the
HIV
neg
ativ
e w
oman
and
her
par
tner
Pro
vide
info
rmat
ion
on re
peat
test
ing
risk
redu
ctio
n an
d pa
rtner
test
ing
RTI
scr
eeni
ng A
ll w
omen
with
hig
h ris
k se
xual
his
tory
or p
rese
ntin
g w
ith s
igns
of R
TI s
uch
as a
bnor
mal
gen
ital d
isch
arge
ge
nita
l ulc
ers
and
pelv
ic in
flam
mat
ory
dise
ase
shou
ld b
e sc
reen
ed a
nd m
anag
ed a
ccor
ding
to K
enya
pro
toco
ls
Tube
rcul
osis
(TB
) A
ll w
omen
pre
sent
ing
for A
NC
ser
vice
s w
ith a
cou
gh o
f mor
e th
an 2
wee
ksrsquo d
urat
ion
shou
ld b
e sc
reen
ed
for T
B re
gard
less
of H
IV s
tatu
s F
ollo
w K
enya
pro
toco
ls fo
r scr
eeni
ng p
roph
ylax
is a
nd tr
eatm
ent
Teta
nus
toxo
id im
mun
isat
ions
Adm
inis
ter a
ccor
ding
to c
urre
nt K
EP
I TT
Imm
uniz
atio
n S
ched
ule
Dew
orm
ing
All
preg
nant
wom
en s
houl
d re
ceiv
e an
ti-he
lmin
thes
afte
r firs
t trim
este
r as
per t
he g
uide
lines
on
m
ater
nal n
utrit
ion
Ant
imal
aria
ls I
TNs
All
preg
nant
wom
en in
mal
aria
end
emic
are
as s
houl
d sl
eep
unde
r an
ITN
and
rece
ive
SP
inte
rmitt
ent
pres
umpt
ive
treat
men
t acc
ordi
ng to
the
Nat
iona
l Mal
aria
gui
delin
es
AR
V a
nd O
ppor
tuni
stic
Infe
ctio
ns p
roph
ylax
is (d
urin
g pr
egna
ncy)
Pro
vide
AR
V C
TX a
nd o
ther
pro
phyl
actic
m
edic
atio
ns a
ccor
ding
to th
e K
enya
AR
T pr
otoc
ol o
n O
I pro
phyl
axis
and
use
of A
RV
s in
pre
gnan
cy
AR
V tr
eatm
ent d
urin
g pr
egna
ncy
Pro
vide
HA
AR
T w
ithin
the
MC
H s
ettin
g ac
cord
ing
to th
e K
enya
pro
toco
l on
use
of A
RV
s
Est
ablis
h cl
ear r
efer
ral n
etw
orks
with
sen
ior c
linic
ians
Pre
vent
ion
with
Pos
itive
s E
ncou
rage
pos
itive
livi
ng d
iscl
osur
e c
orre
ct a
nd c
onsi
sten
t con
dom
use
and
pro
vide
psy
chos
oshyci
al s
uppo
rt to
the
affe
cted
fam
ilies
For
the
HIV
-infe
cted
and
affe
cted
fam
ilies
est
ablis
h an
dor
stre
ngth
en li
nkag
es to
car
e
treat
men
t and
sup
port
serv
ices
incl
udin
g po
st-p
artu
m fo
llow
up
Effe
ctiv
e co
ntra
cept
ion
plan
Cou
nsel
abo
ut o
ther
fam
ily p
lann
ing
met
hods
em
phas
izin
g on
par
tner
invo
lvem
ent
and
dual
pro
tect
ion
met
hods
to a
void
unw
ante
d pr
egna
ncy
new
infe
ctio
n re
-infe
ctio
n an
d fu
rther
tran
smis
sion
Sourc
e K
enya
Nat
ional PM
TC
T T
rain
ing C
urr
iculu
m
2005
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
92
OPE
RA
TIO
NA
L G
UID
ELIN
ES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed in
the
care
and
fo
llow
-up
of c
hild
ren
of H
IV-in
fect
ed m
othe
rs
bull A
ll ch
ildre
n bo
rn t
o H
IV in
fect
ed m
othe
rs s
houl
d be
see
n in
the
he
alth
car
e fa
cilit
y w
ithin
tw
o w
eeks
of
deliv
ery
bull F
or a
ll H
IV e
xpos
ed in
fant
s m
onth
ly f
ollo
w u
p vi
sits
are
re
com
men
ded
begi
nnin
g at
six
wee
ks t
hrou
gh 2
yea
rs
bull W
here
pos
sibl
e v
isits
sho
uld
be li
nked
to
the
imm
unis
atio
n an
d
grow
th m
onito
ring
vis
its
bull A
ll H
IV e
xpos
ed in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e
prop
hyla
xis
from
6 w
eeks
of
age
bull F
or in
fant
s w
ho te
st H
IV p
ositi
ve b
y D
NA
PC
R b
efor
e 18
mon
ths
or
by a
ntib
ody
test
aft
er 1
8 m
onth
s of
age
co
-trim
oxaz
ole
shou
ld b
e gi
ven
daily
for
life
bull F
or in
fant
s w
ho te
st H
IV n
egat
ive
|
If th
ey h
ave
stop
ped
brea
stfe
edin
g fo
r 2 m
onth
s or
mor
e s
top
C
otrim
oxaz
ole
|
If st
ill br
east
feed
ing
con
tinue
Cot
rimox
azol
e un
til tw
o m
onth
s af
ter
com
plet
e ce
ssat
ion
of b
reas
tfeed
ing
bull C
ompr
ehen
sive
car
e fo
r th
e H
IV e
xpos
ed o
r in
fect
ed in
fant
s sh
ould
be
pro
vide
d in
the
bro
ader
con
text
of
othe
r ch
ild h
ealth
car
e st
rate
gies
Hea
lth w
orke
rs s
houl
d pr
ovid
e th
e fo
llow
ing
pack
age
of c
are
as a
min
imum
to
thes
e ch
ildre
n
(1)
Con
firm
HIV
sta
tus
as e
arly
as
poss
ible
(R
efer
to C
hapt
er 7
)
(2)
M
othe
rs s
houl
d be
sup
porte
d to
pro
vide
opt
imal
infa
nt fe
edin
g an
d pa
rticu
larly
to
avoi
d m
ixed
feed
ing
in th
e fir
st 6
mon
ths
of li
fe I
t is
impo
rtant
that
infa
nt fe
edin
g ch
oice
s at
initi
atio
n of
feed
ing
follo
win
g ea
rly in
fant
dia
gnos
is a
t wea
ning
and
at
the
time
of in
trodu
ctio
n of
com
plem
enta
ry fe
eds
are
guid
ed b
y th
e A
FAS
S c
riter
ia
(Ref
er to
Cha
pter
8)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
3
74
Cha
pter
9
Car
e an
d Fo
llow
-up
of C
hild
ren
of H
IV-in
fect
ed M
othe
rs
91
INTR
OD
UC
TIO
N
PMTC
T in
terv
entio
ns re
duce
but
do
not e
limin
ate
the
risk
of H
IV tr
ansm
issi
on fr
om m
othshy
ers t
o th
eir i
nfan
ts a
nd y
oung
child
ren
Bot
h H
IV-in
fect
ed a
nd u
ninf
ecte
d ex
pose
d ch
ildre
n ha
ve in
crea
sed
risk
s of
infe
ctio
n an
d de
ath
from
com
mon
chi
ldho
od in
fect
ions
The
sur
shyvi
val o
f H
IV-e
xpos
ed c
hild
ren
whe
ther
or
not
they
are
inf
ecte
d i
s cl
osel
y lin
ked
to t
he
heal
th a
nd s
urvi
val o
f the
ir m
othe
rs T
here
fore
lon
g-te
rm b
enef
its o
f PM
TCT
prog
ram
s w
ill o
nly
be s
usta
ined
if t
here
is o
ngoi
ng c
ompr
ehen
sive
car
e fo
r th
e ch
ildre
n an
d th
eir
mot
hers
and
or c
are
give
rs
HIV
exp
osed
chi
ldre
n ar
e vu
lner
able
to
the
com
mon
illn
esse
s af
fect
ing
othe
r ch
ildre
n
Thes
e in
fect
ions
incl
ude
neon
atal
infe
ctio
ns m
alar
ia p
neum
onia
dia
rrho
ea m
easl
es a
nd
othe
r vac
cine
pre
vent
able
dis
ease
s H
IV in
fect
ed ch
ildre
n ar
e lik
ely
to s
uffe
r mor
e se
vere
ly
and
have
a h
ighe
r lik
elih
ood
of d
ying
from
com
mon
chi
ldho
od il
lnes
ses
than
non
-infe
cted
ch
ildre
n W
here
as m
alnu
triti
on c
ause
s 53
o
f all
child
hood
dea
ths
HIV
exp
osed
chi
ldre
n ar
e m
ore
vuln
erab
le to
it th
an n
on-in
fect
ed c
hild
ren
Thi
s is
bec
ause
HIV
exp
osed
child
ren
have
hig
her
calo
ric
requ
irem
ents
as
a re
sult
of th
eir
HIV
infe
ctio
n th
e pr
esen
ce o
f opp
orshy
tuni
stic
infe
ctio
ns a
nd o
ther
com
plic
atio
ns re
late
d to
AID
S
Regu
lar
follo
w u
p ca
re is
cri
tical
for
an in
fant
bor
n to
a m
othe
r w
ith H
IVA
IDS
The
com
shypr
ehen
sive
car
e of
HIV
exp
osed
chi
ldre
n in
clud
ing
nutr
ition
im
mun
isat
ion
mon
itori
ng o
f gr
owth
and
dev
elop
men
t pr
even
tion
and
trea
tmen
t of
opp
ortu
nist
ic in
fect
ions
and
ear
ly
infa
nt d
iagn
osis
of
HIV
is f
easi
ble
in r
esou
rce-
cons
trai
ned
sett
ings
and
sig
nific
antly
imshy
prov
es th
e su
rviv
al o
f the
se ch
ildre
n
23
JOB A
IDS
Prov
ider
s ar
e en
cour
aged
to re
fer t
o th
e ap
prop
riate
job
aid(
s) w
hen
deal
ing
with
spe
cific
issu
es
bull P
MT
CT
test
ing
and
coun
selli
ng t
ools
bull C
oupl
e co
unse
lling
tool
s
bull A
NC
alg
orith
ms
for
AR
V p
roph
ylax
is a
nd in
fant
fee
ding
gui
delin
es
as a
dapt
ed f
rom
WH
O g
uide
lines
bull P
reve
ntio
n w
ith p
ositi
ves
tool
kit
on d
iscl
osur
e
bull F
ocus
ed a
nte-
nata
l car
e
bull M
alar
ia in
pre
gnan
cy
bull T
B in
pre
gnan
cy
bull K
EP
I S
ched
ule
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
3
34
A ra
pid
HIV
test
ing
algo
rithm
for s
eria
l tes
ting
is il
lust
rate
d be
low
35
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Pre-Test Education and or Counselling
First HIV Rapid Test ndashDETERMINE
Negative TestResult
Counsel for Negative Result
Positive TestResult
Second HIV Rapid Test ndashBIOLINE
Positive Test ResultCounsel for
Positive Result
NegativeTestResult
Third HIV Rapid Test ndashUNIGOLD
Positive Test ResultCounsel for
Positive Result
Negative Test ResultCounsel for
Negative Result
Figure 32 Rapid HIV testing algorithm Serial testing
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
72
M
othe
r and
Chi
ld H
ealth
Boo
klet
71
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
36
Cha
pter
ref
eren
ces
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
National G
uid
e-lin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
atal Car
e (
2004)
WH
O
UN
FPA
UN
ICEF
World B
ank
Manag
ing C
om
plic
atio
ns
in P
regnan
cy a
nd C
hild
birth
A g
uid
e fo
r m
idw
ives
and d
oct
ors
(2003)
WH
O
Sta
ndar
ds
for
Mat
ernal
and N
eonat
al C
are
(2006)
WH
O
Antire
trovi
ral dru
gs
for
trea
ting p
regnan
t w
om
en a
nd p
reve
nting H
IV infe
ctio
ns
in
infa
nts
in r
esourc
e lim
ited
set
tings
Tow
ard
s U
niv
ersa
l Acc
ess
Rec
om
men
dations
for
a public
hea
lth a
ppro
ach (
2006)
Min
istr
y of
Hea
lth
Nat
ional AID
S amp
STD
Contr
ol Pro
gra
mm
e (N
ASCO
P)
Guid
elin
es f
or
Antire
trovi
ral dru
g t
her
apy
in K
enya
(2005)
Min
istr
y of
Hea
lth
Ken
ya N
atio
nal
Rep
roduct
ive
Hea
lth I
nst
ruct
ional M
anual
for
Ser
vice
Pro
vider
s (M
arch
2005)
Nat
ional AID
S amp
STD
Contr
ol Pro
gra
mm
e K
enya
AID
S I
ndic
ator
Syr
vey
Foo
tnot
es
1
2Ken
ya D
emogra
phic
and H
ealth S
urv
ey (
KD
HS)
2003
37
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
70
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
CH
AP
TE
R 3
Intr
apar
tum
Car
e 3
1 IN
TRO
DU
CTI
ON
Intr
apar
tum
car
e is
the
man
agem
ent
of w
omen
fro
m t
he o
nset
of
labo
ur t
o de
liver
y T
his
peri
od p
oses
the
grea
test
ris
k fo
r tr
ansm
issi
on o
f HIV
from
the
mot
her
to th
e ch
ild (M
TCT)
w
ith 1
0 to
20
perc
ent o
f exp
osed
infa
nts
beco
min
g in
fect
ed a
t thi
s tim
e in
the
abse
nce
of a
ny
inte
rven
tion
1 In
the
con
text
of
HIV
AID
S it
is t
here
fore
im
port
ant
to e
stab
lish
the
HIV
stat
us o
f wom
en p
rior
to o
r du
ring
labo
ur a
nd d
eliv
ery
and
prov
ide
inte
rven
tions
aim
ed a
t re
duci
ng th
e ri
sk o
f tra
nsm
issi
on W
ith a
ppro
pria
te in
terv
entio
ns t
he r
isk
of M
TCT
can
bere
duce
d si
gnifi
cant
ly
32
OPE
RA
TIO
NA
L G
UID
ELIN
ES
a) O
ptim
al In
trap
artu
m C
are
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed fo
r all
wom
en a
dmitt
ed
to la
bour
and
del
iver
y un
its 2
3
1 M
inim
ise
vagi
nal e
xam
inat
ions
2 U
se a
sept
ic t
echn
ique
s in
con
duct
ing
deliv
ery
3 A
void
rou
tine
artif
icia
l rup
ture
of m
embr
anes
(A
RM
)
4 A
void
pro
long
ed la
bour
5 A
void
unn
eces
sary
trau
ma
duri
ng d
eliv
ery
6 M
inim
ise
the
risk
of p
ostp
artu
m h
aem
orrh
age
7 U
se s
afe
bloo
d tr
ansf
usio
n pr
actic
es
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
9
38
b) S
peci
fic M
anag
emen
t of H
IV P
ositi
ve P
regn
ant W
omen
Pro
phyl
acti
c A
ntir
etro
vira
l the
rapi
es4
The
AR
V p
roph
ylac
tic r
egim
en d
epen
ds o
n w
heth
er th
e m
othe
r ha
d A
RV
s du
ring
pre
gshyna
ncy
or n
ot T
hus
the
heal
th c
are
wor
ker s
houl
d es
tabl
ish
the
regi
men
use
d du
ring
th
e A
NC
whe
ther
the
wom
an h
ad ta
ken
the
SdN
VP
and
AZT
at t
he o
nset
of l
abou
r an
d de
term
ine
the
appr
opri
ate
intr
a-pa
rtum
AR
V c
are
as p
er th
e al
gori
thm
s on
pag
e80
(App
endi
x II
I) p
age
81 (A
ppen
dix
IV) a
nd a
s su
mm
aris
ed b
elow
No
AR
Vs t
aken
in p
regn
ancy
Mot
her i
n ea
rly la
bour
(up
to 4
cm c
ervi
cal d
ilata
tion)
bull
Int
rapa
rtum
per
iod
Giv
e m
othe
r S
dNV
P 2
00m
g A
ZT
600
mg
and
3T
C 1
50m
g st
at
bull P
ostp
artu
m m
othe
r G
ive
mot
her
AZ
T 3
00m
g an
d 3T
C 1
50m
g B
D
for
7 da
ys
bull P
ostp
artu
m p
erio
d G
ive
infa
nt S
d N
evir
apin
e 2
mg
kg w
ithin
72
hour
s of
birt
h P
LUS
3T
C 4
mg
kg B
D fo
r 1
wee
k an
d A
ZT
syr
up 4
mg
kg
BD
for
6 w
eeks
Mot
her r
ecei
ved
AZT
300
mg
BD
in P
regn
ancy
bull P
ostp
artu
m
Giv
e in
fant
Sd
Nev
irap
ine
2mg
kg w
ithin
72
hour
s of
birt
h
PLU
S 3
TC
4m
gkg
BD
for
1 w
eek
and
AZ
T sy
rup
4 m
gkg
BD
for
6 w
eeks
Mot
her r
ecei
ved
HA
AR
T in
Pre
gnan
cy
Reg
ardl
ess
of d
urat
ion
rece
ived
HA
AR
T bull
Giv
e m
othe
r A
RV
dos
e as
per
reg
imen
bull P
ostp
artu
m
Giv
e In
fant
Sd
Nev
irap
ine
2mg
kg w
ithin
72
hour
s of
bir
th
PLU
S 3
TC
4m
gkg
BD
for
1 w
eek
and
AZ
T sy
rup
4 m
gkg
BD
for
6 w
eeks
Mod
e of
del
iver
y E
lect
ive
caes
area
n se
ctio
n (C
S) r
educ
es t
he r
isk
of H
IV M
TCT
as c
ompa
red
to v
agin
al
deliv
ery
but
will
not
be
avai
labl
e in
man
y se
ttin
gs in
our
cou
ntry
Whe
re C
S is
per
shyfo
rmed
(ele
ctiv
e or
em
erge
ncy)
in H
IV p
ositi
ve w
omen
the
y sh
ould
rec
eive
pro
phyl
actic
an
tibio
tics
If
the
CS
is p
erfo
rmed
aft
er p
rolo
nged
lab
our
or r
uptu
re o
f m
embr
anes
lo
nger
cour
ses
of a
ntib
iotic
s sh
ould
be
cons
ider
ed
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
9
68
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Supp
ort d
urin
g la
bour
E
mot
iona
l su
ppor
t du
ring
lab
our
is i
mpo
rtan
t fo
r al
l w
omen
and
may
be
even
mor
ene
cess
ary
for
an H
IV p
ositi
ve w
oman
who
is c
once
rned
abo
ut h
er c
ondi
tion
and
risk
of
HIV
tran
smis
sion
to c
hild
Whe
neve
r po
ssib
le d
urin
g la
bour
war
d st
aff m
ust b
e se
nsishy
tive
to t
he fe
ars
and
conc
erns
of t
he H
IV p
ositi
ve m
othe
r ab
out
her
infe
ctio
n a
nd h
owm
uch
she
had
told
her
par
tner
Indu
ctio
n of
labo
ur
Indu
ctio
n of
labo
ur m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f H
IV M
TCT
Car
eful
asshy
sess
men
t of
the
nee
d fo
r an
d de
sira
bilit
y of
ind
uctio
n ra
ther
tha
n C
S is
nec
essa
ry
Whe
n in
duct
ion
of la
bour
is c
hose
n m
embr
anes
sho
uld
be le
ft in
tact
for
as lo
ng a
s po
sshysi
ble
Syn
toci
non
shou
ld n
ot b
e us
ed w
ith in
tact
mem
bran
es
Indi
catio
ns fo
r ele
ctiv
e C
S A
lthou
gh e
lect
ive
CS
will
not
be
avai
labl
e in
mos
t hea
lth fa
cilit
ies
as a
rou
tine
for
HIV
posi
tive
wom
en t
here
may
be
som
e ca
ses
that
mer
it co
nsid
erat
ion
for
CS
The
se i
nshycl
ude
preg
nanc
ies
whe
re l
abou
r is
exp
ecte
d to
be
prol
onge
d or
whe
re o
ther
obs
tetr
ic
com
plic
atio
ns m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f tra
nsm
issi
on (e
g a
brup
tio p
lashy
cent
ae
plac
enta
pra
evia
pr
e-te
rm r
uptu
re o
f m
embr
anes
pr
evio
us C
S an
d br
eech
pr
esen
tatio
n)
Man
agem
ent o
f lab
our a
nd d
eliv
ery
Labo
ur a
nd d
eliv
ery
man
agem
ent
shou
ld fo
llow
opt
imal
obs
tetr
ic m
anag
emen
t gu
ideshy
lines
(R
efer
to
Opt
imal
Int
rapa
rtum
car
e ab
ove
and
Nat
iona
l G
uide
lines
for
Qua
lity
Obs
tetr
ics
and
IMPA
C C
are
Man
ual)
RO
LEO
FTH
E C
OM
MU
NIT
Y
A la
rge
prop
ortio
n (6
0) o
f wom
en in
Ken
ya is
del
iver
ed o
utsid
e th
e he
alth
sys
tem
s by
fam
ilym
embe
rs n
eigh
bour
s and
TBA
s
bull T
here
is n
eed
to e
duca
te th
e co
mm
unity
on
the
risk
of M
TC
T an
d w
ays
of
prev
entio
n
bull T
hose
ass
istin
g th
e de
liver
ies
need
to u
nder
stan
d th
eir
own
risk
of in
fect
ion
and
how
to p
rote
ct th
emse
lves
bull T
he c
omm
unity
sho
uld
be e
ncou
rage
d to
faci
litat
e m
othe
rs to
del
iver
in
heal
th fa
cilit
ies
bull T
he c
omm
unity
sho
uld
be e
ncou
rage
d to
ref
er to
hea
lth fa
cilit
ies
all c
hild
ren
born
at h
ome
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
7
40
Fi
gure
81
Gui
delin
es fo
r Cou
nsel
ling
on H
IV a
nd In
fant
feed
ingJ
ob A
ids
Cha
pter
ref
eren
ces
an
d IE
C M
ater
ials
on
Infa
nt a
nd Y
oung
Chi
ld F
eedi
ng
1R
epublic
of
Ken
ya
Min
istr
y of
Hea
lth
Ess
ential
Obst
etric
Car
e M
anual
for
Hea
lth
Ser
vice
Pro
vider
s in
Ken
ya (
3rd
Editio
n J
an 2
006)
Foo
tnot
es
1 D
e Cock
KM
2002
2 K
enya
National
Rep
roduct
ive
Hea
lth I
nst
ruct
ion M
anual
for
Ser
vice
Pro
vider
s (2
006)
3 D
ivis
ion o
f Rep
roduct
ive
Hea
lth
Guid
elin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
ata
l Car
e
(2004)
4 W
HO
Antire
tovi
ral dru
gs
for
trea
ting p
regnan
t w
om
en a
nd p
reve
nting H
IV infe
ctio
n in
infa
nts
to
ward
s univ
ersa
l acc
ess
(2006)
41
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
66
85
EXTR
AC
TSFR
OM
RES
EAR
CH
ON
I NFA
NT
F EED
ING
A
ND H
IVA
IDS
Evid
ence
ava
ilabl
e fr
om c
urre
nt re
sear
ch d
ata
show
s th
at
bull I
ncre
ased
ris
k of
mor
talit
y w
ith r
epla
cem
ent
feed
ing
is s
igni
fican
t
bull H
IV f
ree
surv
ival
rat
e at
18
mon
ths
of a
ge d
oes
not
sign
ifica
ntly
var
y be
twee
n a
brea
stfe
d an
d re
plac
emen
t fed
chi
ld
bull M
odifi
ed a
nim
alrsquos
milk
doe
s no
t pr
ovid
e ad
equa
te n
utrit
ion
for
ch
ildre
n le
ss t
han
6 m
onth
s he
nce
mic
ronu
trie
nts
shou
ld b
e gi
ven
un
der
thes
e ci
rcum
stan
ces
bull A
brup
t ce
ssat
ion
of b
reas
tfee
ding
is n
o lo
nger
rec
omm
ende
d
bull E
xclu
sive
bre
astf
eedi
ng u
p to
6 m
onth
s is
rec
omm
ende
d un
less
re
plac
emen
t fee
ding
can
mee
t AF
AS
S c
rite
ria
Cha
pter
4
Use
of A
ntire
trov
iral D
rugs
in P
regn
ancy
for T
reat
men
t and
for
Prev
entio
n of
Mot
her-
to-C
hild
Tra
nsm
issi
on o
f HIV
Infe
ctio
n
41
INTR
OD
UC
TIO
N
With
out
any
inte
rven
tion
up
to 4
0 pe
rcen
t of
HIV
pos
itive
wom
en w
ill t
rans
mit
the
infe
ctio
n to
the
ir c
hild
ren
duri
ng p
regn
ancy
lab
our
and
brea
stfe
edin
g U
se o
f ant
iret
shyro
vira
l dru
gs (A
RV
s) o
bste
tric
inte
rven
tions
and
avo
idan
ce o
f all
brea
stfe
edin
g fo
r pr
eshyve
ntio
n of
mot
her
to c
hild
tran
smis
sion
of H
IV in
fect
ion
(PM
TCT)
has
red
uced
the
risk
of m
othe
r to
chi
ld tr
ansm
issi
on o
f HIV
infe
ctio
n (M
TCT)
to le
ss th
an 2
per
cent
in d
evel
shyop
ed c
ount
ries
Shor
t cou
rse
effic
acio
us A
RV
dru
g re
gim
ens
can
redu
ce th
e ri
sk o
f MTC
T to
2-4
per
cent
and
can
be i
mpl
emen
ted
in r
esou
rce-
limite
d se
ttin
gs o
n a
popu
latio
n-ba
sed
publ
ic
heal
th s
cale
AR
Vs
are
used
bot
h fo
r th
e tr
eatm
ent
of H
IV d
isea
se a
nd fo
r PM
TCT
in
HIV
-infe
cted
pre
gnan
t w
omen
and
the
ir n
eona
tes
Ant
iret
rovi
ral t
reat
men
t (A
RT)
for
wom
en w
ho q
ualif
y fo
r it
pro
long
s an
d im
prov
es t
he q
ualit
y of
the
ir l
ives
The
sur
shyvi
val
of t
he c
hild
is
clos
ely
inte
rlin
ked
with
the
hea
lth a
nd s
urvi
val
of t
he m
othe
r
Wom
en e
ligib
le fo
r A
RT
shou
ld b
e st
arte
d on
trea
tmen
t as
soon
as
poss
ible
Pre
gnan
cy
is n
ot a
rea
son
to d
elay
AR
T W
omen
who
are
alr
eady
on
AR
T be
fore
bec
omin
g pr
egshy
nant
sho
uld
cont
inue
with
thei
r tr
eatm
ent
In c
erta
in s
ituat
ions
mod
ifica
tions
may
be
need
ed to
mak
e tr
eatm
ent s
afer
for
the
mot
her
and
the
unbo
rn b
aby
The
bene
fits
of u
sing
AR
Vs
to t
reat
HIV
-infe
cted
pre
gnan
t w
omen
and
or
PMTC
T ou
tshyw
eigh
the
ris
ks H
owev
er w
hen
AR
T or
oth
er s
hort
cou
rse
AR
V r
egim
ens
are
used
ba
selin
e ev
alua
tion
and
mon
itori
ng is
enc
oura
ged
to e
nsur
e th
e sa
fety
of t
he m
othe
rsan
d th
eir
new
born
s L
inka
ges
of H
IV-in
fect
ed p
regn
ant
wom
en a
nd t
heir
chi
ldre
n to
ot
her
care
and
sup
port
pro
gram
s at
hea
lth f
acili
ty a
nd c
omm
unity
lev
els
shou
ld b
e en
sure
d
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
5
42
42
OPE
RA
TIO
NA
L G
UID
ELIN
ES
All
HIV
-infe
cted
pre
gnan
t w
omen
sho
uld
be c
ouns
elle
d on
com
preh
ensi
ve H
IV c
are
incl
udin
g us
e of
AR
Vs
for
thei
r ow
n he
alth
and
for
PMTC
T
All
HIV
-infe
cted
pre
gnan
t wom
en s
houl
d ha
ve th
eir H
IV d
isea
se
stag
ed u
sing
bull W
HO
clin
ical
sta
ging
(se
e A
ppen
dix
1) a
nd
bull I
mm
unol
ogic
al s
tagi
ng (
CD
4 co
unt)
(se
e ta
ble
1)
The
wom
en s
houl
d al
so b
e sc
reen
ed a
nd tr
eate
d fo
r op
port
unis
tic in
fect
ions
(OIs
) inc
ludi
ngTu
berc
ulos
is (T
B)
All
HIV
-infe
cted
pre
gnan
t wom
en s
houl
d ha
ve b
asel
ine
labo
rato
ry a
nd o
ther
nec
essa
rydi
agno
stic
eva
luat
ions
Thes
e di
agno
stic
s sh
ould
incl
ude
bull R
outin
e an
tena
tal c
are
labo
rato
ry in
vest
igat
ions
that
are
nor
mal
ly
done
for
all
preg
nant
wom
en
haem
oglo
bin
(Hb)
rh
esus
blo
od
grou
p an
d A
BO
typ
ing
VD
RL
uri
ne a
naly
sis
and
scre
enin
g fo
r S
TI
bull A
LT a
nd c
reat
inin
e le
vels
for
wom
en e
ligib
le f
or H
AA
RT
Prop
hyla
xis
amp m
icro
nutr
ient
sup
plem
enta
tion
bull
Cot
rimox
azol
e (C
TX) o
ne d
oubl
e st
reng
th o
r tw
o si
ngle
stre
ngth
tabl
ets
once
dai
ly
bull
Mul
tivita
min
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
83
OPE
RA
TIO
NA
L G
UID
ELIN
ESO
N F
EED
ING
CH
ILD
REN
6 M
ON
THS
AN
DO
LDER
The
follo
win
g sh
ould
gui
de fe
edin
g fo
r chi
ldre
n 6
mon
ths
and
olde
r
bull A
t 6
mon
ths
oth
er f
orm
s of
milk
alo
ne a
re n
ot a
dequ
ate
to m
eet
the
baby
rsquos n
utrit
iona
l req
uire
men
ts
bull C
ompl
emen
tary
foo
ds s
houl
d be
intr
oduc
ed w
ith c
ontin
ued
br
east
feed
ing
or w
ith r
epla
cem
ent
feed
ing
until
a n
utrit
iona
lly
adeq
uate
die
t ca
n be
sus
tain
ed w
ithou
t m
ilk
bull A
brup
t ces
satio
n of
bre
astf
eedi
ng s
houl
d be
dis
cour
aged
to
avoi
d
trau
ma
for
both
the
mot
her
and
the
baby
bull M
ilk s
houl
d co
ntin
ue a
s an
impo
rtan
t co
mpo
nent
of
the
diet
bull C
ompl
emen
tary
foo
ds s
houl
d be
enr
iche
d fr
om lo
cally
ava
ilabl
e
fam
ily f
oods
84
NU
TRIT
ION
AL
CA
RE
AN
D S
UPP
OR
TO
F H
IV
INFE
CTE
DC
HIL
DR
EN
bull E
nerg
y ne
eds
for
asym
ptom
atic
HIV
infe
cted
chi
ldre
n in
crea
se b
y 10
pe
rcen
t to
mai
ntai
n gr
owth
as
com
pare
d to
the
non-
infe
cted
chi
ldre
n
bull T
here
is n
o ev
iden
ce o
f in
crea
sed
prot
ein
requ
irem
ents
The
re
quir
emen
ts s
houl
d be
bas
ed o
n in
divi
dual
sym
ptom
s an
d ne
eds
bull M
icro
nutr
ient
req
uire
men
ts d
o no
t ch
ange
W
HO
rec
omm
ends
not
m
ore
than
one
RD
A
(For
fur
ther
det
ails
re
fer
to K
enya
n G
uide
lines
on
nutr
ition
and
HIV
A
IDS
)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
3
64
82
OPE
RA
TIO
NA
L G
UID
ELIN
ESO
N I N
FAN
TFE
EDIN
G (0
-6 M
ON
THS)
The
follo
win
g sh
ould
gui
de in
fant
feed
ing
for t
he fi
rst 6
mon
ths
bull A
ll w
omen
and
men
irre
spec
tive
of th
eir
HIV
sta
tus
shou
ld r
ecei
ve
coun
selin
g an
d de
mon
stra
tions
on
how
to s
afel
y fe
ed t
heir
babi
es
duri
ng t
he a
nten
atal
and
pos
tnat
al f
ollo
w u
p
bull T
he m
ost
appr
opria
te in
fant
fee
ding
opt
ion
for
an H
IV in
fect
ed
mot
her
shou
ld c
ontin
ue t
o de
pend
on
indi
vidu
al c
ircu
mst
ance
s an
d
the
av
aila
ble
supp
ort
bull E
very
HIV
infe
cted
wom
an s
houl
d be
eva
luat
ed a
t ev
ery
visi
t to
ch
eck
whe
ther
her
soc
ial
econ
omic
and
hea
lth s
tatu
s ha
s ch
ange
d
suff
icie
ntly
eno
ugh
to a
ffec
t he
r in
fant
fee
ding
opt
ion
bull E
xclu
sive
bre
astf
eedi
ng fo
r H
IV in
fect
ed w
omen
for
the
firs
t 6
mon
ths
of t
he in
fant
rsquos li
fe is
adv
isab
le
unle
ss r
epla
cem
ent f
eedi
ng is
ac
cept
able
fea
sibl
e a
ffor
dabl
e s
usta
inab
le a
nd s
afe
for
them
and
th
eir
infa
nts
befo
re t
hat t
ime
bull W
hen
repl
acem
ent
feed
ing
is a
ccep
tabl
e f
easi
ble
aff
orda
ble
su
stai
nabl
e an
d sa
fe
avoi
danc
e of
exc
lusi
ve b
reas
tfee
ding
by
HIV
in
fect
ed w
omen
is r
ecom
men
ded
bull I
f th
e co
nditi
ons
for
repl
acem
ent
feed
ing
are
still
not
met
for
6
mon
ths
then
co
ntin
uatio
n of
bre
astf
eedi
ng w
ith a
dditi
onal
co
mpl
emen
tary
fee
ding
is r
ecom
men
ded
giv
ing
prio
rity
to t
he lo
cally
av
aila
ble
food
s
bull I
nfan
t fe
edin
g de
cisi
ons
for
all H
IV e
xpos
ed in
fant
s sh
ould
be
base
d on
the
AF
AS
S c
riter
ia e
ven
whe
re e
arly
infa
nt d
iagn
osis
(E
ID)
is
avai
labl
e
bull B
reas
tfeed
ing
mot
hers
of
infa
nts
and
youn
g ch
ildre
n w
ho a
re k
now
n to
be
HIV
infe
cted
sho
uld
be s
tron
gly
enco
urag
ed to
con
tinue
bre
ast
feed
ing
How
ever
br
east
feed
ing
HIV
infe
cted
mot
hers
sho
uld
be
give
n nu
triti
on s
uppo
rt (
nutr
ition
al c
ouns
elin
g e
duca
tion
foo
d an
d nu
triti
onal
sup
plem
ents
)
63
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
44
Sulp
hur-
base
d in
term
itten
t pr
esum
ptiv
e m
alar
ia t
reat
men
t (I
PT) s
houl
d no
t be
giv
en
to w
omen
who
are
on
CTX
pro
phyl
axis
AR
V us
e
bull A
RV
s ar
e us
ed fo
r tr
eatin
g H
IV-i
nfec
ted
elig
ible
wom
en a
ndo
r fo
r pr
even
tion
of m
othe
r-to
-chi
ld tr
ansm
issi
on
bull H
IV-i
nfec
ted
preg
nant
wom
en e
ligib
le f
or A
RT
sho
uld
initi
ate
AR
T
as s
oon
as p
ossi
ble
as s
how
n in
Tab
le 4
1
bull H
IV-i
nfec
ted
preg
nant
wom
en a
lread
y on
AR
T b
efor
e be
com
ing
preg
nant
sho
uld
cont
inue
AR
T
The
bab
y sh
ould
be
give
n A
RV
pr
ophy
laxi
s so
on a
fter
birt
h as
sho
wn
in T
able
42
Tabl
e 4
1 R
ecom
men
datio
ns fo
r ini
tiatin
g A
RV
trea
tmen
t in
preg
nant
w
omen
bas
ed o
n cl
inic
al s
tage
and
ava
ilabi
lity
of C
D4
Cou
nt
WH
O
CD
4 te
stin
g
CD
4 te
stin
g
Clin
ical
Sta
ge
not a
vaila
ble
avai
labl
e
1 D
o no
t Tre
at
Trea
t if C
D4le
350
cells
mm
3
2 D
o no
t Tre
at
Trea
t if C
D4 le
350
cells
mm
3
3 Tr
eat
Trea
t irre
spec
tive
of C
D4
coun
t (c
onsi
der C
D4
valu
es fo
r bet
ter
man
agem
ent)
4 Tr
eat
Trea
t irre
spec
tive
of C
D4
cell
coun
t
Sourc
e A
dopte
d f
rom
WH
O
Anti-r
etro
vira
l dru
gs
for
trea
ting p
regnant
wom
en a
nd p
re-
venting H
IV infe
ctio
ns
Tabl
e 4
2 R
ecom
men
ded
first
-line
AR
T re
gim
en fo
r tre
atin
g pr
egna
nt w
omen
and
pro
phyl
actic
regi
men
for i
nfan
ts
Mot
her
Ant
epar
tum
AZ
T +
3TC
+ N
VP D
aily
Intra
partu
m
AZT
+ 3T
C +
NVP
Dai
ly
Pos
tpar
tum
AZ
T +
3TC
+ N
VP D
aily
Infa
nt p
roph
ylax
is
Sd
NV
P 2
mg
kg s
tat w
ithin
72
hour
s 3T
C X
1 w
eek
(4
mg
kg B
ID)
AZT
X 6
wee
ks (4
mg
kg B
ID)
Mat
erna
l dos
ages
AZT
300
mg
BID
3TC
150
mg
BID
NV
P 2
00 m
g O
D fo
r tw
o w
eeks
the
reaf
ter 2
00 m
g B
ID
Infa
nt D
osag
es
NV
P
2mg
kg s
tat w
ithin
72
hour
s
AZT
4mg
kg B
ID X
6 w
eeks
3TC
4m
gkg
BID
X 1
wee
k
Cha
pter
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
Bor
n to
HIV
Infe
cted
Mot
hers
81
INTR
OD
UC
TIO
N T
RA
NSM
ISSI
ON
OF
HIV
THR
OU
GH
B
REA
STFE
EDIN
G
In A
fric
a 3
to 4
out
of e
very
10
infa
nts
born
to H
IV in
fect
ed w
omen
acq
uire
HIV
infe
cshytio
n T
here
is t
here
fore
a 5
ndash 2
0 pe
rcen
t ri
sk o
f inf
ants
bor
n to
HIV
pos
itive
mot
hers
ac
quir
ing
infe
ctio
n th
roug
h br
east
-fe
edin
g if
ther
e ar
e no
inte
rven
tions
in
pla
ce
For
wom
en w
ho a
re i
nshyfe
cted
with
HIV
for
the
first
tim
e or
w
ho a
re r
e-in
fect
ed w
ith a
diff
eren
t st
rain
of H
IV d
urin
g th
e br
east
feed
shyin
g ph
ase
the
ris
k in
crea
ses
up t
o29
per
cen
t H
alf (
12)
of H
IV b
reas
t m
ilk t
rans
mis
sion
tak
es p
lace
by
6 w
eeks
and
thre
e qu
arte
rs (3
4) b
y 6
mon
ths
Mix
ed fe
edin
g in
crea
ses
the
risk
of
brea
st m
ilk t
rans
mis
sion
of
HIV
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
5
62
For
prop
hyla
xis
the
reco
mm
enda
tions
are
ran
ked
and
will
dep
end
on t
ime
of fi
rst
conshy
tact
with
the
wom
an H
IV-in
fect
ed p
regn
ant w
omen
who
are
not
elig
ible
for
AR
T or
in
72
3 C
OM
PREH
ENSI
VE
CA
RE
FOR H
IV-E
XPO
SED
CH
ILD
REN
w
hom
it is
not
pos
sibl
e to
sta
rt A
RT
imm
edia
tely
and
the
mot
her
is b
eing
see
n be
twee
n28
and
38
wee
ks o
f pr
egna
ncy
sho
uld
be s
tart
ed o
n re
com
men
ded
mor
e ef
ficac
ious
shor
t co
urse
pro
phyl
actic
AR
V r
egim
ens
as s
how
n in
Tab
le 4
3a
The
bab
y sh
ould
als
obe
giv
en A
RV
pro
phyl
axis
soo
n af
ter
birt
h as
sho
wn
in th
e sa
me
tabl
e T
he r
egim
ens
asou
tline
d be
low
are
for
prop
hyla
xis
and
not f
or tr
eatm
ent
MINI
STRY
OF H
EAL
TH
Tabl
e 4
3a R
ecom
men
ded
Firs
t Lin
e A
RV
prop
hyla
xis
ALGO
RITH
M FO
R EA
RLY
INFA
NTDI
AGNO
SISFO
R HI
VEX
POSE
DCH
ILDRE
N
to p
reve
nt H
IV in
fect
ion
in in
fant
s A
mon
g Pr
egna
nt W
omen
Pr
esen
ting
Bef
ore
38 W
eeks
Ran
king
Ti
me
of A
dmin
istr
atio
n
WEL
L CHI
LD
SICK
CHI
LD
(Man
age
pres
entin
g ill
ness
and
stab
ilize
)
STAR
T CO
TRIM
OXAZ
OLE
PROP
HYLA
XIS
FOR M
OR E
INFOR
MATIO
N C ON
TACT
THE N
ATI O
NAL A
IDS S
TD CO
NTRO
L PRO
GRAM
ME ( N
ASCO
P) PO
BOX
19 36
1-00
20 2 N
AIRO
BI TE
L 02
02 72
95 02
FAX 0
2 0 2 7
1 05 1
8
Exp
osur
e sta
tus s
houl
d be
det
erm
ined
for a
ll in
fants
of u
nkno
wn s
tatu
s at t
he
6 we
ek v
isit o
r firs
t con
t act
Coun
sel o
n inf
ant f
eedi
ng a
s per
nat
iona
l gui
delin
es
Conf
irma
tory
ABt
est
at 1
8 M
onth
s
Eval
uate
for
ART
star
t on
ARV
if el
igibl
e
If HI
V+ a
t 12
Mont
hs
Evalu
ate f
or A
RT
Start
on
ARV
if eli
gible
6 Wee
ks D
BS (P
CR)
HIV
+
If HI
V-sto
p CT
X if
not
BF
for a
t lea
st 2
Mont
hs
HI
V-
Antib
ody
test
ing
12 M
onth
s
Conf
irmat
ory
ABte
st at
18 M
onth
s
Conf
irmat
ory A
B te
st at
18 M
onth
s
Eval
uate
for A
RT
star
t on
ARV
if el
igible
If HIV
+ at
12
Mon
ths
Eval
uate
for A
RT
Star
t on
ARV
if el
igibl
e
If lt1
2 Mon
ths D
BS (P
CR)
If gt
12m
o An
tibod
y te
st
HIV
+
If HIV-
stop
CTX
if n
ot
BF
for a
t lea
st 2
Mont
hs
HI
V-
Antib
ody
testi
ng
12 M
onth
s
Conf
irma
tory
AB
test
at 1
8 Mo
nths
Exp
osur
e sta
tus s
hould
be de
term
ined
for a
ll in
fant
s of u
nkno
wn st
atus
at th
e 6w
eek
visit
or fi
rst c
onta
ct
Co
unse
l on
infa
nt fe
edin
g as
per n
atio
nal g
uideli
nes
Pre
gnan
cy
Labo
ur
Pos
tpar
tum
Mat
erna
l In
fant
Rec
omm
ende
d
AZT(
28-3
8 w
eeks
ge
stat
ion)
sd
NV
P
+ AZ
T+3T
C
AZT+
3TC
X
7 da
ys
sdN
VP
PL
US
3TC
X1
wee
k +
AZT
X
6 w
eeks
Tabl
e 4
3b b
elow
sho
ws
alte
rnat
ive
prop
hyla
ctic
regi
men
s fo
r w
omen
pre
sent
ing
befo
re 3
8 w
eeks
of p
regn
ancy
Ran
king
Ti
me
of A
dmin
istr
atio
n
Alte
rnat
ive
Min
imum
Pre
gnan
cy
AZT(
28-3
8 w
eeks
)
Labo
ur
sd N
VP
+
AZT(
600m
gs
stat
)
sdN
VP
+ A
ZT+3
TC
Pos
tpar
tum
AZT+
3TC
X
7 da
ys
Infa
nt
sdN
VP
+
3TC
X 7
da
ys +
AZT
X
6 w
eeks
sdN
VP
+
3TC
day
s +
AZT
X 6
wee
ks
HIV
-infe
cted
pre
gnan
t w
omen
who
are
see
n fo
r th
e fir
st t
ime
afte
r 38
wee
ks o
f pr
egshy
nanc
y or
in la
bour
sho
uld
be g
iven
AR
V p
roph
ylac
tic r
egim
ens
as s
how
n in
Tab
le 4
4
The
baby
sho
uld
also
be
give
n A
RV
pro
phyl
axis
soo
n af
ter
birt
h as
sho
wn
in t
he s
ame
Bot
h H
IV-in
fect
ed a
nd u
ninf
ecte
d ch
ildre
n re
quir
e co
mpr
ehen
sive
car
e (R
efer
to C
hap-
tabl
ete
r 8
and
9)
61
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
46
Tabl
e 4
4 A
RV
prop
hyla
xis
for P
MTC
T am
ong
preg
nant
wom
en w
ho
have
not
rece
ived
ant
enat
al A
RT
or p
roph
ylax
is
Ran
king
Ti
me
of A
dmin
istr
atio
n
La
bour
P
ostp
artu
m
Mat
erna
l In
fant
Rec
omm
ende
d
sdN
VP
AZ
T+3T
C
SdN
VP
+
X 7
days
P
LUS
3TC
X 1
wee
k +
AZT+
3TC
AZ
T X
6 w
eeks
Min
imum
sd
NV
P
-S
dNV
P
PLU
S 3
TC X
1 w
eek
+
AZT
X 6
wee
ks
Dos
ages
Mot
her
Bab
y
NV
P
200
mg
stat
2m
gkg
sta
t with
in 7
2 ho
urs
AZT
300
mg
BID
4m
gkg
BID
X 6
wee
ks
3TC
15
0 m
g BI
D
4mg
kg B
ID X
1 w
eek
Tabl
e 4
5 R
ecom
men
ded
HA
AR
T fo
r Pre
gnan
t Wom
en
base
d on
CD
4 C
ount
and
Sta
ge o
f Pre
gnan
cy
CD
4 C
ount
H
AA
RT
Trim
este
r C
ells
mm
3
72
2 H
IV P
OSI
TIV
EIN
FAN
TB
Y D
NA
PC
R
bull A
ll H
IV p
ositi
ve in
fant
s sh
ould
be
eval
uate
d fo
r el
igib
ility
for
antishy
retr
ovir
al tr
eatm
ent
and
linke
d to
car
e an
d tr
eatm
ent
as a
ppro
pria
te
bull W
HO
clin
ical
sta
ging
sho
uld
be d
one
for
all H
IV p
ositi
ve in
fant
s
Chi
ldre
n w
ho a
re a
t W
HO
Clin
ical
sta
ge 3
or
4 ar
e el
igib
le f
or
antir
etro
vira
l tre
atm
ent
bull A
ll H
IV p
ositi
ve in
fant
s sh
ould
be
asse
ssed
for
CD
4 co
unt
whe
re
poss
ible
and
ava
ilabl
e R
efer
to
AR
T g
uide
lines
for
CD
4 co
unts
tha
t de
term
ine
elig
ibili
ty f
or A
RT
for
chi
ldre
n of
diff
eren
t ag
e br
acke
ts
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
hav
e a
visi
ble
guar
dian
or
care
-tak
er
befo
re t
hey
can
be s
tart
ed o
n A
RT
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e fr
om 6
w
eeks
or
on f
irst
cont
act t
here
afte
r
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
be
star
ted
on A
RT
if el
igib
le
bull B
reas
tfeed
ing
shou
ld b
e en
cour
aged
for
all
HIV
-pos
itive
infa
nts
for
a
min
imum
of t
wo
year
s (
Ref
er t
o C
hapt
er 8
)
bull F
or a
ll H
IV-p
ositi
ve in
fant
s p
erfo
rm a
ntib
ody
test
ing
at 9
mon
ths
12
mon
ths
and
conf
irm
at
18 m
onth
s
1st T
rimes
ter
2nd T
rimes
ter
3rd T
rimes
ter
lt250
A
ZT+
3TC
+NV
P
AZ
T+3T
C+N
VP
AZT+
3TC
+NVP
250-
350
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
gt 35
0
A
ZT+3
TC+L
PVr
OR
A
BC
+3TC
+LPV
r
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
47
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
60
72
OPE
RA
TIO
NA
L G
UID
ELIN
ES
72
0 G
UID
ELIN
ESFO
R H
IV D
IAG
NO
SIS
INC
HIL
DR
EN
bull P
erfo
rm r
outin
e ra
pid
HIV
ant
ibod
y te
sts
for
all m
othe
rs o
f 6
wee
k ol
d in
fant
s pr
esen
ting
with
unk
now
n st
atus
bull P
erfo
rm r
outin
e dr
y bl
ood
spot
s (D
BS
) fo
r D
NA
PC
R f
or a
ll in
fant
s kn
own
to b
e H
IV-e
xpos
ed a
t 6
wee
ks
bull P
erfo
rm r
outin
e an
tibod
y te
stin
g fo
r al
l sic
k in
fant
s in
out
patie
nt a
nd
paed
iatr
ic w
ards
to
esta
blis
h H
IV e
xpos
ure
infe
ctio
n st
atus
bull P
erfo
rm D
BS
for
all
HIV
-exp
osed
sic
k in
fant
s un
der
12 m
onth
s
bull A
ll H
IV-e
xpos
ed in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e fr
om 6
w
eeks
of
age
or o
n fir
st c
onta
ct th
erea
fter
bull R
efer
to
chap
ter
on c
are
and
follo
w u
p of
the
HIV
-exp
osed
infe
cted
in
fant
72
1 H
IV N
EGA
TIV
EIN
FAN
TA
TA
GE
6 W
EEK
SO
RFI
RST
CO
NTA
CT
Perf
orm
ant
ibod
y te
stin
g at
9 m
onth
s an
d 12
mon
ths
of a
ge
bull I
f H
IV n
egat
ive
at 1
2 m
onth
s an
d st
ill b
reas
tfee
ding
co
ntin
ue
Cot
rim
oxaz
ole
bull I
f not
bre
astf
eedi
ng f
or a
t le
ast
2 m
onth
s s
top
Cot
rim
oxaz
ole
bull P
erfo
rm c
onfir
mat
ory
antib
ody
test
ing
at 1
8 m
onth
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Mat
erna
l dos
ages
AZT
30
0 m
g B
ID
3TC
15
0 m
g BI
D
NVP
200
mg
OD
for t
wo
wee
ks t
here
afte
r 200
mg
BID
AB
C
300m
g B
ID
LPV
r (4
001
00)
2 ta
blet
s B
ID
EFV
60
0mg
QID
Not
es I
mpo
rtan
t con
side
ratio
ns th
at m
odify
cho
ice
of A
RV
s du
ring
pre
gnan
cy in
clud
e C
D4
coun
t m
ater
nal a
naem
ia a
nd
stag
e of
pre
gnan
cy
bull 2
NR
TIs
(A
ZT
and
3TC
) ac
ting
as a
ldquotr
eatm
ent
back
bone
rdquo w
ith a
dditi
on o
f an
N
NR
TI (
NV
P)
rem
ains
the
pre
ferr
ed fi
rst-
line
AR
V t
hera
py in
res
ourc
e-po
or
sett
ings
bull P
rote
ase
inhi
bito
rs b
ased
reg
imen
s ar
e pr
efer
able
whe
n C
D4
coun
t is
high
er
than
250
bull R
epla
ce A
ZT
with
d4T
if H
blt 8
gm
dL
bull
EF
V m
ay b
e us
ed in
stea
d of
NV
P a
fter
first
trim
este
r
bull
Usu
ally
AR
V s
houl
d be
with
held
if C
D4
coun
t is
not
ava
ilabl
e or
not
don
e
AR
V is
how
ever
use
d fo
r P
MT
CT
and
or in
adv
ance
d H
IV d
isea
se (
WH
O
Sta
ge 3
or
4) ir
resp
ectiv
e of
CD
4 co
unt
Bab
ies
who
se
mot
hers
di
d no
t re
ceiv
e an
tepa
rtum
or
in
trap
artu
m
AR
Vpr
ophy
laxi
s sh
ould
be
give
n A
RV
pro
phyl
axis
as
show
n in
Tab
le 4
6
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
9
48
Tabl
e 4
6 A
RV
prop
hyla
ctic
regi
men
s fo
r inf
ants
bor
n to
H
IV-p
ositi
ve w
omen
who
hav
e no
t rec
eive
d an
tepa
rtum
or
intr
apar
tum
AR
T or
AR
V pr
ophy
laxi
s
Ran
king
T
ime
of a
dmin
istr
atio
n an
d In
fant
dos
age
sdN
VP (2
mg
kg s
tat)
PLU
S 3T
C (4
mg
kg B
ID) X
1 w
eek
+ AZ
T (4
mg
kg
BID
) X 6
wee
ks
Rec
omm
ende
d
sdN
VP (2
mg
kg s
tat)
Min
imum
sdN
VP
is g
iven
to th
e in
fant
with
in 7
2 ho
urs
of b
irth
Plea
se n
ote
A
t fir
st c
onta
ct a
ll H
IV i
nfec
ted
preg
nant
wom
en s
houl
d be
giv
en s
dNV
P ta
blet
s to
take
hom
e w
ith t
hem
The
y sh
ould
be
inst
ruct
ed t
o ta
ke t
he t
able
ts a
t th
e on
set
of la
shybo
ur i
f lab
our
occu
rs o
utsi
de h
ealth
faci
lity
sett
ings
The
y sh
ould
als
o be
giv
en N
VP
3T
C a
nd A
ZT s
yrup
for
thei
r ba
bies
to b
e ad
min
iste
red
soon
aft
er b
irth
Som
e w
omen
with
a C
D4
coun
t gr
eate
r th
an 2
50 c
ells
microl
on
Nev
irap
ine
(NV
P)-b
ased
AR
T m
ay d
evel
op N
VP
hype
rsen
sitiv
e re
actio
ns t
hat
can
be li
fe t
hrea
teni
ng I
n th
ese
guid
elin
es it
is r
ecom
men
ded
that
for
preg
nant
wom
en w
ith C
D4
mor
e th
an 2
50 N
VP-
base
d re
gim
en m
ay s
till
be u
sed
but
with
clo
se m
onito
ring
O
ther
wis
e th
e re
com
shym
ende
d re
gim
en to
use
with
CD
4 co
unt a
bove
250
is a
PI-
base
d H
AA
RT
regi
men
Whe
n si
ngle
dos
e N
VP
(sdN
VP)
is u
sed
in P
MTC
T s
ome
wom
en a
nd c
hild
ren
may
deshy
velo
p re
sist
ance
to
NV
P th
at m
ay l
imit
futu
re u
se o
f N
on-N
ucle
osid
e R
ever
se T
ranshy
scri
ptas
e In
hibi
tors
(NN
RTI
s) t
o tr
eat
them
Th
e ri
sk o
f NN
RTI
res
ista
nce
is p
artic
ushyla
rly
high
if
two
dose
s of
sdN
VP
are
give
n T
here
fore
SdN
VP
shou
ld n
ever
be
used
mor
e th
an o
nce
in a
ny o
ne p
regn
ancy
Whe
re p
ossi
ble
AZT
3TC
sho
uld
be g
iven
for
7 da
ys t
o co
ver
the
NV
P ta
il bo
th in
the
mot
her
and
the
baby
Th
e ba
by is
the
n co
ntin
shyue
d on
AZT
for
a to
tal o
f 6 w
eeks
for
prop
hyla
xis
agai
nst M
TCT
HIV
-infe
cted
pre
gnan
t w
omen
sta
rtin
g zi
dovu
dine
(A
ZT)
cont
aini
ng r
egim
ens
shou
ld
have
hae
mog
lobi
n (H
b) le
vels
abo
ve 8
gm
dl
The
Hb
leve
l sho
uld
be c
heck
ed m
onth
ly
for
the
first
thr
ee m
onth
s W
here
pos
sibl
e A
ZT s
houl
d be
use
d in
stea
d of
sta
vudi
ne(d
4T)
Clin
ical
judg
emen
t can
be
used
to e
stim
ate
Hb
leve
ls a
nd in
itiat
e AR
V pr
ophy
laxi
s if l
aboshy
rato
ry te
sts a
re u
nava
ilabl
e
Efa
vire
nz (
EFV
) m
ay b
e te
rato
geni
c if
used
in t
he f
irst
tri
mes
ter
If t
he p
atie
nt is
on
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Cha
pter
7
HIV
Dia
gnos
is in
Chi
ldre
n 7
1 IN
TRO
DU
CTI
ON
In g
ener
al
a ch
ild m
ay b
e te
sted
und
er a
num
ber
of c
ircu
mst
ance
s T
hese
inc
lude
sh
ortly
aft
er b
irth
for
earl
y di
agno
sis
of H
IV f
or th
e pu
rpos
es o
f ind
ivid
ual d
iagn
osis
in
a ch
ild w
ho is
ill (
eg
tho
se p
rese
ntin
g w
ith a
n H
IV r
elat
ed il
lnes
s) i
n ca
ses
whe
re a
child
has
eith
er b
een
expo
sed
or is
pot
entia
lly e
xpos
ed t
o H
IV e
g t
hrou
gh m
othe
r-to
shych
ild t
rans
mis
sion
se
xual
abu
se
sexu
al a
ctiv
ity
with
in a
hea
lthca
re s
ettin
g (e
g
thro
ugh
cont
amin
ated
nee
dles
or
rece
ipt
of p
oten
tially
infe
ctio
us b
lood
) th
roug
h ot
her
mea
ns a
nd in
orp
hans
Ear
ly i
nfan
t di
agno
sis
(EID
) re
fers
to
the
mak
ing
of H
IV d
iagn
osis
in
infa
nts
and
youn
g ch
ildre
n be
fore
18
mon
ths
of a
ge E
ID g
ives
an
oppo
rtun
ity fo
r ea
rly
iden
tific
ashytio
n of
HIV
infe
cted
infa
nts
(des
pite
PM
TCT)
and
ear
ly li
nkag
e to
car
e an
d tr
eatm
ent
Dis
ease
pro
gres
sion
in H
IV in
fect
ed in
fant
s is
fast
with
a h
igh
mor
talit
y ra
te (gt
50
)by
2 y
ears
of a
ge T
he m
edia
n ag
e of
dea
th in
the
first
two
year
s is
6 m
onth
s H
IV a
ntishy
body
tes
ting
amon
g ch
ildre
n ag
ed 1
8 m
onth
s or
mor
e is
abl
e to
det
erm
ine
whe
ther
a
child
is in
fect
ed o
r no
t
Dur
ing
preg
nanc
y m
othe
rs g
ive
thei
r ba
bies
ant
ibod
ies
to in
fect
ions
the
y ha
ve e
xper
ishyen
ced
and
thes
e an
tibod
ies
wan
e w
ith ti
me
Ant
ibod
y te
stin
g in
chi
ldre
n ag
ed le
ss th
an
18 m
onth
s id
entif
ies
child
ren
who
hav
e be
en e
xpos
ed to
thei
r m
othe
rsrsquo H
IV in
fect
ion
or
who
may
be
trul
y in
fect
ed a
nd a
re m
akin
g H
IV a
ntib
odie
s C
urre
ntly
the
re is
no
test
to
diff
eren
tiate
the
mot
herrsquos
ant
ibod
ies
from
tho
se p
rodu
ced
by t
he b
aby
In
orde
r to
id
entif
y th
e H
IV-in
fect
ed c
hild
age
d le
ss t
han
18 m
onth
s a
sec
ond
test
is r
equi
red
for
all b
abie
s te
stin
g po
sitiv
e on
ant
ibod
y te
stin
g or
kno
wn
to b
e H
IV-e
xpos
ed (m
othe
r is
H
IV-p
ositi
ve)
Infa
nt D
NA
(or
RN
A) P
CR
tes
ting
is t
he c
urre
nt r
ecom
men
ded
met
hod
for
EID
Sinc
e m
ost b
abie
s lo
se m
ater
nal a
ntib
odie
s (A
b) b
y 12
mon
ths
a n
egat
ive
antib
ody
test
will
ide
ntify
uni
nfec
ted
babi
es a
s lo
ng a
s th
ey a
re n
ot s
till
brea
stfe
edin
g A
pos
itive
antib
ody
test
at
12 m
onth
s a
lthou
gh h
ighl
y lik
ely
to b
e di
agno
stic
may
stil
l be
due
topa
ssiv
ely
carr
ied
mat
erna
l ant
ibod
ies
Suc
h te
sts
need
to
be c
onfir
med
by
PCR
tes
ting
or r
epea
t ant
ibod
y te
st a
t 18
mon
ths
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
9
58
CARE
SU
PPO
RTAN
DTR
EATM
ENT
FOR
HIV
PO
SITI
VEM
OTH
ERAN
DCH
ILD
HIV
-pos
itive
mot
hers
requ
ire c
are
and
supp
ort w
hich
incl
udes
bull
Cou
nsel
ing
bull P
roph
ylax
is a
nd tr
eatm
ent
bull L
ink
to s
uppo
rt g
roup
s an
d as
sess
men
t of
the
nee
d fo
r A
RT
bull E
arly
infa
nt d
iagn
osis
sho
uld
be p
rovi
ded
at s
ix w
eeks
usi
ng D
NA
shyP
CR
tes
ting
Cha
pter
ref
eren
ces
1
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
Pla
nnin
g
Guid
elin
es f
or
serv
ice
pro
vider
s
Rev
ised
in M
arch
2006
Foo
tnot
es
1
Pre
ble
and P
iwoz
2001
2
WH
O
Contr
ace
ptive
Elig
ibili
ty C
rite
ria
Guid
e
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
EFV
bef
ore
beco
min
g pr
egna
nt i
t sho
uld
be s
ubsi
tute
d w
ith N
VP
in th
e 1s
t tri
mes
ter
In c
ase
of s
ever
e hy
pere
mes
is g
ravi
daru
m A
RT
may
nee
d to
be
brie
fly in
terr
upte
d
On
aver
age
mot
her-
to-c
hild
tra
nsm
issi
on r
ates
are
15
for
sdN
VP
65
fo
r m
ore
effishy
caci
ous
dual
reg
imen
s an
d 2
4 fo
r 3-
drug
AR
V c
ombi
natio
n
Futu
re P
ersp
ectiv
es
Ext
ende
d pr
ophy
laxi
s w
ith 3
AR
V d
rug
com
bina
tions
sta
rtin
g du
ring
pre
gnan
cy a
nd
cont
inui
ng a
fter
del
iver
y fo
r a
peri
od o
f up
to
6 m
onth
s a
mon
g H
IV-in
fect
ed b
reas
t-fe
edin
g m
othe
rs h
as b
een
show
n in
a f
ew r
ecen
t an
d is
olat
ed s
tudi
es a
nd p
ilot
proshy
gram
me
to le
ad to
low
er b
reas
tfee
ding
-rel
ated
pos
tnat
al M
TCT
Thi
s ap
proa
ch m
ay b
e co
nsid
ered
whe
re th
is is
feas
ible
acc
epta
ble
saf
e an
d w
here
adh
eren
ce c
an b
e as
sure
d
Mor
e st
udie
s on
this
issu
e ar
e ex
pect
ed
Thre
e A
RV
dru
g co
mbi
natio
ns g
iven
to
HIV
pos
itive
pre
gnan
t w
omen
who
are
not
yet
el
igib
le fo
r in
itiat
ion
of A
RTs
for
thei
r ow
n he
alth
als
o le
ad to
low
er M
TCT
and
may
be
cons
ider
ed in
pro
gram
mes
with
the
capa
city
to in
itiat
e th
e re
gim
en a
nd fo
llow
up
such
wom
en S
uch
inte
rven
tion
is in
itiat
ed a
t ar
ound
28
wee
ks o
r so
on a
fter
and
sto
pped
af
ter
birt
h if
CD
4 co
unt i
s st
ill a
bove
350
cel
lsm
m3
App
endi
ces
Appen
dix
I
Appen
dix
II
Appen
dix
III
Appen
dix
IV
WH
O C
linic
al S
tagin
g o
f H
IVA
IDS f
or
Adults
and A
dole
scen
ts
w
ith c
onfirm
ed H
IV infe
ctio
n
Contr
acep
tive
Options
for
Peo
ple
Liv
ing w
ith H
IV
Sum
mar
y of
ARV D
rug U
se f
or
PMTCT o
f H
IV
In
tegra
ted M
onitori
ng a
nd E
valu
ation R
eport
Form
MO
H 7
26
Cha
pter
ref
eren
ces
1
Sum
mar
y of
ARV D
rugs
Adve
rse
Effec
ts a
nd M
anag
emen
t T
able
6-1
0
pages
101-1
12 o
f G
uid
elin
es f
or
Antire
trovi
ral D
rug T
her
apy
in K
enya
3rd
Editio
n
De-
cem
ber
2005
2
Dru
g I
nte
ract
ions
Tab
le 7
-10
pag
es 1
12-1
22 o
f G
uid
elin
es f
or
Antire
trovi
ral
Dru
g T
her
apy
in K
enya
3rd
editio
n
Dec
2005
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
7
50
Cha
pter
5
Imm
edia
te P
ostn
atal
and
Neo
nata
l Car
e 5
1 IN
TRO
DU
CTI
ON
Imm
edia
te p
ostn
atal
and
neo
nata
l car
e re
fers
to th
e pa
ckag
e of
ser
vice
s pr
ovid
ed to
the
mot
her
and
infa
nt b
efor
e th
ey le
ave
the
heal
th fa
cilit
y (u
p to
48
hour
s) a
fter
del
iver
yTh
e pe
riod
pro
vide
s an
opp
ortu
nity
to e
duca
te a
ll m
othe
rs a
bout
HIV
to
prov
ide
coun
shyse
lling
and
tes
ting
if it
was
not
don
e pr
evio
usly
and
to
rein
forc
e th
e ed
ucat
ion
proshy
vide
d du
ring
the
ant
enat
al p
erio
d B
oth
HIV
inf
ecte
d an
d H
IV u
ninf
ecte
d m
othe
rs
shou
ld r
ecei
ve th
is e
duca
tion
and
coun
selli
ng b
efor
e di
scha
rge
52
OPE
RA
TIO
NA
L G
UID
ELIN
ES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed fo
r all
wom
en a
nd
infa
nts
in th
e im
med
iate
pos
t par
tum
per
iod
a)
Opt
imal
pos
tpar
tum
car
e
bull R
outin
e ca
re in
clud
ing
brea
st e
xam
inat
ion
exa
min
atio
n of
the
ute
rus
ex
amin
atio
n of
the
per
ineu
m a
nd lo
chia
pa
ssag
e of
uri
ne r
egul
arly
pr
oper
hyg
iene
to
prev
ent
infe
ctio
n c
heck
ing
for
sign
s of
ana
emia
fe
ver
and
tach
ycar
dia
bull D
iscu
ss m
ater
nal n
utri
tion
bull E
stab
lish
the
HIV
sta
tus
of t
he m
othe
rs in
clud
ing
thos
e gi
ving
birt
h ou
tsid
e th
e he
alth
inst
itutio
n se
tting
bull P
rovi
de H
IV C
T f
or m
othe
rs w
ith u
nkno
wn
HIV
sta
tus
bull E
ncou
rage
HIV
res
ults
dis
clos
ure
and
part
ner
test
ing
bull F
ollo
w t
he s
tand
ard
guid
elin
es o
n th
e ca
re o
f a n
ewbo
rn (
IMP
AC
C
are
Man
ual)
bull A
ll ba
bies
sho
uld
rece
ive
thei
r ro
utin
e im
mun
izat
ion
(OP
V a
nd B
CG
) in
th
eir
first
hou
rs o
f lif
e1
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Con
trac
eptio
n A
ll m
othe
rs r
egar
dles
s of
the
ir H
IV s
tatu
s h
ave
a ri
ght
to r
ecei
ve a
dequ
ate
info
rmashy
tion
on a
vaila
ble
met
hods
of f
amily
pla
nnin
g an
d to
mak
e an
info
rmed
cho
ice
on w
hat
is b
est
for
them
H
IV-in
fect
ed w
omen
who
are
not
bre
astf
eedi
ng s
houl
d in
itiat
e a
relia
ble
cont
race
ptiv
e m
etho
d by
2-4
wee
ks p
ostp
artu
m
This
is
in a
dditi
on t
o th
epr
oper
and
con
sist
ent
use
of t
he c
ondo
m a
s a
form
of
dual
pro
tect
ion
All
met
hods
of
cont
race
ptio
n ca
n be
use
d by
HIV
pos
itive
wom
en b
ased
on
stan
dard
med
ical
elig
ibili
tycr
iteri
a in
clud
ing
taki
ng c
are
of d
rug
inte
ract
ions
as
outli
ned
belo
w2
bull L
acta
tiona
l Am
enor
rhoe
a M
etho
d (L
AM
) S
uita
ble
for
excl
usiv
ely
brea
stfe
edin
g H
IV in
fect
ed w
omen
who
hav
e no
t re
sum
ed m
ense
s
bull H
orm
onal
con
trac
eptio
n A
ll ho
rmon
al c
ontr
acep
tives
can
be
used
in
HIV
pos
itive
wom
en in
clud
ing
thos
e on
HA
AR
T
Com
bine
d or
al
cont
race
ptiv
es a
re c
ontr
aind
icat
ed f
or u
se w
ith d
rugs
that
indu
ce
hepa
tic m
icro
-enz
yme
that
may
red
uce
the
effe
ctiv
enes
s of
hor
mon
al
cont
race
ptiv
es
Som
e an
ti-T
Bs
ant
iret
rovi
rals
an
tifun
gals
and
ant
i-ep
ilept
ics
and
in c
ondi
tions
tha
t ca
use
mal
abso
rptio
n8
bull I
ntra
-ute
rine
con
trac
eptiv
e de
vice
s (I
UC
Ds)
IU
CD
s ar
e no
t co
ntra
indi
cate
d in
HIV
pos
itive
wom
en
In s
ever
ely
imm
uno
supp
rese
d w
omen
use
sho
uld
not
be d
isco
ntin
ued
but
new
inse
rtio
n is
dis
cour
aged
as
it m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f in
fect
ion
duri
ng t
he in
sert
ion
proc
ess
bull S
urgi
cal m
etho
ds S
urgi
cal c
ontr
acep
tion
shou
ld b
e of
fere
d to
HIV
po
sitiv
e w
omen
and
the
ir pa
rtne
rs
bull B
arri
er m
etho
ds
Fem
ale
and
mal
e co
ndom
s pr
ovid
e pr
otec
tion
agai
nst
ST
Ds
and
redu
ce t
he r
isk
of H
IV t
rans
mis
sion
and
sho
uld
be
enco
urag
ed a
lone
or
toge
ther
with
oth
er c
ontr
acep
tive
met
hods
bull S
perm
icid
es
Use
d in
con
junc
tion
with
bar
rier
met
hods
spe
rmic
ides
w
ill p
rovi
de a
dditi
onal
con
trac
eptiv
e pr
otec
tion
How
ever
sp
erm
icid
es s
houl
d no
t be
use
d al
one
as t
hey
can
incr
ease
the
ris
k of
HIV
acq
uisi
tion
bull E
mer
genc
y co
ntra
cept
ion
HIV
pos
itive
wom
en s
houl
d be
info
rmed
ab
out
emer
genc
y co
ntra
cept
ion
whe
re it
is a
vaila
ble
and
how
to
obta
in a
nd u
se it
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
1
56
Bre
ast c
are
in b
reas
tfeed
ing
mot
hers
bull E
ncou
rage
dai
ly c
lean
ing
of t
he b
reas
ts a
nd a
void
ing
the
appl
icat
ion
of lo
tions
bull T
reat
mat
erna
l vag
inal
can
didi
asis
and
infa
nt o
ral c
andi
dias
is
bull E
duca
te m
othe
r on
opt
imal
bre
astf
eedi
ng te
chni
que
incl
udin
g la
tchi
ng
on t
echn
ique
ex
lusi
ve b
reas
tfee
ding
and
rem
ovin
g ba
by f
rom
bre
ast
bull E
duca
te th
e m
othe
r on
bre
ast c
are
to p
reve
nt c
ompl
icat
ions
(cr
acki
ng
and
engo
rgem
ent)
bull E
xpre
ss a
nd h
eat
trea
t th
e m
ilk if
bre
ast
has
mas
titis
or
absc
ess
Opt
imal
pos
tpar
tum
car
e fo
r HIV
pos
itive
wom
en
Loch
ia
bull P
ut e
mph
asis
on
good
per
inea
l hyg
iene
and
pro
per
hand
ling
of b
ody
fluid
s
bull A
void
con
tam
inat
ing
the
baby
with
bod
y flu
ids
or w
ith b
eddi
ng s
oile
d w
ith lo
chia
bull S
hari
ng o
f be
ds b
y m
othe
rs in
the
hos
pita
l sho
uld
be d
isco
urag
ed
Cae
sare
an S
ectio
n
Bro
ad s
pect
rum
ant
ibio
tics
shou
ld b
e us
ed r
outin
ely
afte
r C
S
Esse
ntia
l mat
erna
l edu
catio
n an
d fo
llow
-up
bull M
onito
r fo
r br
east
and
pel
vic
infe
ctio
n at
all
post
nat
al c
linic
vis
its
bull E
duca
te o
n pr
ompt
hea
lth s
eeki
ng b
ehav
iour
bull H
ealth
edu
catio
n on
hyg
iene
lo
chia
and
bre
ast
care
bull A
void
sex
ual i
nter
cour
se f
or a
t lea
st 2
wee
ks a
fter
birt
h or
unt
il th
ere
is
no lo
nger
any
loch
ia r
ubra
or
sero
sa
bull D
o pa
p sm
ear
or V
IA a
t 4-
6 w
eeks
bull F
or e
very
sex
ual a
ctiv
ity
the
coup
le s
houl
d us
e co
ndom
s
bull D
iscu
ss f
amily
pla
nnin
g at
eve
ry o
ppor
tuni
ty a
nd p
rovi
de t
he
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Supp
ort
infa
nt fe
edin
g op
tions
For
all
HIV
neg
ativ
e w
omen
wom
en o
f unk
now
n H
IV
stat
us a
nd H
IV p
ositi
ve m
othe
rs o
ptin
g fo
r ex
clus
ive
brea
stfe
edin
g in
itiat
e br
east
feed
shyin
g w
ithin
hal
f hou
r of
bir
th a
nd fo
llow
oth
er g
uide
lines
as
per
Bab
y Fr
iend
ly H
ospi
tal
Initi
ativ
e2 (B
FHI)
bull G
ive
info
rmat
ion
on fa
mily
pla
nnin
g an
d du
al p
rote
ctio
n
bull C
ouns
el o
n H
IV r
isk
redu
ctio
n
bull S
ched
ule
post
nata
l clin
ic v
isits
at
2 w
eeks
and
at
4-6
wee
ks a
nd
com
plet
e m
othe
r-ch
ild b
ookl
et (
refe
r to
DR
H m
anua
l)
(b) S
peci
fic p
ostp
artu
m c
are
for H
IV p
ositi
ve w
omen
bull S
uppo
rt e
xclu
sive
bre
astf
eedi
ng u
nles
s m
othe
r ha
s ap
prop
riat
ely
opte
d fo
r an
d be
en c
ouns
elle
d on
rep
lace
men
t fe
edin
g an
tena
tally
bull I
nitia
te o
r co
ntin
ue c
o-tr
imox
azol
e pr
ophy
laxi
s -1
dou
ble
stre
ngth
tab
shyle
t da
ily
bull F
or H
IV p
ositi
ve m
othe
rs t
hat
rece
ived
sd
nevi
rapi
ne in
trap
artu
m
initi
shyat
e A
ZT
300m
g an
d 3T
C 1
50 m
g B
D f
or 1
wee
k
bull F
or n
ewly
dia
gnos
ed m
othe
rs
do H
IV s
tagi
ng
CD
4 co
unt
and
refe
r ap
prop
riat
ely
for
cont
inue
d ca
re
(c)
Spec
ific
care
for H
IV e
xpos
ed in
fant
s
bull F
or H
IV e
xpos
ed in
fant
s a
dmin
iste
r sd
NV
P 2
mg
kg s
tat
with
in 7
2 ho
urs
Giv
e A
ZT
4 m
gkg
BID
for
6 w
eeks
and
3T
C 4
mg
kg B
ID f
or 1
w
eek
Ref
er t
o C
hapt
er 4
bull R
efer
to C
hapt
er 8
for
deta
ils o
n in
fant
fee
ding
opt
ions
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
5
52
Cha
pter
ref
eren
ces
1
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
Nat
ional
Guid
elin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
ata
l Car
e (2
004)
2
2R
epublic
of
Ken
ya M
inis
try
of
Hea
lth
Ess
ential
Obst
etri
c C
are
Man
ual
for
Hea
lth
Ser
vice
Pro
vider
s in
Ken
ya 3
rd E
ditio
n (
Jan 2
006)
Foo
tnot
es
1
WH
O r
ecom
men
ds
that
all
vacc
ines
should
be
giv
en t
o H
IV-s
ero-n
egat
ive
child
ren
and t
o a
sym
pto
mat
ic s
ero-p
osi
tive
s
The
only
vac
cines
to b
e w
ithhel
d f
rom
child
ren w
ith s
ympto
mat
ic A
IDS a
re B
CG
and
Yel
low
fev
er v
acc
ines
2
The
ldquoTen
Ste
psrdquo
of
BFH
I R
ecom
men
ded
Pra
ctic
es f
or
Mat
ernity
Ser
vice
s ad
apte
d f
or
W
HO
UN
ICEF
1989
Cha
pter
6
Late
Pos
tnat
al C
are
and
Fam
ily P
lann
ing
61
INTR
OD
UC
TIO
N
Late
pos
tnat
al c
are
is p
rovi
ded
to t
he m
othe
r an
d th
e ch
ild 4
8 ho
urs
to 6
wee
ks a
fter
deliv
ery
Dur
ing
this
per
iod
the
heal
th o
f the
mot
her
and
child
is a
sses
sed
and
clos
ely
mon
itore
d
The
risk
of M
TCT
duri
ng th
e po
stpa
rtum
per
iod
can
be r
educ
ed b
y pr
ovid
ing
HIV
cou
nshyse
lling
and
test
ing
pos
t-ex
posu
re p
roph
ylax
is fo
r ex
pose
d ba
bies
cou
nsel
ling
on a
ppro
shypr
iate
infa
nt fe
edin
g op
tions
and
bre
ast c
are
Pos
tpar
tum
car
e fo
r H
IV p
ositi
ve w
omen
shou
ld in
clud
e cl
inic
al s
tagi
ng C
D4
coun
t and
AR
T fo
r th
ose
who
qua
lify
Fam
ily p
lann
ing
serv
ices
are
am
ong
the
core
inte
rven
tions
of P
MTC
T pr
ovid
ed to
hel
pw
omen
det
erm
ine
futu
re c
hild
bear
ing
patt
erns
inc
ludi
ng t
he p
reve
ntio
n of
HIV
-in
fect
ed b
irth
s
Rep
rodu
ctiv
e he
alth
cou
nsel
ling
can
help
a w
oman
pra
ctis
e sa
fer
sex
and
dete
rmin
e he
r fu
ture
ch
ildbe
arin
g pa
tter
ns
on
a m
ore
resp
onsi
ble
and
info
rmed
bas
is1
62
OPE
RA
TIO
NA
L G
UID
ELIN
ES
Opt
imal
pos
tpar
tum
car
e fo
r all
wom
en
This
ent
ails
rou
tine
care
inc
ludi
ng b
reas
t ex
amin
atio
n e
xam
inat
ion
of t
he u
teru
s
exam
inat
ion
of t
he p
erin
eum
and
loch
ia p
assa
ge o
f uri
ne r
egul
arly
pro
per
hygi
ene
topr
even
t in
fect
ion
che
ckin
g fo
r si
gns
of a
nem
ia
feve
r an
d ta
chyc
ardi
a an
d do
ing
peri
neal
exe
rcis
es
Add
ition
al c
are
incl
udes
bull C
ouns
ellin
g an
d te
stin
g fo
r m
othe
rs o
f un
know
n H
IV s
tatu
s bull
Pro
visi
on o
f co
ndom
s an
d ris
k re
duct
ion
coun
selli
ng
bull C
ouns
ellin
g on
con
trac
eptiv
e op
tions
in
clud
ing
dual
met
hod
use
bull D
iscu
ssin
g m
ater
nal n
utrit
ion
bull M
alar
ia p
reve
ntio
n bull
Scr
eeni
ng f
or S
TI a
nd c
ervi
cal c
ance
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
3
54
MIN
ISTR
Y O
F H
EALT
H
Rep
ublic
of K
enya
Gui
delin
es fo
r
Prev
entio
n of
Mot
her t
o C
hild
Tr
ansm
issi
on (P
MTC
T) o
f HIV
AID
S
in K
enya
NA
TIO
NA
L A
IDS
amp S
TI C
ON
TRO
L PR
OG
RA
MM
E
PO
BO
X 19
361-
002
00
NA
IRO
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Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
106
Enq
uiri
es r
egar
ding
thes
e PM
TCT
Gui
delin
es s
houl
d be
add
ress
ed to
Dire
ctor
N
atio
nal A
IDS
and
STI C
ontr
ol P
rogr
amm
e (N
ASC
OP)
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inis
try
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ealth
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O B
ox 1
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airo
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enya
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nect
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enya
org
Third
edi
tion
Cop
yrig
ht copy
200
9 M
inis
try o
f Hea
lth G
over
nmen
t of K
enya
105
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
A
ppen
dix
VII
I Li
st o
f Con
trib
utor
s
Dr
Ayi
si R
ober
t K
Dep
uty
Hea
d N
ASC
OP
PMTC
T Pr
grm
Mng
r
MO
H-N
ASC
OP
Dr
Abd
alla
h S
aade
H
IV T
rain
er J
HPI
EG
O
Ms
Ake
lola
Rut
h
Nut
ritio
n amp
HIV
Man
ager
MO
H-N
ASC
OP
Mr
Dey
a J
osph
at
PMTC
T Pr
ogra
m O
ffice
r M
OH
-NA
SCO
P
Dr
Die
lem
ans
Pau
l
Mat
erna
l Neo
nata
l Hea
lth (M
NH
) Adv
isor
EH
SD
RH
Ms
Gitu
to A
nnie
W
Prog
ram
Offi
cer
MO
H-D
RH
Dr
Inw
ani
Iren
e
Paed
iatr
icia
n IC
AR
T K
NH
Mr
Isav
wa
Ant
hony
D
ata
Prog
ram
Man
ager
CD
C K
enya
Dr
Kar
anja
Dom
inic
PM
TCT
Prog
ram
Man
ager
PA
THFI
ND
ER
Inte
rnat
iona
l
Dr
Kia
rie
Jam
es N
PM
TCT
Prog
ram
Man
ager
KN
HU
ON
Dr
Kig
en B
atile
l Pr
ogra
m M
anag
er M
OH
-DR
H
Ms
Koe
ch R
osel
ine
Pr
ogra
m O
ffice
r M
OH
-DR
H
Dr
Mac
hari
a S
heila
R
H S
ervi
ces
Spec
ialis
t U
SAID
K
Dr
Mat
u L
ucy
PM
TCT
Prog
ram
Man
ager
USA
IDK
Ms
Mau
a J
udith
Pr
ogra
m O
ffice
r D
RH
-MO
H
Prof
Mbo
ri-N
gach
a D
Se
nior
Tec
hnic
al A
dvis
or A
ssoc
iate
Pro
fess
or
of P
aedi
atri
cs C
DC
Ken
ya U
oN
Dr
Mud
any
Mild
red
Te
chni
cal A
dvis
or C
DC
Ken
ya
Ms
Muh
enje
Ody
lia
Beh
avio
ral S
cien
tist
CD
C K
enya
Ms
Mut
sots
o W
infr
ed
PMTC
T Te
chni
cal A
dvis
orP
rogr
am M
anag
er C
DC
Ken
ya
Ms
Mut
uku
Ter
esia
H
IV T
rain
er J
HPI
EG
O
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
104
App
endi
x V
II
103
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Ms
Mw
anga
ngi
Alic
e Pr
ogra
m O
ffice
r D
RH
-MO
H
Ms
Mw
angi
Nan
cy
PMTC
T A
dmin
istr
ativ
e A
ssis
tant
CD
C K
enya
Mr
Ndw
iga
Fra
ncis
Pr
ogra
m O
ffice
r M
OH
-NA
SCO
P
Prof
Ndu
ati
Rut
h
Ass
ocia
te P
rofe
ssor
of P
aedi
atri
cs U
oN
Dr
Nju
guna
Cha
rles
Pr
ogra
m A
ssoc
iate
MSH
RPM
Plu
s
Mr
Nya
beri
Dav
id
Prog
ram
Offi
cer
MO
H-D
RH
Mr
Ode
ra J
W
Prog
ram
Coo
rdin
ator
GTZ
Ms
Olu
och
Pat
rici
a Te
chni
cal A
dvis
or C
DC
Ken
ya
Mr
Olu
och
Tom
Te
chni
cal A
dvis
or C
DC
Ken
ya
Dr
Onrsquo
gech
Joh
n
Prog
ram
Coo
rdin
ator
KN
H
Dr
Otie
no-N
yuny
a B
Se
nior
Lec
ture
rH
ead
of D
epar
tmen
t PM
TCT
Dir
ecto
rM
oi U
nive
rsity
AM
PATH
Dr
Oum
a C
hris
PM
TCT
Prog
ram
Offi
cer
UN
ICE
F
Dr
Saw
e F
redr
ick
K
Dep
uty
Dir
ecto
r W
RP
Mr
Soo
Leo
nard
Pr
ogra
m M
anag
er W
RP
Dr
Vak
il S
obha
N
Tech
nica
l Adv
isor
AR
T Pr
ogra
m N
ASC
OP
Ms
Way
ua R
uth
Prog
ram
Offi
cer
MO
H-D
RH
Dr
Yon
ga I
sabe
lla
PMTC
T Te
chni
cal A
dvis
or E
GPA
F
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
Tabl
e of
Con
tent
s Li
st o
f con
trib
utor
s 3
Tabl
e of
con
tent
s 5
Ack
now
ledg
emen
ts
10
Fore
wor
d 11
Abb
revi
atio
ns a
nd A
cron
yms
12
Exe
cutiv
e Su
mm
ary
16
Cha
pter
1
Bac
kgro
und
20
11T
he G
loba
l Pan
dem
ic
20
12
Mag
nitu
de o
f HIV
in P
regn
ancy
in
22
13
Ris
ks o
f Tra
nsm
issi
on o
f MTC
T at
Diff
eren
t Tim
e Pe
riod
s 23
14
Ris
k Fa
ctor
s of
MTC
T of
HIV
24
15
Ben
efits
of P
MTC
T of
HIV
25
16
Ben
efits
of H
IV C
ouns
ellin
g amp
Tes
ting
25
17
The
Four
-pro
nged
App
roac
h to
PM
TCT
26
18
Ove
rvie
w o
f the
New
PM
TCT
Gui
delin
es
28
19
Obj
ectiv
es amp
Org
anis
atio
n of
the
Gui
delin
es
28
110
U
sing
the
Gui
delin
es
29
Cha
pter
2 A
nten
atal
Car
e an
d Pr
even
tion
of M
TCT
of H
IV
32
21
Intr
oduc
tion
32
5
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4 B
acte
riolo
gica
l con
firm
atio
n
App
ropr
iate
clin
ical
sam
ples
incl
ude
sput
um
gast
ric
aspi
rate
s an
d ce
rtai
n ot
her
mat
eria
ls
Sin
ce m
ost
TB
in c
hild
ren
is in
infa
nts
and
youn
g ch
ildre
n s
putu
m
indu
ctio
n m
ay b
e do
ne fi
rst
or g
astr
ic a
spira
tions
and
exp
ecto
ratio
ns
a S
putu
m In
duct
ion
Spu
tum
indu
ctio
n is
saf
e an
d ef
fect
ive
in c
hild
ren
of a
ll ag
es a
nd t
he b
acte
rial
yi
elds
a]r
e as
goo
d or
bet
ter
that
for
gas
tric
asp
irate
s
b G
astr
ic a
spira
tion
Thi
s is
per
form
ed in
you
ng c
hild
ren
who
are
una
ble
or u
nwill
ing
to
expe
ctor
ate
sput
um
A g
astr
ic a
spir
ate
shou
ld b
e ob
tain
ed o
n ea
ch o
f th
e th
ree
cons
ecut
ive
mor
ning
s
c E
xpec
tora
tions
S
putu
m s
houl
d al
way
s be
obt
aine
d in
adu
lts a
nd o
lder
chi
ldre
n gt1
0 ye
ars
of
age
susp
ecte
d of
hav
ing
pulm
onar
y T
B
Bac
teri
al y
ield
s ar
e hi
gher
in o
lder
chi
ldre
n
Thr
ee s
putu
m s
peci
men
s sh
ould
be
obta
ined
an
on-
the
ndashspo
t sp
ecim
en (
at t
he
first
eva
luat
ion)
an
ear
ly m
orni
ng s
peci
men
and
a s
econ
d on
-the
-spo
t sp
ecim
en
Spu
tum
indu
ctio
n is
saf
e an
d ef
fect
ive
in c
hild
ren
of a
ll ag
es a
nd t
he b
acte
rial
yi
elds
are
as
good
or
bett
er t
han
for
gast
ric a
spira
tes
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
102
NO
TES
1 H
isto
ry
bull A
sk f
or s
ympt
oms
cons
iste
nt w
ith T
B in
clud
ing
chro
nic
coug
hgt 2
wee
ks
feve
r- b
ody
tem
pera
ture
of
38 o C
for
14 d
ays
afte
r co
mm
on c
ause
s su
ch a
s m
alar
ia a
nd p
neum
onia
hav
e be
en e
xclu
ded
wei
ght
loss
or
failu
re t
o th
rive
(
also
look
at
the
grow
th c
hart
) a
nd o
r ni
ght
swea
ts
Enq
uire
whe
ther
the
pat
ient
has
bee
n in
clo
se c
onta
ct w
ith s
mea
r-po
sitiv
e pu
lshym
onar
y T
B (
usua
lly a
par
ent
or o
ther
mem
ber
of th
e fa
mily
)
2 C
linic
al e
xam
inat
ion
a P
hysi
cal s
igns
hig
hly
sugg
estiv
e of
ext
ra p
ulm
onar
y T
B
bull O
ften
the
mai
n cl
inic
al f
indi
ng is
just
fai
lure
to
thriv
e
bull G
ibus
es
peci
ally
of
rece
nt o
nset
(re
sulti
ng f
rom
ver
tebr
al T
B)
bull N
on-p
ainf
ul e
nlar
ged
cerv
ical
lym
phad
enop
athy
with
fis
tula
for
mat
ion
b P
hysi
cal s
igns
req
uiri
ng in
vest
igat
ions
to
excl
ude
extr
a pu
lmon
ary
TB
bull M
enin
gitis
not
res
pond
ing
to a
ntib
iotic
s tr
eatm
ent
bull P
leur
al e
ffus
ion
bull P
eric
ardi
al e
ffus
ion
bull D
iste
nded
abd
omen
with
asc
itis
bull N
on-p
ainf
ul e
nlar
ged
lym
ph n
odes
with
out
fistu
la f
orm
atio
n
bull N
on-p
ainf
ul e
nlar
ged
join
t
Sig
ns o
f tu
berc
ulin
hyp
erse
nsiti
vity
3 M
anto
ux te
st
A m
anto
ux t
est
shou
ld b
e re
gard
ed p
ositi
ve a
s fo
llow
s
bull I
n hi
gh-r
isk
child
ren
(inc
lude
s H
IV-i
nfec
ted
child
ren
and
seve
rely
mal
shyno
uris
hed
child
ren
) gt
5mm
dia
met
er o
f in
dura
tion
bull I
n al
l oth
er c
hild
ren(
whe
ther
the
y ha
ve r
ecei
ved
BC
G o
r no
t)
gt10m
m d
ishyam
eter
of i
ndur
atio
n
101
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
22
Ope
ratio
nal G
uide
lines
32
23
Job
Aid
s 34
24
App
endi
ces
13
Cha
pter
3 I
ntra
part
um C
are
38
31
Intr
oduc
tion
38
32
Ope
ratio
nal G
uide
lines
38
Cha
pter
4
Use
of A
RVs
in P
regn
ancy
for T
reat
men
t amp P
MTC
T of
HIV
infe
ctio
n 42
41
Intr
oduc
tion
42
42
Ope
ratio
nal G
uide
lines
43
Cha
pter
5 I
mm
edia
te P
ostn
atal
and
Neo
nata
l Car
e
51
51
Intr
oduc
tion
51
52
Ope
ratio
nal G
uide
lines
51
Cha
pter
6 L
ate
Post
nata
l Car
e an
d Fa
mily
Pla
nnin
g
54
61
Intr
oduc
tion
54
62
Ope
ratio
nal G
uide
lines
54
Cha
pter
7 H
IV D
iagn
osis
in C
hild
ren
58
71
Intr
oduc
tion
58
72
Ope
ratio
nal G
uide
lines
59
72
0 G
uide
lines
for
HIV
Dia
gnos
is in
Chi
ldre
n
59
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
72
1 H
IV N
egat
ive
Infa
nt a
t 6 w
eeks
or
Firs
t Con
tact
59
72
2 H
IV P
ositi
ve In
fant
by
DN
A P
CR
60
72
3 C
ompr
ehen
sive
Car
e fo
r H
IV-e
xpos
ed In
fant
61
D
IAG
NO
STIC
ALG
OR
ITH
MFO
R P
ULM
ON
AR
Y T
B IN
CH
ILD
REN
Cha
pter
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
Bor
n to
HIV
infe
cted
mot
hers
62
81
Intr
oduc
tion
62
82
Ope
ratio
nal G
uide
lines
on
Infa
nt F
eedi
ng (0
-6 m
onth
s)
63
83
Ope
ratio
nal G
uide
lines
on
Feed
ing
Chi
ldre
n 6
mon
ths
and
olde
r 64
84
Nut
ritio
nal C
are
and
Supp
ort o
f HIV
infe
cted
Chi
ldre
n 64
85
Ext
ract
s fr
om R
esea
rch
on In
fant
Fee
ding
and
HIV
AID
S 65
Cha
pter
9
Car
e an
d Fo
llow
up
of C
hild
ren
of H
IV-in
fect
ed m
othe
rs 7
3
91
Intr
oduc
tion
73
92
Ope
ratio
nal G
uide
lines
74
Cha
pter
10
Mon
itorin
g an
d Ev
alua
tion
of P
MTC
T se
rvic
es
83
101
In
trod
uctio
n 83
102
O
pera
tiona
l Gui
delin
es
85
Bib
liogr
aphy
91
Job
Aid
sR
efer
ence
s
91
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
App
endi
x V
I
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
100
App
endi
x V
C
OM
MO
N A
DV
ERSE
EFF
ECTS
OF
AR
V U
SE D
UR
ING
PR
EGN
AN
CY
Cla
ss
Adv
erse
effe
cts
Nuc
leos
ide
Nuc
leot
ide
Rev
erse
Tra
nscr
ipta
se In
hibi
tors
( NR
TIs)
Zido
vudi
ne(A
ZT)
Nau
seau
La
miv
idin
e (3
TC)
Dia
rhoe
a
Stav
udin
e (d
4T)
Hyp
erse
nsiti
vity
(AB
C)
Aba
cavi
r(A
BC
) A
naem
ia(A
ZT)
Teno
fovi
r(TF
VTD
F)
Emitr
icita
bine
(FTC
)
Non
- Nuc
leos
ide
Rev
erse
Tra
nscr
ipta
se In
hibi
tors
(NN
RTI
s)
Nev
irapi
ne(N
VP)
Del
avird
in
Efav
irenz
(EFV
)
Pro
teas
e In
hibi
tors
(PIs
)
Saqu
inav
ir(SQ
V)
Indi
navi
r(ID
V)
Rito
navi
r(R
TV)
Nel
finav
ir(N
LF)
Lopi
navi
rrito
navi
r(LP
Vr)
A
taza
navi
r(A
TV)
Fose
mpr
enav
ir Ti
pana
vir(
TPV)
D
arun
avir(
DR
V)
Ras
h
Elev
ated
live
r enz
ymes
(c
omm
on w
ith N
VP in
hig
h C
D4
co
unt)
EFV
CN
S ef
fect
s(se
datio
n in
-so
mni
a v
ivid
dre
ams
diz
zine
ss
conf
usio
n fe
elin
g of
lsquod
isen
gage
men
trsquo
Tera
toge
nici
ty
GI i
ntol
eran
ce
Hep
atot
oxic
ity
Lipo
dyst
roph
y
Dys
lipid
emia
s
Insu
lin re
sist
ance
Hyp
ergl
ycae
mia
La
ctic
aci
dosi
s an
d he
patic
ste
a-to
sis
Cou
nsel
ing
and
Follo
w-u
p Ti
ps
May
not
be
wel
l-tol
erat
ed in
ear
l pr
egna
ncy
whe
n
mor
ning
sic
knes
s is
com
mon
M
ay in
crea
se ri
sk o
f non
-ad
here
nce
May
hav
e in
adeq
uate
blo
od le
vels
A
ll A
RVs
sho
uld
be d
isco
ntin
ued
and
rest
arte
d w
hen
Namp
V is
gon
e or
effe
ctiv
ely
trea
ted
Fo
llow
-up
labs
CB
C L
FTs
If ra
sh in
1st
2 w
ks d
o no
t inc
reas
e N
VP d
ose
and
cont
act c
linic
ian
Mild
rash
may
be
man
aged
with
an
tihis
tam
ines
A
void
cor
ticos
tero
ids
durin
g N
VP
dose
esc
alat
ion
EFV
shou
ld b
e ta
ken
initi
ally
at
bed
time
Avo
id E
FV in
wom
en o
f hig
h ch
ild-b
earin
g po
tent
ial
Do
not o
pera
te h
eavy
mac
hine
ry
Mon
itor g
luco
se le
vels
A
sk re
gula
rly fo
r sym
ptom
s of
hy
perg
lyca
emia
M
onito
r hep
atic
tran
sam
inas
es
(ALT
and
AST
) par
ticul
arly
dur
ing
the
first
18
wee
ks o
f the
rapy
w
hen
this
toxi
city
is m
ost l
ikel
y Ta
ke w
ith fo
od
Ant
iem
etic
s A
ntim
otili
ty
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
App
endi
ces
92
App
endi
x I
WH
O C
linic
al S
tagi
ng o
f HIV
AID
S fo
r A
dults
and
A
dole
scen
ts w
ith C
onfir
med
HIV
infe
ctio
n 92
App
endi
x II
C
ontr
acep
tive
Opt
ions
for
Peop
le L
ivin
g w
ith H
IV
95
App
endi
x II
I U
se o
f AR
Vs
for
Trea
tmen
t and
PM
TCT
of H
IV in
AN
C
97
App
endi
x IV
Use
Of A
RV
s fo
r PM
TCT
of H
IV in
Lab
our
And
Del
iver
y U
nit
98
App
endi
x V
Com
mon
Adv
erse
Effe
cts
of A
RV
Use
Dur
ing
Preg
nanc
y 99
App
endi
x V
I D
iagn
ostic
alg
orith
m fo
r pu
lmon
ary
TB in
Chi
ldre
n 10
0
App
endi
x V
II I
nteg
rate
d M
onito
ring
and
Eval
uatio
n Re
port
For
m M
OH
726
10
3
App
endi
x V
III
Rep
rodu
ctiv
e H
ealth
HIV
AID
S R
epor
t For
m M
OH
711
10
4
Lis
t of T
able
s
Tabl
e 1
1 A
dult
HIV
-pre
vale
nce
Est
imat
e by
Pro
vinc
e in
200
6 21
Tabl
e 1
2 E
stim
ated
Mag
nitu
de o
f MTC
T in
Ken
ya 2
007
22
Tabl
e 1
3 Tr
ansm
ission
Pat
tern
s in
Brea
stfee
ding
and
Non
bre
astfe
edin
g Pop
ulat
ions
23
Tabl
e 1
4 R
isk
Fact
ors
for
MTC
T of
HIV
24
Tabl
e 1
5 Th
e Fo
ur-p
rong
ed A
ppro
ach
App
lied
to th
e PM
TCT
Gui
delin
es
30
Tabl
e 2
1 E
ssen
tial P
acka
ge o
f Int
egra
ted
Ant
enat
al C
are
Serv
ices
33
Tabl
e 4
1 R
ecom
men
datio
ns fo
r In
itiat
ing
AR
V T
reat
men
t in
Preg
nant
Wom
en B
ased
on
Clin
ical
Sta
ge a
nd A
vaila
bilit
y of
CD
4 co
unt
44
Tabl
e 4
2 R
ecom
men
ded
Firs
t Lin
e A
RT
Reg
imen
for
Trea
ting
Preg
nant
Wom
en a
nd P
roph
ylac
tic R
egim
en fo
r In
fant
s 45
Tabl
e 4
3a R
ecom
men
ded
Firs
t Lin
e A
RV
Pro
phyl
axis
to P
reve
nt H
IV
46
Infe
ctio
n in
Infa
nts
Am
ong
preg
nant
Wom
en P
rese
ntin
gB
efor
e 38
Wee
ks
Tabl
e 4
3b A
ltern
ativ
e A
RV
Pro
phyl
axis
to P
reve
nt H
IV In
fect
ion
in In
fant
s 4
6 A
mon
g Pr
egna
nt W
omen
Pre
sent
ing
Bef
ore
38 W
eeks
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
9
9
47
IV
Wom
en w
ho h
ave
not r
ecei
ved
Intr
apar
tum
AR
T or
A
RV
Pro
phyl
axis
with
H
IV
Infe
ctio
n
Tabl
e 4
4 A
RV
Pro
phyl
axis
for
PMTC
T am
ong
Preg
nant
Wom
en w
ho h
ave
not r
ecei
ved
Ant
enat
al A
RT
or P
roph
ylax
is
App
endi
x Ta
ble
45
Cho
ice
of H
AA
RT
for
Preg
nant
Wom
en b
ased
on
CD
4 co
unt
47
Tabl
e 4
6 A
RV
Pro
phyl
actic
Reg
imen
s fo
r In
fant
s B
orn
to H
IV-p
ositi
ve
49
Tabl
e 9
1 D
ose
of C
o-tr
imox
azol
e fo
r PC
P pr
ophy
laxi
s 76
Tabl
e 9
2 W
HO
Rec
omm
enda
tions
for
Follo
w-u
p of
an
HIV
-exp
osed
Chi
ld
79
Tabl
e 10
1 C
ontr
acep
tive
Met
hods
for
Use
in C
oupl
es a
nd W
omen
Liv
ing
96
Figu
re 2
1 R
apid
HIV
Ser
ial T
estin
g A
lgor
ithm
35
Figu
re 8
1 G
uide
lines
for
Cou
nsel
ling
on H
IV a
nd In
fant
feed
ing
66
Job
Aid
s an
d IE
C M
ater
ials
on
Infa
nt a
nd Y
oung
Chi
ld F
eedi
ng
67
List
of F
igur
es
Figu
re 1
01
Mon
itori
ng a
nd E
valu
atio
n D
ata
Flow
in K
enya
84
September 0 8
USE OF ARVs FOR PMTCT OF HIV IN LABOUR AND DELIVERY UNITSALL MOTHERS
1 History 2 Examination3 Establish motherrsquos HIV status4 Offer HIV counseling and testing for mother with unknown HIV status5 Provide standard obstetrical management and care
HIV NEGATIVECounsel on risk reduction
HIV POSITIVE
Establish Motherrsquos use of ARVs in pregnancy and give appropriate ARVs as shown in boxesbelow
Regardless of Duration received HAART
Action
i Give mother ARV dose as per regimen
ii Post partu m Infant Give Infant sd Nevi rapine 2mgkg with in 72 hours of birthPL US 3T C 4mgkg BD for 1 w eek an d AZT syrup 4 m gkg BD for 6 w eeks
iii Post partum mother Continue w ith AR Vs as per regimen
MOTHE R RECEIVED HAART IN PREGNANCY
F OR MORE INFORMAT ION CONT ACT THE NATIONAL AIDSSTD CONTROL PROGRAMME (NASCOP)PO BO X 19361-00202 NAIROBI TEL 0202729502 FAX 020 2710518
MINISTRY OF HEALTH
bull G ive mo ther sd Nevirap ine 200m g AZT 600mg and 3TC 150 mg stat
bull Post partum Infant Give Infant sd Nevirapine 2mgkg within 72 ho urs of birth PL US
3TC syrup 4mg kg BD for 1 week and AZT syrup 4 mg kg BD fo r 6 w eeks
bull Post partum mother Give moth er AZT 300mg amp 3TC 150 mg BID for 7 d ays
MO THER RECEIVED AZT IN PREGNANCY OR NO ARVs TAKE N IN PREGNANCY
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
98
MINISTRY OF HEALTH
USE OF ARVs FOR TREATMENT AND PMTCT OF HIV IN ANC
App
endi
x II
I
Ack
now
ledg
emen
ts
ALL M O THERS1 History 2 Health Information3 Examination4 In vestigations (with informed consent for HIV test)
HIV NEGATIVE1 P rov id e pos t-te s t HIV pr ev e nti v e
i nter ve ntion s defi ned i n na tion alHT C gui de li nes
2 Re fe r for othe r p os t-te st HIVp re ve ntive inte rv e nti ons no tavai lable in the cli nic b ut avail ab le w ithi n the fa c ili ty
HIV PO SI TI VE1 C ounsel on risk reduction2 Per form WH O clinical staging for H IV disease3 D etermine CD 4 level (if testing facilities available)4 D etermine Gestation age and HB level5 Give ARVrsquos as shown below6 Provide or refer for other post-test HIV interventions defined in national HTC
guidelines
1 WHO clin ica l stage I o r II w ith CD4 cell co unt gt 350mm3 OR 2 WHO clin ica l stage I o r II no CD4 cell co unt do ne3 HB =8 gdl OR n o clinical feat ures of anaemia
bull Initiate AZT 30 0mg BD daily at 28 weeks gestation or any time periodimmediately there after
bull Monitor for clinical featur es of anemia and treatbull Dispense ANC Nev ir apine 200mg PLUS AZT 600mg + 3TC 1 50mg for
moth er to tak e at onset of labourbull Dispense NVP syrup to give infant at birth
bull At on set o f l abo uro Administer Nevirapine 20 0mg AZT 600mg 3TC 150 mg
stat to moth erbull Post p artum
o Give Infa nt sd Nevirapine 2mgk g within 72 hours ofbirth PLUS 3TC 4mg BD for 1 w eek and AZT syrup 4 mgkg BD for 6 w eeks
o Give mother AZT30 0 mg 3 TC 150 BID for 7 day s
1 WHO clinical stag e I or II with CD4 c ell count gt 35 0 mm3 OR 2 WHO clinical stag e I or II w ith no C D4 c ell c ount done
bull Dispense ANC Nevirapine 2 00mg PLUS AZ T 600 mg + 3TC 150mgfo r mo ther to take at onse t of labour
bull Dispense NVP sy rup to give infant at birthbull At Onset of lab our
o Administe r sd Nevirapine AZT 6 00 mg and 3TC1 50mg stat
bull Po st Par tu mo G iv e Infant sd Nev ir apine 2mg kg w ithin 72
h ours of bir th PLUS 3T C 4mgkg BD fo r 1 week a nd AZT syrup 4mgkg BD for 6 we eks
o G iv e mother AZ T300 mg 3TC 1 50 mg BID for 7d ays
1 Any gest ational age2 WHO clin ica l stage III or IV of HIV dis ease regardles s of CD4 cell count OR3 WHO clin ica l stages I or II of HIV d is ease with CD4 cell count =350mm3 ()
bull Refer to Clinician for Evaluation and initiation of NNRTI based ART as pernation al ART guidelines
bull At O nset of Lab ou ro G ive mo ther ARV dos e as per r egimen
bull Post par tumo G ive Infan t sd Nev ira pine 2mgkg within 72 hours of b irth PLUS
3TC 4mgkg and AZT syr up 4 mgkg BD for 6 weeks o G ive mo ther ARVs as per regimen
4 If no HAART av ailable man age the wo man as ind icated in box no2 a nd refer to ARTsite appro priately
F O R M OR E IN FOR M AT IO N CO N T AC T T H E N ATI ON A L A IDS STD C O NTR O L PR O G RAM ME ( N ASC O P)P O B OX 19361-00202 N AIR OBI TEL 0202729502 FAX 020 2710518
EL IGIBL E FO R T R EATMEN T
N O T E LIG IBLE FO R TR EA TM ET AN D PR ESE NTING B ELO W 3 8 W EE KSGESTA TIO N N OT ELIGIB LE FOR TREA TMEN T AN D PR ESE NTING gt 3 8 W EEK S
GE STATIO N
Plea se notebull Pregnan t w omen with WHO clinical stag e I or II plus CD4 cell co unt gt250 mm3 and = 350 mm3 can be initiated on ART wher e a PI based HAART re gimen is av ailable NVP hypersen sitivity h as been previously r eported amon g women in this gr oup initiated on N NRT I based
ART re gimens Where PI ba sed ART reg imen is not av ailab le r efer the patient to a site whe re th e regimen is availab le or c ontinue to ma nage th e w oman a s is indicated in box No 2bull The grading of ana emia in pregna ncy is gt 8-10 Milda nemia gt 6 -8 Moderate anem ia lt 6 Sever e anemiabull Treatment if common p ath ologies ruled out Mild anae mia haematinics irrespectiv e of gestatio n Moder ate a naemia tr ansfusion if close to term gt36 weeks otherwise give haema tinics Severe an aemia transfus ion irr espe ctive of ge statio n Do not stop AZT if Hb dr op s but
would manage it as above and only stop if continues to fall or fails to res pon d des pite transfusion
The
thir
d ed
ition
of
Gui
delin
es f
or P
reve
ntio
n of
Mot
her-
to-C
hild
Tra
nsm
issi
on o
f H
IV A
IDS
in K
enya
is a
res
ult o
f effo
rts
of m
any
indi
vidu
als
and
orga
niza
tions
in th
eco
untr
y T
he T
echn
ical
Wor
king
Gro
up o
n PM
TCT
led
thes
e ef
fort
s M
embe
rs o
f the
te
am r
evie
wed
all
the
mod
ules
rev
ised
and
in s
ome
case
s re
-wro
te th
e m
odul
es b
ased
on
the
seco
nd e
ditio
n to
mak
e th
em u
p to
dat
e an
d in
line
with
cur
rent
sci
entif
ic e
vishy
denc
e an
d ex
peri
ence
We
ackn
owle
dge
the
cont
ribu
tors
and
rev
iew
ers
of t
he c
urre
ntan
d pr
evio
us e
ditio
ns O
f sp
ecia
l m
entio
n ar
e th
e fo
llow
ing
Ken
ya O
bste
tric
al a
nd
Gyn
aeco
logi
cal S
ocie
ty (K
OG
S) t
he U
nive
rsity
of N
airo
bi a
nd M
oi U
nive
rsity
We
wou
ld l
ike
to t
hank
the
fol
low
ing
inst
itutio
ns f
or t
echn
ical
as
wel
l as
fin
anci
al
supp
ort
duri
ng t
he r
evis
ion
of t
he g
uide
lines
N
atio
nal A
IDS
and
STD
Con
trol
Pro
shygr
amm
e (N
ASC
OP)
the
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
Cen
ters
for
Dis
ease
Con
trol
and
Prev
entio
n (C
DC
) It
is n
ot p
ossi
ble
to m
entio
n al
l ind
ivid
uals
and
org
aniz
atio
ns
that
par
ticip
ated
in th
is im
port
ant e
xerc
ise
To
all o
f you
Asa
nte
Sana
Min
istr
y of
Hea
lth
September 2008
97
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
10
Fore
wor
d
The
Min
istr
y of
Hea
lth (
MoH
) is
com
mitt
ed t
o de
velo
pmen
t of
effe
ctiv
e PM
TCT
proshy
gram
mes
Gui
delin
es a
re a
n im
port
ant
part
of t
he G
over
nmen
t st
rate
gy t
o re
duce
MTC
Tan
d is
in
line
with
the
Nat
iona
l H
ealth
Sec
tor
Stra
tegi
c Pl
an I
I (N
HSS
PII)
and
Ken
yaN
atio
nal A
IDS
Stra
tegi
c Pl
an (K
NA
SP) 2
000-
2010
whi
ch fo
cuse
s on
pri
ority
are
as o
f pre
shyve
ntio
n of
new
infe
ctio
ns i
mpr
ovin
g qu
ality
of l
ife o
f tho
se in
fect
ed a
nd a
ffect
ed a
nd m
itishy
gatio
n of
soc
ial a
nd e
cono
mic
impa
ct o
f the
infe
ctio
n
MTC
T is
the
pre
dom
inan
t m
ode
of t
rans
mis
sion
of
HIV
in
infa
nts
and
youn
g ch
ildre
n
This
tra
nsm
issi
on o
ccur
s du
ring
pre
gnan
cy
labo
ur a
nd d
eliv
ery
and
am
ong
brea
stfe
d ba
bies
in
the
post
-par
tum
per
iod
Mem
bers
of t
he T
echn
ical
Wor
king
Gro
up (T
WG
) on
PMTC
T re
view
ed t
he m
odul
es o
f the
se
cond
edi
tion
rev
ised
and
in s
ome
case
s re
-wro
te th
e m
odul
es b
ased
on
up to
dat
e kn
owlshy
edge
and
in
line
with
cur
rent
sci
entif
ic e
vide
nce
and
expe
rien
ce T
he T
WG
con
sist
s of
agr
oup
of p
rofe
ssio
nals
dra
wn
from
var
ious
dis
cipl
ines
tha
t ar
e im
plem
entin
g an
dor
man
shyag
ing
PMTC
T T
he g
roup
ado
pted
and
ada
pted
the
late
st r
ecom
men
datio
ns o
f the
WH
O o
nPM
TCT
as w
ell a
s va
riou
s na
tiona
l gui
delin
es o
n H
IV p
reve
ntio
n tr
eatm
ent a
nd c
are
A f
our-
pron
ged
appr
oach
thr
ough
the
var
ious
rep
rodu
ctiv
e lif
e cy
cles
as
prop
osed
by
the
Inte
r-A
genc
y Ta
sk T
eam
(IA
TT)
on c
hild
ren
and
HIV
and
AID
S w
as a
dopt
ed i
n th
ese
guid
elin
es w
ith e
mph
asis
bei
ng p
lace
on
all t
he fo
ur p
rong
s
For
any
of t
he P
MTC
T in
terv
entio
ns t
o be
suc
cess
fully
impl
emen
ted
coun
selin
g an
d te
stshy
ing
(CT)
mus
t fir
st b
e do
ne R
outin
e H
IV te
stin
g w
ith o
pt-o
ut o
ptio
n is
rec
omm
ende
d T
his
is fo
llow
ed b
y ap
prop
riat
e m
edic
al s
urgi
cal i
nter
vent
ions
incl
udin
g an
tiret
rovi
ral p
roph
yshyla
xis
saf
er o
bste
tric
pra
ctic
es a
s w
ell a
s in
fant
feed
ing
coun
selin
g an
d pr
ovis
ion
of a
ppro
shypr
iate
infa
nt fe
edin
g H
IV-p
ositi
ve w
omen
are
ass
esse
d cl
inic
ally
usi
ng W
HO
sta
ging
and
whe
re f
easi
ble
imm
unol
ogic
al a
sses
smen
t us
ing
CD
4 ce
ll co
unt
HIV
exp
osed
infa
nts
are
test
ed th
roug
h ea
rly
infa
nt d
iagn
osis
(EID
)
In th
ese
guid
elin
es m
ore
effic
acio
us r
egim
ens
are
intr
oduc
ed fo
r th
e fir
st ti
me
whi
le in
forshy
mat
ion
and
coun
selin
g on
inf
ant
feed
ing
follo
ws
the
AFA
SS (
Ava
ilabl
e f
easi
ble
acc
eptshy
able
saf
e an
d su
stai
nabl
e) c
rite
ria
The
mod
ule
on m
onito
ring
and
eva
luat
ion
addr
esse
s is
sues
of d
ata
colle
ctio
n c
olla
tion
and
repo
rtin
g as
wel
l as
use
of d
ata
for
deci
sion
-mak
ing
at th
e fa
cilit
y-le
vel
We
hope
that
app
ropr
iate
impl
emen
tatio
n in
stru
men
ts w
ill b
e us
ed to
ope
ratio
naliz
e th
ese
guid
elin
es
Tabl
e 11
1
Con
trac
eptiv
e M
etho
ds fo
r Use
in
Cou
ples
and
Wom
en L
ivin
g w
ith H
IV In
fect
ion
MET
HO
D
CO
MM
ENTS
Con
dom
s bull
M
ale
amp f
emal
e co
ndom
s av
aila
ble
bull
P
rovi
de d
ual p
rote
ctio
n ag
ains
t STI
sH
IV
amp p
regn
ancy
bull
R
equi
re a
ttent
ion
amp ca
re
for c
orre
ct u
se e
ach
time
bull
M
ay re
quire
co-
oper
atio
n of
par
tner
Hor
mon
al
bull V
ery
effe
ctiv
e an
d ea
sy to
use
M
etho
ds
bull S
uita
ble
for s
hort-
or lo
ng-
term
use
bull
Rev
ersi
ble
bull A
ssoc
iate
d w
ith n
on-
cont
race
ptiv
e he
alth
ben
efits
bull
Ser
ious
com
plic
atio
ns
extre
mel
y ra
re
Intra
uter
ine
bull
H
ighl
y ef
fect
ive
long
-term
C
ontra
cept
ive
reve
rsib
le m
etho
d
Dev
ice
bull
Rem
ains
in p
lace
up
to 1
2 ye
ars
bull
A
lmos
t 100
per
cent
ef
fect
ive
bull
H
as n
o ef
fect
on
ferti
lity
whe
n us
ed b
y nu
llipar
ous
wom
en
bull
Sho
uld
not b
e pr
ovid
ed to
w
omen
with
hig
h ris
k se
xual
life
styl
e bull
B
acte
rial S
TIs
shou
ld b
e sc
reen
ed fo
r and
or
treat
ed a
s a
prec
autio
n pr
ior t
o in
serti
on o
f IU
CD
Ste
riliz
atio
n bull
Goo
d v
ery
effe
ctiv
e fo
r co
uple
s or
indi
vidu
als
who
w
ant n
o m
ore
child
ren
bull S
afe
sim
ple
surg
ical
pr
oced
ure
Con
side
red
perm
anen
t
US
E IN
HIV
PO
SITI
VE
PA
TIE
NTS
bull
Can
and
sho
uld
be u
sed
at a
ll st
ages
of H
IV
infe
ctio
n bull
C
an a
nd s
houl
d be
use
d by
pat
ient
s on
AR
T
bull
Cor
rect
and
con
sist
ent u
se b
y H
IV in
fect
ed p
atie
nts
is
reco
mm
ende
d re
gard
less
of t
he u
se o
f oth
er m
etho
ds
of c
ontra
cept
ion
(dua
l con
trace
ptio
n)
bull C
an b
e us
ed w
ithou
t res
trict
ion
in H
IV+
wom
en n
ot o
n AR
T bull
Can
be
used
with
out r
estri
ctio
n in
all
HIV
+ w
omen
for
emer
genc
y co
ntra
cept
ion
bull S
ome
AR
V dr
ugs
may
redu
ce m
etho
d ef
fect
iven
ess
bull
DM
PA
Im
plan
ts c
an h
owev
er b
e us
ed w
ith A
RT
reshy
inje
ctio
n of
DM
PA
sho
uld
be d
one
at 1
0-12
wee
ks
bull If
horm
onal
met
hod
is c
hose
n c
ondo
ms
shou
ld s
till b
e us
ed c
orre
ctly
and
con
sist
ently
bull
Attr
activ
e m
etho
d fo
r wom
en w
ith H
IV w
ho d
esire
ver
y re
liabl
e pr
egna
ncy
prot
ectio
n bull
C
an b
e in
serte
d in
HIV
+ w
omen
who
do
not h
ave
WH
O
Sta
ge 4
dis
ease
AID
S d
efin
ing
illne
ss
bull
For w
omen
with
sta
ge 4
dis
ease
IUD
can
be
inse
rted
once
they
are
on
ART
and
have
con
trolle
d sy
mpt
oms
of s
ever
e ill
ness
bull N
o m
edic
al re
ason
s to
den
y st
eriliz
atio
n to
clie
nts
w
ith H
IV
bull P
roce
dure
may
be
dela
yed
in e
vent
of a
cute
HIV
-rel
ated
in
fect
ion
or s
tage
4 d
isea
se p
endi
ng im
mun
e re
cons
titut
ion
bull E
ncou
rage
con
dom
use
as
wel
l
DM
PA =
Dep
ot M
edro
xypr
oges
tero
ne A
ceta
te (D
epo-
Prov
era)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
1
96
App
endi
x II
CO
NTR
AC
EPTI
VE
OPT
ION
SFO
R P
EOPL
E L I
VIN
G W
ITH
HIV
It
has
bee
n sh
own
in a
num
ber
of s
tudi
es o
f coh
orts
of H
IV p
ositi
ve w
omen
tha
t so
me
choo
se t
o co
ntin
ue s
exua
l act
ivity
des
pite
kno
wle
dge
of t
heir
sta
tus
Evi
denc
e of
con
shyce
ptio
n ha
s de
mon
stra
ted
that
fert
ility
in H
IV p
ositi
ve w
omen
for
the
mos
t pa
rt is
unshy
affe
cted
H
owev
er c
erta
in c
ondi
tions
may
affe
ct fe
rtili
ty s
uch
as lo
w b
ody
mas
s in
dex
A
IDS
and
inte
rcur
rent
illn
ess
esp
ecia
lly t
uber
culo
sis
Put
ting
wom
en w
ho a
re H
IV
infe
cted
on
cont
race
ptiv
es is
one
of t
he m
eans
of p
reve
ntin
g m
othe
r to
chi
ld t
rans
mis
shysi
on o
f HIV
(PM
TCT)
It is
the
rig
ht o
f HIV
infe
cted
wom
en t
o m
ake
thei
r ow
n de
cisi
ons
rega
rdin
g re
prod
ucshy
tion
The
y m
ay w
ish
to h
ave
mor
e ba
bies
lim
it th
eir
fam
ilies
or
avoi
d pr
egna
ncy
alto
shyge
ther
The
hea
lth c
are
prov
ider
s th
ey c
onsu
lt sh
ould
ena
ble
them
to
mak
e in
form
edch
oice
s by
them
selv
es
The
follo
win
g co
ntra
cept
ive
met
hods
are
ava
ilabl
e in
Ken
ya -
pro
gest
eron
e on
ly p
ills
lo
w d
ose
com
bine
d or
al c
ontr
acep
tives
de
pot
med
roxy
prog
este
rone
ace
tate
(D
MPA
shyde
po)
levo
norg
estr
el a
nd e
tono
gest
rel i
mpl
ants
Em
erge
ncy
cont
race
ptiv
e pi
lls c
oppe
rin
trau
teri
ne c
ontr
acep
tive
devi
ces
bar
rier
met
hods
fem
ale
and
mal
e st
erili
satio
n ar
e al
so a
vaila
ble
Som
e dr
ugs
inte
ract
with
hor
mon
al c
ontr
acep
tives
A
nd c
oncu
rren
t us
e sh
ould
be
avoi
ded
The
se d
rugs
incl
ude
bull P
rote
ase
inhi
bito
rs ndash
Rito
navi
r N
elfin
avir
Lop
inav
ir w
ith R
itona
vir
bull N
on-n
ucle
otid
e re
vers
e tr
ansc
ript
ase
inhi
bito
rs (
NN
RT
Is)
ndash N
evir
apin
e
bull E
favi
renz
bull A
nti-T
B d
rugs
ndash R
ifam
pici
n an
d R
ifabu
tin
bull O
ther
dru
gs ndash
Gris
eofu
lvin
P
heno
barb
itone
C
arba
maz
epin
e P
heny
toin
All
the
abov
e do
not
app
ly i
n th
e fa
ce o
f ot
her
med
ical
con
ditio
ns t
hat
are
cont
ra-
indi
catio
ns f
or t
he v
ario
us m
etho
ds e
g k
now
n ca
rdio
vasc
ular
dis
ease
hep
atic
con
dishy
tions
sm
okin
g h
igh
bloo
d pr
essu
re a
nd th
rom
boem
bolic
dis
orde
rs
The
follo
win
g ta
ble
sum
mar
ises
maj
or is
sues
reg
ardi
ng u
se o
f diff
eren
t co
ntra
cept
ives
by H
IV-p
ositi
ve w
omen
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Abb
revi
atio
ns a
nd A
cron
yms
AFA
SS
Acc
epta
ble
Fea
sibl
e A
fford
able
Sus
tain
able
and
Saf
e
Ab
Ant
i-bod
y
AID
S A
cqui
red
Imm
une
Def
icie
ncy
Synd
rom
e
ALT
Ala
nine
Tra
nsfe
rase
AN
C
Ant
enat
al C
are
AR
M
Art
ifici
al R
uptu
re o
f Mem
bran
es
AR
T
Ant
iret
rovi
ral T
hera
py
A
RV
A
ntir
etro
vira
l
AZT
A
zido
thym
idin
e (Z
idov
udin
e or
ZD
V)
AZT
3TC
Com
bivi
r
3TC
Lam
ivud
ine
BC
C
Beh
avio
ur C
hang
e C
omm
unic
atio
n
BC
G
Bac
ille
Cal
met
te G
ueri
ne v
acci
ne
BFH
I B
aby
Frie
ndly
Hos
pita
l Ini
tiativ
e
BID
BD
ldquoT
wic
e a
dayrdquo
CD
C (K
) C
entr
es fo
r D
isea
se C
ontr
ol a
nd P
reve
ntio
n K
enya
CN
S C
entr
al N
ervo
us S
yste
m
CS
Cae
sare
an S
ectio
n
CT
Cou
nsel
ling
and
Test
ing
CTX
CTZ
Cot
rim
oxaz
ole
d4T
Stav
udin
e
D
ASC
O
Dis
tric
t AID
SST
I Coo
rdin
ator
G
uid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
5
12
DB
S D
ried
Blo
od S
pot s
peci
men
DN
A
Deo
xyri
bonu
clei
c A
cid
DR
H
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
EC
V
Ext
erna
l Cep
halic
Ver
sion
EFV
Efa
vire
nz
EID
E
arly
Infa
nt D
iagn
osis
ELI
SA
Enz
yme
Link
ed Im
mun
osor
bent
Ass
ay
FBC
Fu
ll B
lood
Cou
nt
GTZ
G
erm
an T
echn
ical
Coo
pera
tion
HA
AR
T
Hig
hly
Act
ive
Ant
iret
rovi
ral T
hera
py
Hb
Hae
mog
lobi
n
HIV
H
uman
Imm
unod
efic
ienc
y Vi
rus
IATT
Inte
r-A
genc
y Ta
sk T
eam
IMC
I In
tegr
ated
Man
agem
ent o
f Chi
ldho
od Il
lnes
s
IPPT
Inte
rmitt
ent P
resu
mpt
ive
Trea
tmen
t for
Mal
aria
ITN
s In
sect
icid
es T
reat
ed N
ets
IUC
D
Intr
a U
teri
ne C
ontr
acep
tive
Dev
ice
KD
HS
Ken
ya D
emog
raph
ic a
nd H
ealth
Sur
vey
KE
PI
Ken
ya E
xpan
ded
Prog
ram
me
on Im
mun
izat
ion
KO
GS
Ken
ya O
bste
tric
al a
nd G
ynae
colo
gica
l Soc
iety
KN
H
Ken
yatt
a N
atio
nal H
ospi
tal
LAM
Lact
atio
nal A
men
orrh
oea
Met
hod
Mamp
E
Mon
itori
ng a
nd E
valu
atio
n
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
Cyt
omeg
alov
irus
infe
ctio
n (r
etin
itis
or in
fect
ion
of o
ther
org
ans)
9
Cen
tral
ner
vous
sys
tem
tox
opla
smos
is
10
HIV
enc
epha
lopa
thy
11
Ext
rapu
lmon
ary
cryp
toco
ccos
is in
clud
ing
men
ingi
tis
12
Dis
sem
inat
ed n
on-t
uber
culo
us m
ycob
acte
rial
infe
ctio
n
13
Pro
gres
sive
mul
tifoc
al le
ukoe
ncep
halo
path
y
14
Chr
onic
cry
ptos
pori
dios
is
15
Chr
onic
isos
poria
sis
16
Dis
sem
inat
ed m
ycos
is (
extr
apul
mon
ary
hist
opla
smos
is
or c
occi
diom
ycos
is)
17
Rec
urre
nt s
eptic
aem
ia (
incl
udin
g no
n-ty
phoi
dal S
alm
onel
la)
18
Lym
phom
a (c
ereb
ral o
r B
-cel
l non
-Hod
gkin
s)
19
Inv
asiv
e ce
rvic
al c
arci
nom
a
20
Aty
pica
l dis
sem
inat
ed le
ishm
ania
sis
21
Sym
ptom
atic
HIV
-ass
ocia
ted
neph
ropa
thy
or s
ympt
omat
ic H
IV-
asso
ciat
ed
22
Car
diom
yopa
thy
Ple
ase
note
S
igns
and s
ympto
ms
of
HIV
was
ting s
yndro
me
incl
ude
Unex
pla
ined
invo
lunta
ry w
eight
loss
(gt
10
base
line
body
wei
ght)
with o
bvi
ous
was
ting o
f body
mas
s in
dex
lt185
PLU
S
unex
pla
ined
chro
nic
dia
rrhoea
(lo
ose
or
wat
ery
stools
thre
e or
more
tim
es d
aily
) re
port
ed
for
longer
than
one
month
OR r
eport
s of
feve
r or
nig
ht
swea
ts f
or
more
than
one
month
w
ithout
oth
er c
ause
and lack
of
resp
onse
to a
ntibio
tics
or
antim
ala
rial ag
ents
M
ala
ria
must
be
excl
uded
in m
ala
ria
pro
ne
area
s
Fo
r th
e purp
ose
of
the
WH
O s
tagin
g s
yste
m
adole
sents
and a
dults
are
def
ined
as
adults
aged
ge15 y
ears
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
3
94
CLI
NIC
AL
STA
GE
3 1
Une
xpla
ined
sev
ere
wei
ght
loss
(gt1
0 o
f pr
esum
ed o
r m
easu
red
bo
dy w
eigh
t)
2
Une
xpla
ined
chr
onic
dia
rrho
ea fo
r lo
nger
tha
n on
e m
onth
3
Une
xpla
ined
per
sist
ent
feve
r (a
bove
37
5degC
inte
rmitt
ent
or c
onst
ant
for
long
er t
han
one
mon
th)
4
Per
sist
ent
oral
can
didi
asis
5
Ora
l hai
ry le
ukop
laki
a
6
Pul
mon
ary
tube
rcul
osis
7
Tub
ercu
lous
Lym
phad
enop
athy
8
Sev
ere
bact
eria
l inf
ectio
ns (
such
as
pneu
mon
ia
empy
ema
pyo
myo
sitis
bo
ne o
r jo
int
infe
ctio
n m
enin
gitis
or
bact
erae
mia
)
9
Acu
te n
ecro
tizin
g ul
cera
tive
stom
atiti
s g
ingi
vitis
or
perio
dont
itis
10
Une
xpla
ined
ana
emia
(lt8
gdl
) n
eutr
opae
nia
(lt0
5 times1
09 pe
rlitr
e) a
ndo
r ch
roni
c th
rom
bocy
topa
enia
(lt5
0times10
9 per
litr
e)
CLI
NIC
AL
STA
GE
4 1
HIV
was
ting
synd
rom
e
2
Pne
umoc
ystis
pne
umon
ia
3
Rec
urre
nt s
ever
e ba
cter
ial p
neum
onia
4
Chr
onic
her
pes
sim
plex
infe
ctio
n (o
rola
bial
ge
nita
l or
anor
ecta
l of
mor
e th
an o
ne
mon
thrsquos
dur
atio
n or
vis
cera
l at
any
site
)
5
Oes
opha
geal
can
didi
asis
(or
can
didi
asis
of
trac
hea
bro
nchi
or
lung
s)
6
Ext
rapu
lmon
ary
tube
rcul
osis
exc
ept
Tub
ercu
lous
Lym
ph a
deno
path
y
7
Kap
osirsquos
sar
com
a
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
MC
H
Mat
erna
l and
Chi
ld H
ealth
MoH
M
inis
try
of H
ealth
MSF
M
edic
ins
Sans
Fro
ntie
rs
M
TCT
Mot
her-
To-C
hild
Tra
nsm
issi
on
NA
SCO
P N
atio
nal A
IDS
and
STD
Con
trol
Pro
gram
me
NV
P
Nev
irap
ine
OD
ldquoO
nce
a D
ayrdquo
OI
Opp
ortu
nist
ic In
fect
ion
OPV
O
ral P
olio
Vac
cine
PASC
O
Prov
inci
al A
IDS
STI C
oord
inat
or
PCP
Pneu
moc
ystis
jiro
veci
i pne
umon
ia
PCR
Po
lym
eras
e C
hain
Rea
ctio
n
PI
Prot
ease
Inhi
bito
r
PLW
HA
Pe
rson
sPe
ople
Liv
ing
With
HIV
AID
S
PMTC
T
Prev
entio
n of
Mot
her
To C
hild
Tra
nsm
issi
on
RD
A
Rec
omm
ende
d D
aily
Allo
wan
ce
RH
Rep
rodu
ctiv
e H
ealth
RN
A
Rib
onuc
leic
Aci
d
SdN
VP
Si
ngle
dos
e N
evir
apin
e
SRH
Se
xual
and
Rep
rodu
ctiv
e H
ealth
STD
Se
xual
ly T
rans
mitt
ed D
isea
se
STI
Sexu
ally
Tra
nsm
itted
Infe
ctio
n
TB
Tube
rcul
osis
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
3
14
TBA
s Tr
aditi
onal
Bir
th A
tten
dant
s
TLC
To
tal L
ymph
ocyt
e C
ount
TT
Teta
nus
Toxo
id v
acci
ne
UN
ICE
F U
nite
d N
atio
ns C
hild
renrsquo
s Fu
nd
UN
GA
SS
Uni
ted
Nat
ions
Gen
eral
Ass
embl
y Sp
ecia
l Ses
sion
on
HIV
AID
S
UoN
Uni
vers
ity o
f Nai
robi
VC
T V
olun
tary
Cou
nsel
ling
and
Test
ing
VIA
V
isua
l Ins
pect
ion
usin
g A
ceto
ne
VD
RL
Ven
erea
l Dis
ease
Res
earc
h La
bora
tory
(tes
t for
syp
hilis
)
WH
O
Wor
ld H
ealth
Org
anis
atio
n
WR
P W
alte
r R
eed
Prog
ram
App
endi
x I
WH
O C
LIN
ICA
L S T
AG
ING
OF
HIV
AID
S FO
R A
DU
LTS
AN
D A
DO
LES-
CEN
TSW
ITH
CO
NFI
RM
ED H
IV IN
FEC
TIO
N
CLI
NIC
AL
STA
GE
1
bull
Asy
mpt
omat
ic
bull
Per
sist
ent
gene
raliz
ed ly
mph
aden
opat
hy
CLI
NIC
AL
STA
GE
2 1
Une
xpla
ined
mod
erat
e w
eigh
t lo
ss (
lt10
of
pres
umed
or
mea
sure
d bo
dy w
eigh
t)
2
Rec
urre
nt u
pper
res
pira
tory
tra
ct in
fect
ions
(si
nusi
tis
tons
illiti
s
otiti
s m
edia
and
pha
ryng
itis)
3
Her
pes
Zos
ter
4
Ang
ular
Che
ilitis
5
Rec
urre
nt o
ral u
lcer
atio
n
6
Pap
ular
pru
ritic
eru
ptio
ns
7
Seb
orrh
oeic
der
mat
itis
8
Fun
gal n
ail i
nfec
tions
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
5
92
Bib
liog
raph
y 1
Offic
e of
the
Pres
iden
t N
ational
AID
S C
ontr
ol Counci
l K
enya
Nat
ional H
IVA
IDS
Str
ate
gic
pla
n 2
0056
-20091
0
2
Rep
ublic
of
Ken
ya
Nat
ional AID
S C
ontr
ol C
ounci
l N
atio
nal H
IVA
IDS M
onitori
ng
and E
valu
atio
n F
ram
ework
3
Rep
ublic
of
Ken
ya
Nat
ional AID
S C
ontr
ol C
ounci
l N
atio
nal H
IVA
IDS M
onitori
ng
and E
valu
atio
n I
mple
men
tation M
anual
Job
Aid
sR
efer
ence
s 1
MoH
AN
C R
egis
ters
2
MoH
Mat
ernity
Reg
iste
rs
3
MoH
Post
-nata
l Reg
iste
rs
4
Mat
ernal
and C
hild
Wel
fare
Han
dbook
5
Rep
roduct
ive
Hea
lth S
ervi
ces
month
ly r
eport
6
MoH
Form
726
(Appen
dix
IV)
7
MoH
Form
727
8
MO
H F
orm
711
Exec
utiv
e Su
mm
ary
The
Rev
ised
Gui
delin
es (3
rd
editi
on) f
or P
reve
ntio
n of
Mot
her
to C
hild
Tra
nsm
issi
on(P
MTC
T) o
f H
IV a
nd A
IDS
addr
esse
s th
e ri
sks
of m
othe
r-to
-chi
ld t
rans
mis
sion
(MTC
T) o
f H
IV a
nd A
IDS
usin
g m
ore
effic
acio
us in
terv
entio
ns t
han
in t
he p
revi
ous
editi
ons
The
Gui
delin
es a
re i
n lin
e w
ith K
enya
rsquos N
atio
nal
Hea
lth S
ecto
r St
rate
gic
Plan
II
(NH
SSP
II)
and
are
anch
ored
on
the
Ken
ya N
atio
nal
AID
S St
rate
gic
Plan
(KN
ASP
) 20
00-2
010
whi
ch f
ocus
es o
n th
e pr
iori
ty a
reas
of
prev
entio
n of
new
inf
ecshy
tions
im
prov
ing
the
qual
ity o
f life
of p
eopl
e in
fect
ed a
nd a
ffect
ed b
y H
IV a
nd A
IDS
and
miti
gatio
n of
the
soc
ial a
nd e
cono
mic
impa
ct o
f the
infe
ctio
n O
ne o
f the
pri
ority
ar
eas
of N
HSS
P II
is
adhe
renc
e to
set
clin
ical
and
pub
lic h
ealth
sta
ndar
ds
The
Gui
delin
es w
ere
deve
lope
d th
roug
h a
part
icip
ator
y an
d co
nsul
tativ
e pr
oces
s th
at
drew
par
ticip
ants
fro
m p
ublic
hea
lth i
nstit
utio
ns
NG
Os
FB
Os
aca
dem
ic a
nd r
eshyse
arch
ins
titut
ions
and
dev
elop
men
t pa
rtne
rs
The
proc
ess
was
co-
ordi
nate
d by
N
ASC
OP
with
tech
nica
l and
fina
ncia
l sup
port
from
CD
C (K
)
HIV
infe
ctio
n ha
s re
vers
ed g
ains
rea
lised
in c
hild
hea
lth a
nd s
urvi
val i
n th
e la
st d
ecshy
ade
in K
enya
The
infe
ctio
n ha
s al
so c
ontr
ibut
ed s
igni
fican
tly t
o th
e co
mm
on c
ompl
ishyca
tions
of
preg
nanc
y in
man
y co
untr
ies
Glo
bally
mor
e th
an 6
300
00 c
hild
ren
wer
ein
fect
ed w
ith H
IV t
hrou
gh M
TCT
in 2
003
In
2007
K
enya
had
a p
opul
atio
n es
tishym
ated
at
34 m
illio
n t
he n
umbe
r of
bir
ths
per
annu
m w
as 1
73
mill
ion
the
HIV
prev
alen
ce a
mon
g pr
egna
nt m
othe
rs w
as 6
7 p
er c
ent
and
the
tota
l num
ber
of b
irth
s to
HIV
-infe
cted
mot
hers
exp
osed
to
MTC
T w
as 1
638
00
Ass
umin
g a
tran
smis
sion
rate
of 4
0 pe
r ce
nt a
nd in
the
abs
ence
of a
ny in
terv
entio
n t
he n
umbe
r of
HIV
pos
ishytiv
e in
fant
s pe
r an
num
wou
ld b
e 65
520
Ken
ya A
IDS
Indi
cato
r su
rvey
(KA
IS) 2
007
HIV
ser
opre
vale
nce
amon
g ad
ults
age
d 15
-49
year
s is
78
Var
ious
inte
rven
tions
hav
e be
en p
ut in
pla
ce t
o re
spon
d to
the
em
ergi
ng c
halle
nges
an
d co
nstr
aint
s to
MTC
T ac
ross
the
cou
ntry
Ana
lysi
s of
effe
ctiv
enes
s of
the
var
ious
ap
proa
ches
nee
ded
to m
anag
e ri
sks
of M
TCT
prov
ides
val
uabl
e in
sigh
ts th
at n
eces
sishy
tate
the
ado
ptio
n of
mor
e ef
ficac
ious
car
e an
d tr
eatm
ent
regi
men
s T
hese
ins
ight
s ha
ve in
form
ed t
he d
evel
opm
ent
of n
ew G
uide
lines
The
Gui
delin
es in
corp
orat
e th
ese
chan
ges
and
are
reco
mm
ende
d fo
r us
e by
hea
lth p
rofe
ssio
nals
and
hea
lth in
stitu
tions
at a
ll le
vels
of c
are
The
Gui
delin
es w
ill e
nhan
ce th
e ca
paci
ty o
f hea
lth c
are
prov
ider
sto
giv
e m
ore
effic
ient
and
effe
ctiv
e se
rvic
es t
o H
IV p
ositi
ve e
xpec
tant
mot
hers
and
ne
wbo
rns
The
Gui
delin
es h
ave
ten
chap
ters
and
cov
er th
e fo
llow
ing
just
ifyin
g th
e ne
ed fo
r sp
eshyci
fic m
anag
emen
t of
HIV
pos
itive
wom
en c
are
befo
re d
urin
g an
d af
ter
preg
nanc
yus
e of
ant
iret
rovi
ral t
hera
py in
pre
gnan
cy p
ostn
atal
car
e fa
mily
pla
nnin
g e
arly
inshy
fant
dia
gnos
is
feed
ing
car
e an
d fo
llow
-up
of H
IV-in
fect
ed i
nfan
ts
and
mon
itori
ng
and
eval
uatio
n A
dditi
onal
inf
orm
atio
n on
WH
O s
tagi
ng
cont
race
ptiv
e op
tions
for
PLW
As
and
a su
mm
ary
of A
RV
use
in P
MTC
T is
giv
en in
the
appe
ndic
es
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
1
16
The
Gui
delin
es h
ave
also
inc
orpo
rate
d ba
sic
info
rmat
ion
that
pro
gram
man
ager
sne
ed in
ord
er to
mak
e th
eir
inst
itutio
ns P
MTC
T-fr
iend
ly T
his
info
rmat
ion
is fo
und
in
the
boxe
s an
d ap
pend
ices
Sum
mar
ies
of t
he i
nfor
mat
ion
cont
aine
d in
the
tex
t ar
e fo
und
in th
e ta
bles
The
Gui
delin
es p
rovi
de a
bac
kgro
und
to t
he P
MTC
T pr
oble
m in
the
wor
ld i
n A
fric
a an
d in
Ken
ya T
hey
also
giv
e de
tails
on
HIV
in p
regn
ancy
the
tran
smis
sion
pat
tern
sof
MTC
T an
d de
scri
be t
he b
enef
its o
f pr
even
ting
mot
her-
to-c
hild
tra
nsm
issi
on(P
MTC
T) T
hey
also
pro
vide
info
rmat
ion
on in
terv
entio
ns n
eces
sary
to
redu
ce M
TCT
that
incl
ude
coun
selli
ng a
nd te
stin
g la
bora
tory
inve
stig
atio
ns o
bste
tric
inte
rven
tions
and
trea
tmen
tpro
phyl
axis
The
ante
nata
l man
agem
ent
for
HIV
pos
itive
wom
en i
nclu
ding
pol
icy
guid
e jo
b ai
dsw
ith s
umm
aris
ed e
ssen
tial p
acka
ge o
f int
egra
ted
ante
nata
l car
e se
rvic
es a
re d
etai
led
in C
hapt
er 2
Cha
pter
3 p
rovi
des
info
rmat
ion
on i
ntra
part
um c
are
Thi
s is
the
man
agem
ent
ofw
omen
from
the
onse
t of l
abou
r to
del
iver
y A
t thi
s st
age
it is
impo
rtan
t to
esta
blis
hth
e H
IV s
tatu
s of
wom
en p
rior
to d
eliv
ery
or d
urin
g la
bour
Gui
delin
es s
houl
d be
folshy
low
ed fo
r al
l wom
en a
dmitt
ed to
labo
ur a
nd d
eliv
ery
To
cond
uct v
agin
al d
eliv
erie
s fo
r H
IV p
ositi
ve w
omen
m
odifi
ed r
outin
e ca
re i
s gi
ven
The
gui
delin
es p
rovi
de a
reshy
min
der
on th
e ac
tiviti
es e
ssen
tial t
o ca
rry
out f
or s
afe
vagi
nal d
eliv
ery
for
all w
omen
no
t ju
st fo
r th
ose
infe
cted
with
HIV
It
is r
ecom
men
ded
that
the
re s
houl
d be
no
disshy
crim
inat
ion
or is
olat
ion
of H
IV p
ositi
ve w
omen
dur
ing
labo
ur a
nd d
eliv
ery
Del
iver
y th
roug
h el
ectiv
e ca
esar
ean
sect
ion
redu
ces
the
risk
of
HIV
MTC
T as
com
pare
d to
vagi
nal d
eliv
ery
amon
g H
IV p
ositi
ve w
omen
Whe
re C
S is
per
form
ed a
s an
em
erge
ncy
or e
lect
ivel
y a
ntib
iotic
s sh
ould
be
give
n
Ant
iret
rovi
ral (
AR
V) t
hera
py is
dis
cuss
ed in
det
ail i
n C
hapt
er 4
Thi
s in
clud
es t
hershy
apy
for
the
mot
her
befo
re la
bour
dur
ing
labo
ur a
nd a
fter
del
iver
y a
nd fo
r th
e in
fant
afte
r de
liver
y C
urre
ntly
N
evir
apin
e is
the
rec
omm
ende
d re
gim
en H
owev
er
shor
tco
urse
effi
caci
ous
AR
V d
rug
regi
men
s ca
n be
im
plem
ente
d in
res
ourc
e lim
ited
setshy
tings
AR
Vs
are
used
bot
h fo
r tr
eatm
ent
and
for
PMTC
T in
HIV
inf
ecte
d pr
egna
ntw
omen
and
thei
r ne
onat
es
Gui
delin
es f
or t
he p
ostp
artu
m c
are
of t
he m
othe
r an
d ca
re f
or H
IV e
xpos
ed in
fant
s ar
e de
taile
d in
Cha
pter
5 I
n C
hapt
er 6
the
Gui
de p
rovi
des
deta
iled
info
rmat
ion
on
late
pos
tnat
al c
are
and
fam
ily p
lann
ing
HIV
pos
itive
wom
en c
an u
se a
ll ty
pes
of fa
mshy
ily p
lann
ing
base
d on
sta
ndar
d el
igib
ility
cri
teri
a as
exp
licitl
y ou
tline
d in
the
text
Gui
delin
es fo
r in
fant
dia
gnos
is c
are
and
trea
tmen
t ar
e di
scus
sed
in C
hapt
er 7
Cur
shyre
ntly
the
re is
no
test
to
diffe
rent
iate
bet
wee
n an
tibod
ies
from
the
mot
her
and
thos
e pr
oduc
ed b
y th
e ba
by T
o id
entif
y H
IV in
fect
ed in
fant
s le
ss t
han
18 m
onth
s D
NA
or
RN
A ndash
PC
R te
st is
cur
rent
ly r
ecom
men
ded
HIV
exp
osed
infa
nts
at 6
wee
ks a
nd s
ick
infa
nts
at 1
2 m
onth
s sh
ould
hav
e ac
cess
to
DB
S fo
r D
NA
PC
R H
IV e
xpos
ed in
fant
ssh
ould
be
star
ted
on c
otri
mox
azol
e fr
om 6
wee
ks A
ll m
othe
rs w
ith 6
wee
k ol
d in
fant
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
E
Upt
ake
of c
ouns
ellin
g an
d te
stin
g in
Mat
erni
ty c
linic
Rat
io o
f m
ater
nity
clie
nts
with
unk
now
n H
IV s
tatu
s w
ho a
re c
ouns
elle
d an
d te
sted
for H
IV in
mat
erni
ty
Num
erat
or
Num
ber o
f pre
gnan
t wom
en a
dmitt
ed in
to m
ater
nity
with
un
know
n H
IV s
tatu
s th
at a
re c
ouns
elle
d an
d te
sted
for H
IV
durin
g la
bour
or a
fter d
eliv
ery
Den
omin
ator
N
umbe
r of p
regn
ant w
omen
adm
itted
into
mat
erni
ty
with
unk
now
n H
IV s
tatu
s
F
Mat
erni
ty m
othe
r AR
V pr
ophy
laxi
s up
take
R
atio
of H
IV in
fect
ed m
othe
rs in
mat
erni
ty c
linic
rece
ivin
g pr
even
tive
A
RV
pro
phyl
axis
Num
erat
or
Num
ber o
f HIV
-infe
cted
mot
hers
adm
itted
in m
ater
nity
takshy
ing
or re
porte
d to
hav
e ta
ken
the
mot
her d
ose(
s) o
f pre
venshy
tive
AR
V p
roph
ylax
is
Den
omin
ator
N
umbe
r of p
regn
ant w
omen
adm
itted
into
mat
erni
ty w
ho
are
HIV
-infe
cted
G
Infa
nt A
RV
prop
hyla
xis
upta
ke
Rat
io o
f inf
ants
bor
n to
HIV
-infe
cted
mot
hers
in m
ater
nity
clin
ic
rece
ivin
g pr
even
tive
AR
V p
roph
ylax
is
Num
erat
or
Num
ber o
f inf
ants
bor
n to
HIV
-infe
cted
mot
hers
who
rece
ive
prev
entiv
e
Den
omin
ator
N
umbe
r of i
nfan
ts b
orn
to H
IV-in
fect
ed m
othe
rs
Num
ber o
f pre
gnan
t wom
en a
dmitt
ed in
to m
ater
nity
who
are
H
IV-in
fect
ed is
use
d to
app
roxi
mat
e th
is n
umbe
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
7
90
With
the
mea
sure
men
ts li
sted
abo
ve t
he fo
llow
ing
perf
orm
ance
indi
cato
rs
for m
onito
ring
PMTC
T ac
tiviti
es a
re c
alcu
late
d
A
Upt
ake
of c
ouns
ellin
g an
d te
stin
g in
Ant
enat
al c
linic
R
atio
of a
nten
atal
clie
nts
who
wer
e co
unse
lled
and
test
ed fo
r HIV
Num
erat
or
This
is n
umbe
r of p
regn
ant w
omen
atte
ndin
g th
eir f
irst
ante
nata
l clin
ic v
isit
who
are
test
ed fo
r HIV
Den
omin
ator
N
umbe
r of n
ew v
isits
to th
e an
tena
tal c
linic
B
Ant
enat
al H
IV s
erop
reva
lenc
e
Rat
io o
f Ant
enat
al p
regn
ant w
omen
test
ed fo
r HIV
that
are
HIV
infe
cted
Num
erat
or
Num
ber o
f clie
nts
who
test
HIV
pos
itive
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
test
ed fo
r HIV
in a
nten
ashyta
l clin
ic
C
Ant
enat
al m
othe
r AR
V pr
ophy
laxi
s up
take
R
atio
of k
now
n H
IV in
fect
ed p
regn
ant w
omen
in a
nten
atal
clin
ic
rece
ivin
g A
RV
pre
vent
ive
prop
hyla
xis
Num
erat
or
Tota
l num
ber o
f HIV
-infe
cted
pre
gnan
t wom
en in
ant
enat
al
clin
ic re
ceiv
ing
mot
her p
reve
ntiv
e A
RV
pro
phyl
axis
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
who
are
HIV
-infe
cted
in
the
ante
nata
l clin
ic
D
Ant
enat
al in
fant
AR
V pr
ophy
laxi
s up
take
R
atio
of k
now
n H
IV-in
fect
ed p
regn
ant w
omen
in a
nten
atal
clin
ic w
ho
rece
ive
infa
nt d
ose(
s) o
f pre
vent
ive
AR
V p
roph
ylax
is
Num
erat
or
Tota
l num
ber o
f HIV
infe
cted
pre
gnan
t wom
en in
an
tena
tal c
linic
rece
ivin
g in
fant
dos
e(s)
pre
vent
ive
A
RV
pro
phyl
axis
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
who
are
HIV
-infe
cted
in
the
ante
nata
l clin
ic
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
shou
ld h
ave
rout
ine
HIV
ant
ibod
y te
st
Gui
delin
es f
or f
eedi
ng in
fant
s an
d yo
ung
child
ren
born
to
HIV
infe
cted
mot
hers
are
di
scus
sed
in C
hapt
er 8
The
Min
istr
y of
Hea
lth r
ecom
men
ds p
rom
otio
n of
exc
lusi
vebr
east
feed
ing
for
the
first
6 m
onth
s of
life
Whe
re r
epla
cem
ent f
eedi
ng is
acc
epta
ble
feas
ible
af
ford
able
su
stai
nabl
e an
d sa
fe (
AFA
SS)
avoi
danc
e of
bre
astf
eedi
ng b
yH
IV-in
fect
ed w
omen
is
reco
mm
ende
d (W
HO
200
6) D
iscu
ssio
n on
diff
eren
t ty
pes
offe
edin
g al
tern
ativ
es t
o br
east
feed
ing
is c
aptu
red
in t
he t
ext
Thes
e op
tions
exi
st f
orth
e m
othe
r to
cho
ose
with
the
aid
of
coun
selli
ng I
deal
ly c
oupl
e de
cisi
on-m
akin
g is
enco
urag
ed f
or t
he H
IV p
ositi
ve m
othe
r F
or t
he H
IV n
egat
ive
mot
her
exc
lusi
ve
brea
stfe
edin
g is
rec
omm
ende
d fo
r 6
mon
ths
or le
ss fo
llow
ed b
y w
eani
ng
Car
e an
d fo
llow
-up
of c
hild
ren
of H
IV-in
fect
ed m
othe
rs is
dis
cuss
ed in
det
ail i
n C
hapshy
ter
9 A
ll ch
ildre
n bo
rn t
o H
IV i
nfec
ted
mot
hers
sho
uld
be f
ollo
wed
up
clos
ely
from
birt
h th
roug
h 2
year
s T
able
92
pro
vide
s th
e W
HO
rec
omm
ende
d fo
llow
up
deta
ils
Sim
ilarl
y t
he m
othe
rs s
houl
d be
sup
port
ed t
o pr
ovid
e op
timal
infa
nt fe
edin
g an
d to
av
oid
mix
ed fe
edin
g w
ithin
6 m
onth
s
In C
hapt
er 1
0 t
he G
uide
lines
exp
lain
the
ben
efits
of
mon
itori
ng a
nd e
valu
atio
n of
PMTC
T pr
ogra
ms
Mamp
E p
rovi
des
an o
ppor
tuni
ty t
o m
easu
re a
nd a
ppra
ise
perf
orm
shyan
ce w
ithin
def
ined
tim
e fr
ame
to e
nsur
e ac
com
plis
hmen
t of s
et g
oals
and
obj
ectiv
es
PMTC
T se
rvic
es m
ust
be g
uide
d by
tim
ely
and
accu
rate
dat
a re
port
ed f
rom
the
heal
th f
acili
ties
thr
ough
the
dis
tric
t an
d pr
ovin
cial
lev
els
to
the
natio
nal
leve
l at
NA
SCO
P
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
9
18
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
(xiii
) H
IV in
fect
ed in
mat
erni
ty w
ard
Num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to
mat
erni
ty c
linic
who
are
HIV
infe
cted
In
clud
es b
oth
thos
e w
ho w
ere
adm
itted
al
read
y kn
owin
g th
ey a
re H
IV-i
nfec
ted
and
thos
e w
ho w
ere
test
ed a
nd r
ecei
ved
thei
r re
sults
in m
ater
nity
clin
ic T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(xiv
) P
reve
ntiv
e A
RV
pro
phyl
axis
in m
ater
nity
war
d (m
othe
r do
se)
Num
ber
of
preg
nant
wom
en a
dmitt
ed in
mat
erni
ty t
akin
g or
rep
orte
d to
hav
e ta
ken
the
mot
her
dose
(s)
of p
reve
ntiv
e A
RV
pro
phyl
axis
T
his
is o
btai
ned
from
the
m
ater
nity
reg
iste
r
(xv)
Inf
ant
prev
entiv
e A
RV
pro
phyl
axis
in m
ater
nity
clin
ic
war
d N
umbe
r of
inshy
fant
s bo
rn in
mat
erni
ty r
ecei
ving
the
infa
nt p
reve
ntiv
e A
RV
pro
phyl
axis
in t
he
mat
erni
ty c
linic
T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(xvi
) D
eliv
erie
s T
otal
num
ber
of p
regn
ant
wom
en d
eliv
erin
g at
the
hea
lth fa
cilit
y
(xvi
i) C
ouns
ellin
g on
infa
nt f
eedi
ng o
ptio
ns
Num
ber
of m
othe
rs d
eliv
erin
g at
the
he
alth
fac
ility
cou
nsel
led
on in
fant
fee
ding
opt
ions
T
his
is o
btai
ned
from
the
m
ater
nity
reg
iste
r
(xvi
ii) I
nfan
t te
stin
g at
6 w
eeks
bull N
umbe
r of
infa
nts
test
ed f
or H
IV a
t 6
wee
ks o
ld
bull N
umbe
r of
infa
nts
test
ing
HIV
-pos
itive
T
his
is o
btai
ned
from
labo
rato
ry
regi
ster
(xix
) R
efer
red
for
care
and
tre
atm
ent
bull N
umbe
r of
HIV
infe
cted
wom
en a
ttend
ing
ante
nata
l clin
ic t
hat
is r
efer
red
for
HIV
car
e an
d tr
eatm
ent
bull N
umbe
r of
HIV
infe
cted
wom
en in
mat
erni
ty t
hat
is r
efer
red
for
HIV
car
e an
d tr
eatm
ent
bull N
umbe
r H
IV in
fect
ed in
fant
s re
ferr
ed f
or H
IV c
are
and
trea
tmen
t T
his
is
ob
tain
ed f
rom
ant
enat
al a
nd m
ater
nity
reg
iste
rs
(xx)
Ini
tiate
d on
Cot
rim
oxaz
ole
Num
ber
of H
IV in
fect
ed p
regn
ant
wom
en a
ttend
ing
ante
nata
l clin
ic th
at h
as
been
initi
ated
on
Cot
rimox
azol
e T
his
is o
btai
ned
from
the
ant
enat
al r
egis
ter
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
9
88
Th
e da
ta is
pre
sent
ed u
sing
def
ined
per
form
ance
indi
cato
rs th
at in
clud
e th
e fo
llow
ing
(i)
New
clie
nts
first
ant
enat
al c
linic
vis
its
Num
ber
of p
regn
ant
wom
en a
ttend
ing
thei
r fir
st a
nten
atal
vis
it fo
r th
e cu
rren
t pr
egna
ncy
at t
he h
ealth
fac
ility
T
his
is
obta
ined
fro
m t
he a
nten
atal
reg
iste
r
(ii)
Ret
urn
visi
tsr
evis
its
Num
ber
of r
etur
n an
tena
tal c
linic
vis
itsr
evis
its
atte
nded
by
the
preg
nant
wom
en a
t th
e fa
cilit
y T
his
is o
btai
ned
from
the
an
tena
tal r
egis
ter
(iii)
C
ouns
ellin
g an
d te
stin
g fo
r H
IV in
ant
enat
al c
linic
Tot
al n
umbe
r of
pre
gnan
t w
omen
cou
nsel
led
and
test
ed f
or H
IV a
t th
e an
tena
tal c
linic
w
heth
er t
his
is d
one
on th
e fir
st a
nten
atal
vis
it or
a la
ter
visi
t T
his
is o
btai
ned
from
the
an
tena
tal r
egis
ter
(iv)
H
IV c
ouns
ellin
g an
d te
stin
g at
fir
st a
nten
atal
clin
ic v
isit
Num
ber
of p
regn
ant
wom
en a
tten
ding
the
ir fir
st a
nten
atal
clin
ic v
isit
for
curr
ent
preg
nanc
y w
ho a
re
test
ed f
or H
IV
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(v)
Lear
ning
HIV
sta
tus
in a
nten
atal
clin
ic
Num
ber
of a
nten
atal
clin
ic p
regn
ant
wom
en t
este
d fo
r H
IV w
ho r
ecei
ve t
heir
HIV
res
ults
w
heth
er t
his
is d
one
on t
he
first
ant
enat
al c
linic
vis
it or
at
a la
ter
visi
t T
his
is o
btai
ned
from
the
ant
enat
al
regi
ster
(vi)
HIV
infe
cted
in a
nten
atal
clin
ic
Num
ber
of a
nten
atal
clin
ic p
regn
ant
wom
en
who
are
HIV
-inf
ecte
d on
the
late
st t
est
durin
g th
e pr
egna
ncy
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(vii)
Pre
vent
ive
AR
V p
roph
ylax
is in
ant
enat
al c
linic
(m
othe
r do
se)
Num
ber
of
preg
nant
wom
en in
the
ant
enat
al c
linic
rec
eivi
ng t
he m
othe
r do
se(s
) of
pre
venshy
tive
AR
V p
roph
ylax
is
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(viii
) P
reve
ntiv
e A
RV
pro
phyl
axis
in a
nten
atal
clin
ic (
infa
nt d
ose)
N
umbe
r of
pr
egna
nt w
omen
in t
he A
nten
atal
clin
ic is
sued
with
the
infa
nt d
ose(
s) o
f pr
even
shytiv
e A
RV
pro
phyl
axis
T
his
is o
btai
ned
from
the
ant
enat
al r
egis
ter
(ix)
New
clie
nts
in m
ater
nity
clin
ic
Num
ber
of p
regn
ant
wom
en a
tten
ding
the
Mashy
tern
ity c
linic
for
the
firs
t tim
e T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(x)
Unk
now
n H
IV s
tatu
s at
mat
erni
ty
Num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to
the
mat
erni
ty w
ith u
nkno
wn
HIV
sta
tus
Thi
s is
obt
aine
d fr
om t
he m
ater
nity
reg
isshy
ter
(xi)
Cou
nsel
ling
and
test
ing
for
HIV
in m
ater
nity
war
dT
otal
num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to m
ater
nity
with
unk
now
n st
atus
tha
t ar
e co
unse
lled
and
test
ed fo
r H
IV d
urin
g la
bour
or
afte
r de
liver
y T
his
is o
btai
ned
from
the
mat
erni
ty
regi
ster
(xii)
Lea
rnin
g H
IV s
tatu
s in
mat
erni
ty w
ard
Num
ber
of p
regn
ant
wom
en a
dmitt
ed
into
mat
erni
ty a
nd t
este
d fo
r H
IV w
ho r
ecei
ved
thei
r H
IV r
esul
ts
Thi
s is
obt
aine
d fr
om t
he m
ater
nity
reg
iste
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Cha
pter
1
Bac
kgro
und
11
THE
GLO
BA
L P A
ND
EMIC
Ove
r 38
mill
ion
peop
le a
re li
ving
with
HIV
AID
S w
orld
wid
e a
nd a
bout
two-
thir
ds o
r 25
m
illio
n of
PLW
HA
liv
e in
sub
-Sah
aran
Afr
ica1
H
IVA
IDS
mai
nly
affe
cts
peop
le o
fre
prod
uctiv
e ag
e an
d in
crea
sing
ly a
ffect
s w
omen
w
ho n
ow a
ccou
nt f
or 5
7 o
f ne
win
fect
ions
in s
ub-S
ahar
an A
fric
a w
here
wom
en a
re 3
0 m
ore
likel
y to
be
livin
g w
ith
HIV
AID
S th
an m
en a
nd y
oung
wom
en a
ged
15-2
4 ar
e ne
arly
four
tim
es m
ore
likel
y to
be
inf
ecte
d th
an t
heir
mal
e co
unte
rpar
ts2
Youn
g m
arri
ed w
omen
w
ho a
re o
ften
m
onog
amou
s h
ave
beco
me
one
of t
he g
roup
s m
ost
vuln
erab
le t
o H
IV i
n th
e re
gion
Th
is r
equi
res
new
and
rap
id r
espo
nses
that
bro
aden
the
focu
s be
yond
trad
ition
al ldquoh
igh
risk
rdquo gro
ups
like
com
mer
cial
sex
wor
kers
tru
ck d
rive
rs a
nd d
rug
user
s
To r
each
you
ng m
arri
ed w
omen
w
ho m
ay n
ot b
e aw
are
of t
heir
vul
nera
bilit
y H
IV
AID
S pr
even
tion
ca
re
and
supp
ort
activ
ities
m
ust
be
inte
grat
ed
into
al
read
yes
tabl
ishe
d he
alth
ser
vice
s th
at a
re u
sed
by t
he g
ener
al p
opul
atio
n A
n es
timat
ed
630
000
child
ren
wor
ld-w
ide
beca
me
infe
cted
with
HIV
in
2003
mdash m
ost
thro
ugh
MTC
T3
The
risk
of
an H
IV-in
fect
ed m
othe
r pa
ssin
g th
e vi
rus
to h
er i
nfan
t du
ring
pr
egna
ncy
labo
ur a
nd d
eliv
ery
or in
the
post
nata
l per
iod
is 1
in 3
if n
othi
ng is
don
e to
re
duce
this
ris
k I
n ot
her
wor
ds o
ut o
f 100
infa
nts
born
to w
omen
with
HIV
AID
S an
d w
ithou
t in
terv
entio
n 6
0-75
of t
hem
will
not
be
infe
cted
Of t
he o
ne-t
hird
who
bec
ome
infe
cted
abo
ut 5
-10
babi
es w
ill b
e in
fect
ed d
urin
g pr
egna
ncy
15
will
be
infe
cted
dur
ing
labo
ur a
nd d
eliv
ery
whi
le 5
-15
will
be
infe
cted
dur
ing
brea
stfe
edin
g l
arge
ly b
eing
de
pend
ent
on b
reas
tfee
ding
pra
ctic
es a
nd o
n th
e du
ratio
n of
bre
astfe
edin
g4 I
n 20
03
near
ly 5
000
00 c
hild
ren
died
of A
IDS-
rela
ted
caus
es M
ost
child
ren
born
with
HIV
die
befo
re th
ey r
each
thei
r fif
th b
irth
day
with
mos
t not
sur
vivi
ng b
eyon
d tw
o ye
ars5
The
high
rat
es o
f M
TCT
in d
evel
opin
g co
untr
ies
com
pare
d to
muc
h lo
wer
rat
es i
nri
cher
cou
ntri
es
illus
trat
e gr
owin
g in
equa
litie
s in
glo
bal
heal
th
In t
he w
ealth
y co
untr
ies
the
rat
e of
MTC
T is
les
s th
an 2
b
ecau
se o
f w
ides
prea
d ac
cess
to
antishy
retr
ovir
al th
erap
y (A
RT)
pla
nned
cae
sare
an s
ectio
ns (C
S) t
he m
eans
to s
afel
y fo
rmul
afe
ed a
nd a
cces
s to
qua
lity
med
ical
ser
vice
s I
n po
orer
cou
ntri
es li
ke K
enya
the
re is
a
30-4
0 c
hanc
e th
at a
n H
IV-p
ositi
ve b
reas
tfee
ding
mot
her
will
pas
s H
IV to
her
chi
ld in
th
e ab
senc
e of
the
se s
ervi
ces
In
such
set
tings
it
is c
ritic
al t
hat
prev
entio
n pr
oced
ures
be i
nteg
rate
d in
to e
xist
ing
sexu
al a
nd r
epro
duct
ive
heal
th (
SRH
) an
d m
ater
nal
and
child
hea
lth (
MC
H)
serv
ices
re
achi
ng a
s m
any
wom
en a
s po
ssib
le a
nd l
ower
ing
tran
smis
sion
rat
es A
lthou
gh p
harm
aceu
tical
com
pany
don
atio
ns d
onor
sup
port
and
othe
r go
vern
men
t in
itiat
ives
hav
e he
lped
exp
and
acce
ss t
o H
IV t
estin
g fo
r pr
egna
ntw
omen
and
use
of a
ntir
etro
vira
l dru
gs li
ke N
evir
apin
e w
hich
red
uce
the
chan
ce o
f HIV
tr
ansm
issi
on s
till o
nly
10
of p
regn
ant w
omen
glo
bally
hav
e ac
cess
to th
ese
drug
s6
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
7
20
HIV
AID
S tr
ansm
issi
on fr
om m
othe
r to
chi
ld in
Ken
ya is
one
of t
he b
igge
st h
ealth
and
de
velo
pmen
t cha
lleng
es in
Ken
ya A
ccor
ding
to th
e 20
03 D
emog
raph
ic a
nd H
ealth
Sur
shyve
y7 6
7
or
over
12
mill
ion
Ken
yan
adul
ts w
ere
livin
g w
ith H
IVA
IDS
in 2
003
The
re
has
been
a s
tead
y de
clin
e in
HIV
ser
opre
vale
nce
in K
enya
In
2005
the
pre
vale
nce
rate
w
as e
stim
ated
at 5
9
and
as
per
the
2006
sta
tistic
s th
e pr
eval
ence
rat
e am
ong
adul
tsha
d dr
oppe
d to
51
8
Acc
ordi
ng t
o 20
07 K
enya
AID
S In
dica
tor
Surv
ey (
KA
IS)8a
the
H
IV s
erop
reva
lenc
e in
Ken
ya is
cur
rent
ly 7
8
am
ong
adul
ts a
ged
15-4
9 ye
ars
bei
nghi
gher
in
wom
en (
87
) th
an i
n m
en (
56
) Y
oung
wom
en a
re m
ore
vuln
erab
le i
n K
enya
tha
n m
en a
s ev
iden
ced
by a
nea
rly
9 p
reva
lenc
e ra
te a
mon
g w
omen
and
unshy
der
5 a
mon
g m
en9
Ther
e ar
e w
ide
vari
atio
ns b
etw
een
urba
n an
d ru
ral
area
s b
etw
een
regi
ons
bet
wee
n ad
ults
and
you
ng p
eopl
e an
d be
twee
n m
en a
nd w
omen
The
re h
as b
een
a no
tabl
e dr
op
in t
he n
umbe
r of
new
inf
ectio
ns
with
an
estim
ated
60
000
new
inf
ectio
ns i
n 20
05
drop
ping
to 5
500
0 in
200
6 In
fant
s an
d yo
ung
child
ren
unde
r 15
yea
rs a
ccou
nt fo
r 16
of
all
new
HIV
infe
ctio
ns m
ainl
y as
a r
esul
t of M
TCT
Mos
t of t
he n
ew in
fect
ions
occ
ur
amon
g yo
ung
peop
le i
n w
hom
the
mai
n m
ode
of t
rans
mis
sion
is t
hrou
gh s
exua
l int
ershy
cour
se
Tabl
e 1
1 A
dult
HIV
-Pre
vale
nce
Estim
ate
by P
rovi
nce
in 2
006
Prov
ince
N
umbe
r of H
IV +
Pre
vale
nce
()
Nai
robi
Cen
tral
Coa
st
Eas
tern
N E
aste
rn
Nya
nza
Rift
Val
ley
Wes
tern
Tota
l
197
000
960
00
930
00
720
00
900
0 18
300
0
171
000
112
000
11
milli
on
Tota
l
101
41
59
28
14
78
38
53
51
Mal
e
80
17
50
11
09
61
26
42
35
Fem
ale
123
65
69
44
18
96
49
64
67
Mal
eFe
mal
e R
atio
15
38
14
40
20
16
19
15
19
all t
he d
ata
from
the
prov
ince
s (a
nd r
efer
ral h
ospi
tals
) Th
e ag
greg
ated
dat
a is
di
ssem
inat
ed t
o th
e H
ealth
Man
agem
ent
Info
rmat
ion
Syst
em N
atio
nal A
IDS
Con
trol
Cou
ncilrsquo
s (N
AC
C)
natio
nal
data
ban
k an
d re
sour
ce c
entr
e T
he f
ocal
pe
rson
s he
re a
re t
he d
irec
tor
NA
CC
and
the
Mamp
E m
anag
er D
ata
is d
isse
mishy
nate
d ba
ck to
the
prov
ince
s an
d re
ferr
al h
ospi
tals
for
use
in d
ecis
ion-
mak
ing
7
Dat
a flo
w f
rom
fac
ility
lev
el t
o na
tiona
l le
vel
At
the
heal
th f
acili
ty P
MTC
T in
divi
dual
le
vel d
ata
reco
rded
in t
he M
oH s
tand
ardi
sed
regi
ster
s (A
NC
Mashy
tern
ity a
nd P
ostn
atal
) is
sum
mar
ised
ag
greg
ated
on
a m
onth
ly b
asis
ont
o M
oH F
orm
726
F
orm
726
is
then
for
war
ded
upw
ards
to
the
dist
rict
Lev
el
(DA
SCO
rsquos O
ffice
) for
agg
rega
tion
of th
e D
istr
ict l
evel
dat
a on
to F
orm
727
Cop
shyie
s of
For
m 7
26 a
nd F
orm
727
are
forw
arde
d to
the
Nat
iona
l Offi
ce (N
ASC
OP)
w
ith a
noth
er c
opy
of F
orm
727
bei
ng s
ent t
o th
e Pr
ovin
cial
Offi
ce (P
ASC
O)
8
Dat
a di
ssem
inat
ion
Thi
s is
car
ried
out
at
all
leve
ls s
tart
ing
from
fac
ility
to
natio
nal l
evel
It i
s th
e re
spon
sibi
lity
of N
AC
C to
coo
rdin
ate
the
diss
emin
atio
n an
d us
e of
all
HIV
AID
S da
ta a
nd in
form
atio
n fo
r na
tiona
l res
pons
e J
APR
a
join
t pro
gram
me
of a
ll st
akeh
olde
rs in
HIV
AID
S re
ceiv
es a
nd u
ses
the
data
to
disc
uss
the
chal
leng
es a
chie
vem
ents
and
les
sons
lea
rnt
from
HIV
AID
S an
d gi
ves
feed
back
for n
atio
nal r
espo
nse
9
PMTC
T in
dica
tors
and
thei
r so
urce
s H
ealth
car
e fa
cilit
ies
colle
ct th
e fo
llow
ing
data
as
a m
inim
um t
o be
use
d in
the
mon
itori
ng o
f PM
TCT
prog
ram
s T
he
data
is
to b
e ag
greg
ated
on
a m
onth
ly b
asis
ont
o th
e M
inis
try
of H
ealth
In
tegr
ated
Mon
itori
ng a
nd E
valu
atio
n R
epor
t For
m M
oH 7
26 u
sing
dat
a fr
om
the
Min
istr
y of
Hea
lth
Ken
ya A
nten
atal
and
Mat
erni
ty R
egis
ters
(D
eliv
ery
Reg
iste
r) M
oH 4
05 a
nd M
oH 3
33 r
espe
ctiv
ely
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
1
86
102
O
PER
ATI
ON
AL
GU
IDEL
INES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed in
the
mon
itorin
g an
d ev
alua
-tio
n of
PM
TCT
serv
ices
1
W
ithin
PM
TCT
prog
ram
s d
ata
is c
olle
cted
and
rep
orte
d at
the
fol
low
ing
leve
ls I
ndiv
idua
l fa
cilit
y d
istr
ict
prov
inci
al a
nd n
atio
nal
2
Indi
vidu
al l
evel
The
com
bine
d m
othe
r an
d ch
ild h
ealth
boo
klet
pro
vide
s de
shyta
iled
info
rmat
ion
on t
he w
oman
and
chi
ld i
nclu
ding
the
HIV
sta
tus
oth
er
HIV
car
e se
rvic
es d
rugs
del
iver
y in
form
atio
n im
mun
isat
ion
gro
wth
mon
itorshy
ing
and
othe
r par
amet
ers
3
Faci
lity
leve
l da
ta c
aptu
re t
ools
The
MoH
has
sta
ndar
dise
d re
gist
ers
for
reshy
cord
ing
data
at
faci
litie
s T
hese
inc
lude
the
Rev
ised
AN
C R
egis
ter
Rev
ised
M
ater
nity
Reg
iste
r an
d Po
st N
atal
Reg
iste
r an
d W
orkl
oad
MO
H 7
17 O
ther
re
gist
ers
incl
ude
Chi
ld H
ealth
and
Nut
ritio
n In
form
atio
n Sy
stem
and
Inshy
patie
nt M
orbi
dity
and
Mor
talit
y F
orm
711
and
the
Rep
rodu
ctiv
e H
ealth
Ser
shyvi
ces
mon
thly
rep
orts
are
use
d fo
r m
akin
g fa
cilit
y le
vel s
umm
arie
s on
PM
TCT
and
repr
oduc
tive
heal
th s
ervi
ces
3 F
acili
ty le
vel d
ata
capt
ure
tool
s T
he M
oH
has
stan
dard
ized
reg
iste
rs f
or r
ecor
ding
dat
a at
fac
ilitie
s T
hese
inc
lude
the
R
evis
ed A
NC
Reg
iste
r R
evis
ed M
ater
nity
Reg
iste
r an
d Po
st N
atal
Reg
iste
r an
d w
orkl
oad
MO
H 7
17 O
ther
reg
iste
rs in
clud
e C
hild
Hea
lth a
nd N
utri
tion
Info
rmat
ion
Syst
em a
nd I
n-pa
tient
mor
bidi
ty a
nd m
orta
lity
Fo
rm 7
26 a
nd
the
Rep
rodu
ctiv
e he
alth
ser
vice
s m
onth
ly r
epor
ts a
re u
sed
for
mak
ing
faci
lity
leve
l sum
mar
ies
on P
MTC
T an
d re
prod
uctiv
e he
alth
ser
vice
s
4
Dis
tric
t le
vel
data
For
m 7
27 i
s us
ed t
o su
mm
aris
e an
d re
port
dis
tric
t le
vel
data
Oth
er s
umm
ary
repo
rtin
g to
ols
are
also
use
d to
rep
ort
dist
rict
leve
l inshy
form
atio
n A
t th
e di
stri
ct le
vel
the
DAS
CO
rsquos of
fice
aggr
egat
es d
ata
from
sev
shyer
al h
ealth
faci
lity
spec
ific
Form
726
ont
o Fo
rm 7
27 th
at is
use
d to
sum
mar
ise
and
repo
rt d
istr
ict l
evel
dat
a
5
Prov
inci
al l
evel
dat
a A
t th
e pr
ovin
cial
lev
el t
he P
ASC
O r
ecei
ves
Form
727
da
ta f
rom
the
res
pect
ive
DA
SCO
rsquos of
fices
in
the
prov
ince
for
the
ir o
wn
data
us
e an
d re
cord
s A
cop
y of
the
sam
e is
sen
t to
the
Nat
iona
l Offi
ce (N
ASC
OP)
by
the
DA
SCO
rsquos of
fice
At
the
prov
inci
al le
vel
the
dist
rict
leve
l dat
a is
agg
reshy
gate
d to
giv
e th
e pr
ovin
cial
leve
l dat
a
6 N
atio
nal
leve
l da
ta
At
the
natio
nal
leve
l th
e M
ampE
Man
ager
rec
eive
s da
ta
from
the
PASC
Os
for
each
of t
he p
rovi
nces
Dat
a is
als
o re
ceiv
ed fr
om th
e R
eshyfe
rral
hos
pita
ls a
nd o
ther
fac
ilitie
s at
the
ref
erra
l ho
spita
l or
ter
tiary
lev
el
The
data
rec
eive
d at
the
nat
iona
l lev
el is
als
o co
pied
to
the
Hea
d of
NA
SCO
P an
d PM
TCT
prog
ram
me
man
ager
The
Mamp
E m
anag
er a
t NA
SCO
P ag
greg
ates
85
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
12
MA
GN
ITU
DE
OF
HIV
IN P
REG
NA
NC
YIN
KEN
YA
Ken
ya N
atio
nal
AID
SST
I C
ontr
ol P
rogr
amm
e (N
ASC
OP)
est
imat
es t
hat
ther
e w
ere
12
mill
ion
babi
es b
orn
in 2
006
in K
enya
and
that
as
man
y as
9
of p
regn
ant w
omen
inK
enya
wer
e liv
ing
with
HIV
AID
S10
At
leas
t 50
000
to
600
00 i
nfan
ts i
n K
enya
wer
e th
ough
t to
hav
e be
en i
nfec
ted
with
H
IV a
s a
resu
lt of
MTC
T th
at y
ear
With
an
estim
ated
pop
ulat
ion
of 3
72
mill
ion
in th
eye
ar 2
007
the
num
ber
of b
irth
s in
200
7 w
as 1
73
mill
ion
With
an
HIV
pre
vale
nce
of 6
7
the
num
ber
of H
IV -
expo
sed
babi
es is
114
101
and
at
leas
t 45
640
HIV
-pos
itive
bab
ies
are
born
ass
umin
g a
40
tran
smis
sion
(Tab
le 1
2)
Tabl
e 1
2 E
stim
ated
mag
nitu
de o
f MTC
T in
Ken
ya 2
007
Popu
latio
n (E
stim
ates
200
7)
372
mill
ion
Birt
hs p
er a
nnum
1
73 m
illio
n
HIV
pre
vale
nce
in m
othe
rs
67
Tota
l num
ber o
f birt
hs to
HIV
-infe
cted
mot
hers
exp
osed
14
110
1 to
MTC
T as
sum
ing
no m
ultip
le p
regn
ancy
Num
ber o
f HIV
pos
itive
infa
nts
per a
nnum
in K
enya
45
640
as
sum
ing
40
tran
smis
sion
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
22
13
RIS
KS
OF
T RA
NSM
ISSI
ON
OF
MTC
T A
T D
IFFE
REN
T
T
IME
P ER
IOD
S
In K
enya
an
estim
ated
40
000
to 5
000
0 in
fant
s ar
e in
fect
ed w
ith H
IV a
nnua
lly d
ue to
m
othe
r-to
-chi
ld t
rans
mis
sion
Th
is c
an o
ccur
in u
tero
dur
ing
labo
ur a
nd d
eliv
ery
and
thro
ugh
brea
stfe
edin
g D
urin
g pr
egna
ncy
abo
ut 5
to
8 pe
rcen
t of
HIV
-exp
osed
bab
ies
beco
me
infe
cted
thr
ough
tra
nsm
issi
on a
cros
s th
e pl
acen
ta L
abou
r an
d de
liver
y po
ses
the
grea
test
ris
k fo
r tr
ansm
issi
on w
ith 1
0 to
20
perc
ent
of e
xpos
ed i
nfan
ts b
ecom
ing
infe
cted
at t
his
time
Bre
astf
eedi
ng a
lso
expo
ses
infa
nts
to H
IV
Whe
n m
othe
rs b
reas
tfee
d fo
r 18
to
24m
onth
s an
othe
r 10
to 1
5 pe
rcen
t of i
nfan
ts b
ecom
e in
fect
ed T
hus
in n
on-b
reas
tfee
ding
po
pula
tions
with
out
antir
etro
vira
l tre
atm
ent
appr
oxim
atel
y 15
to
30 p
erce
nt in
fant
s w
ill b
ecom
e in
fect
ed
with
pro
long
ed b
reas
tfee
ding
25
to
45 p
erce
nt i
nfan
ts w
ill
beco
me
infe
cted
Tabl
e 1
3 T
rans
mis
sion
pat
tern
s in
bre
astfe
edin
g an
d no
n br
east
feed
ing
popu
latio
ns
Tran
smis
sion
rate
in
Tim
ing
No
Bre
astfe
edin
g B
reas
tfeed
ing
Bre
astfe
edin
g th
roug
h
thro
ugh
6
mon
ths
18 to
24
mon
ths
Dur
ing
preg
nanc
y 05
to 1
0 05
to 1
0 05
to 1
0
Dur
ing
labo
ur
10 to
20
10 to
20
10 to
20
Thro
ugh
brea
stfe
edin
g 10
to 2
0 05
to 1
0 05
to 1
0
Ear
ly (f
irst 2
mon
ths)
10
to 2
0 05
to 1
0 05
to 1
0
Late
(afte
r 2 m
onth
s)
10 to
20
01 to
05
05 to
10
Ove
rall
15 to
30
25 to
35
30 to
45
Sou
rce
De
Coc
k K
M (2
002)
Form
MoH
711
has
bee
n re
com
men
ded
to r
epla
ce F
orm
MoH
726
HIV
Mamp
E d
ata
flow
pip
elin
e fr
om t
he i
ndiv
idua
l he
alth
fac
ilitie
s t
o th
e di
stri
ct a
ndpr
ovin
cial
leve
ls u
p to
the
cent
ral o
r na
tiona
l lev
els
at N
ASC
OP
and
NA
CC
is s
umm
ashyri
sed
in F
igur
e 1
01
Figu
re 1
01
HIV
Mon
itorin
g an
d Ev
alua
tion
data
flow
pip
elin
e in
Ken
ya
HM
IS
NA
SC
OP
N
ACC
H
ead
Nat
iona
l Dat
a B
ank
amp
Res
ourc
e C
entre
M
E M
anag
er
The
Dire
ctor
P
rogr
amm
e M
anag
er
ME
Man
ager
Ref
erra
l Hos
pita
ls
CE
Os
Spe
cial
ists
The
Prov
ince
P
MO
P
AS
CO
P
AR
TO
PH
RIO
P
CO
The
Dis
trict
D
MO
D
AS
CO
Dat
a en
try
cler
k D
AR
TO
DH
RIO
Hea
lth F
acilit
y P
ublic
Sec
tor
FBO
etc
23
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
84
Cha
pter
10
Mon
itorin
g an
d Ev
alua
tion
of P
MTC
T Se
rvic
es
101
IN
TRO
DU
CTI
ON
PMTC
T pr
ogra
m m
onito
ring
and
eva
luat
ion
activ
ities
pro
vide
the
oppo
rtun
ity to
mea
sshyur
e an
d ap
prai
se p
erfo
rman
ce w
ithin
def
ined
par
amet
ers
that
ens
ure
acco
mpl
ishm
ent
of g
oals
and
obj
ectiv
es
Ken
ya is
com
mitt
ed to
the
ldquoThr
ee-o
nesrdquo
pri
ncip
les
whi
ch a
re
bull O
ne a
gree
d A
IDS
Act
ion
Fra
mew
ork
that
pro
vide
s th
e ba
sis
for
coor
dina
ting
the
wor
k pl
an o
f al
l par
tner
s
bull O
ne N
atio
nal A
IDS
Coo
rdin
atin
g A
utho
rity
with
a b
road
-bas
ed
mul
tisec
tora
l man
date
bull O
ne a
gree
d co
untr
y-le
vel M
onito
ring
and
Eva
luat
ion
(M
ampE
) sy
stem
In l
ine
with
thi
s t
he c
ount
ry h
as d
evel
oped
the
Nat
iona
l H
IVA
IDS
Mon
itori
ng a
ndE
valu
atio
n Fr
amew
ork
that
pro
vide
s st
akeh
olde
rs w
ith a
too
l fo
r w
ell
coor
dina
ted
in
terl
inke
d an
d fu
nctio
nal H
IVA
IDS
Mamp
E s
yste
m t
hat
allo
ws
for
effic
ient
mon
itori
ngof
int
erve
ntio
ns i
n ac
hiev
ing
the
natio
nal
prog
ram
mat
ic g
oals
usi
ng d
efin
ed t
arge
ts
This
pro
vide
s th
e fr
amew
ork
for M
ampE
act
iviti
es w
ithin
PM
TCT
prog
ram
s
Nat
iona
l PM
TCT
data
is
repo
rted
usi
ng M
oH I
nteg
rate
d M
onito
ring
and
Eva
luat
ion
Rep
ortin
g Fo
rms
For
m M
oH 7
11 o
r Fo
rm M
oH 7
27
Indi
vidu
al P
MTC
T da
ta is
col
shyle
cted
at
the
heal
th f
acili
ties
offe
ring
PM
TCT
serv
ices
usi
ng s
tand
ard
MoH
reg
iste
rs(A
NC
Mat
erni
ty a
nd P
ostn
atal
Reg
iste
rs)
On
mon
thly
bas
is t
he h
ealth
faci
litie
s w
ill a
ggre
gate
the
dat
a fr
om t
he r
egis
ters
on
to
Form
MoH
711
or
MO
H 7
26 w
hich
is th
en fo
rwar
ded
upw
ards
to th
e D
ASC
Orsquos
offic
e A
copy
is
left
at
the
heal
th f
acili
ty f
or t
heir
ow
n da
ta u
se
At
the
dist
rict
lev
el
the
DA
SCO
rsquos of
fice
aggr
egat
es d
ata
from
sev
eral
hea
lth f
acili
ty s
peci
fic F
orm
726
ont
o Fo
rm M
oH 7
27 (o
r Fo
rm 7
11) t
hat
is u
sed
to s
umm
aris
e an
d re
port
dis
tric
t le
vel d
ata
B
oth
Form
726
and
For
m M
oH 7
27 a
re th
en s
ent t
o N
ASC
OP
A c
opy
of th
e Fo
rm 7
27
or F
orm
711
is s
ent t
o th
e PA
SCO
and
ano
ther
to th
e he
alth
faci
litie
s in
the
dist
rict
for
thei
r ow
n da
ta u
se
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
14
RIS
K F
AC
TOR
SFO
R M
TCT
OF
HIV
M
any
fact
ors
are
know
n or
sus
pect
ed t
o in
crea
se t
he r
isk
of a
n H
IV in
fect
ed m
othe
r tr
ansm
ittin
g th
e vi
rus
to h
er i
nfan
t Th
ese
fact
ors
incl
ude
the
HIV
vir
al l
oad
in t
he
mot
her
as
wel
l as
othe
r m
ater
nal
obst
etri
cal
vira
l and
infa
nt fa
ctor
s (T
able
14
)
The
mos
t sig
nific
ant r
isk
fact
or a
ppea
rs to
be
the
HIV
vir
al lo
ad in
the
mot
her
thou
gh
the
othe
r fa
ctor
s m
ay a
lso
cont
ribu
te t
o in
crea
sing
an
infa
ntrsquos
expo
sure
or
susc
eptib
ilshyity
to
acqu
irin
g H
IV S
ome
fact
ors
may
cau
se a
bre
akdo
wn
in t
he p
rote
ctio
n of
fere
d to
the
foet
us b
y th
e pl
acen
ta w
hich
in n
orm
al c
ircu
mst
ance
s w
ould
not
allo
w H
IV to
cro
ssth
e pl
acen
ta fr
om m
othe
r to
foet
us
Tran
smis
sion
dur
ing
labo
ur a
nd d
eliv
ery
occu
rs w
hen
the
infa
nt s
ucks
im
bibe
s or
asshy
pira
tes
mat
erna
l bl
ood
or c
ervi
cal
secr
etio
ns t
hat
cont
ain
HIV
or
whe
n it
has
othe
r m
ucou
s m
embr
ane
expo
sure
Tab
le 1
4
Ris
k fa
ctor
s fo
r M
TCT
of H
IV
Stro
ng e
vide
nce
Lim
ited
evid
ence
VIR
AL
MA
TER
NA
L
OB
STE
TRIC
AL
FETA
LIN
FAN
T
BR
EA
ST-
FEE
DIN
G
Hig
h vi
ral l
oad
Imm
une
defic
ienc
y (lo
w
CD
4 co
unt)
HIV
infe
ctio
n ac
quire
d du
ring
preg
nanc
y o
r br
east
feed
ing
perio
d
Vagi
nal d
eliv
ery
(com
pare
d to
ele
ctiv
e ca
esar
ean
sect
ion)
ru
ptur
e of
the
mem
bran
es
for m
ore
than
4 h
ours
Prem
atur
ity
Dur
atio
n of
bre
astfe
edin
g
mix
ed fe
edin
g b
reas
t di
seas
e (m
astit
isc
rack
ed
nipp
les)
Vira
l res
ista
nce
(theo
retic
al p
ossi
bilit
y)
Vira
l gen
otyp
e an
d ph
enot
ype
Vita
min
A d
efic
ienc
y a
naem
ia s
exua
lly
trans
mitt
ed d
isea
ses
ch
orio
amni
oniti
s fr
eque
nt u
npro
tect
ed
sexu
al in
terc
ours
e m
ultip
le s
exua
l pa
rtner
s s
mok
ing
inje
ctin
g dr
ug a
buse
Inva
sive
or t
raum
atic
pro
cedu
res
in
stru
men
tal d
eliv
erie
s a
mni
ocen
tesi
s
epis
ioto
my
ext
erna
l cep
halic
ver
sion
(E
CV
) et
c i
ntra
partu
m h
aem
orrh
age
Lesi
ons
of s
kin
and
or m
ucou
s m
embr
anes
Ora
l thr
ush
(bab
y)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
3
24
15
BEN
EFIT
SO
F P R
EVEN
TIN
G M
OTH
ER-T
O-C
HIL
D
T
RA
NSM
ISSI
ON
OF
HIV
A
IDS
rela
ted
deat
hs a
re r
ever
sing
gai
ns m
ade
in c
hild
hea
lth a
nd s
urvi
val i
n K
enya
C
arin
g fo
r H
IV-in
fect
ed c
hild
ren
has
maj
or e
cono
mic
and
soc
ial
impa
cts
on f
amili
es
and
heal
th s
yste
ms
Thu
s at
the
nat
iona
l lev
el p
reve
ntin
g M
TCT
has
the
pote
ntia
l to
incr
ease
the
unde
rsta
ndin
g an
d ac
cept
ance
of t
he H
IVA
IDS
epid
emic
and
thos
e liv
ing
with
HIV
AID
S C
ouns
ellin
g t
estin
g an
d co
mm
unity
sen
sitis
atio
n ca
n co
ntri
bute
to
redu
cing
stig
ma
Red
uctio
n of
MTC
T of
HIV
bull
Dec
reas
es n
umbe
rs o
f H
IV in
fect
ed c
hild
ren
bull
Incr
ease
s ch
ild h
ealth
and
sur
viva
l
bull
Dec
reas
es t
he lo
ad o
n th
e he
alth
sys
tem
bull
Giv
es a
n op
port
unity
to im
prov
e an
d ex
pand
hea
lth s
ervi
ces
as w
ell a
s to
str
engt
hen
the
exis
ting
heal
th in
fras
truc
ture
16
BEN
EFIT
SO
F H
IV C
OU
NSE
LLIN
GA
ND T
ESTI
NG
(CT)
(a) I
t pro
mot
es b
ehav
iour
cha
nge
by
bull R
educ
ing
high
ris
k be
havi
our
for
HIV
bull Id
entif
ying
HIV
dis
cord
ant
coup
les
bull In
crea
sing
the
use
of
dual
met
hods
of f
amily
pla
nnin
g an
d S
TI
prev
entio
n
bull Im
prov
ing
ante
nata
l car
e
bull G
uidi
ng in
fant
fee
ding
(b) I
t ena
bles
pre
vent
ive
ther
apy
for
bull
Mal
aria
bull O
ppor
tuni
stic
infe
ctio
ns (
eg
Pne
umoc
ystis
jiro
veci
i pn
eum
onia
)
bull T
B
25
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
82
Foo
tnot
es
9
Use
oth
er o
ptions
for
child
ren o
ver
9 k
ilogra
ms
10
Use
reg
ula
r or
double
-str
ength
tab
lets
for
child
ren o
ver
16 k
ilogra
ms
NO
T A
PP
LIC
AB
LE
bullPsp
sm
ear
The
fram
ewor
k be
low
illu
stra
tes
poin
ts o
f int
egra
tion
of c
ompr
ehen
sive
HIV
ca
re p
acka
ge in
to e
xist
ing
child
hea
lth s
ervi
ces
Fram
ewor
k for
integ
ratio
n F
rom
Ped
iatr
ic H
IV P
reve
nti
on
to C
are
A
Co
nce
ptu
al F
ram
ewo
rk N
ewb
orn
In
fan
t W
om
an
H
IV e
duca
tion
Pre
gn
an
cy
prev
entio
n C
T
bull F
ocus
ed A
NC
incl
udin
g
AR
V p
roph
ylax
is s
tagi
ng
STI
syph
ilis
CT
Z p
roph
ylax
isA
RT
M
alar
ia tr
eatm
ent amp
pre
vent
ion
CD
4 w
here
ava
ilabl
e in
clud
ing
IPT
amp I
TNs
Infa
nt f
eedi
ng c
ouns
elin
g (I
FC)
Lab
ou
r an
d D
eliv
ery
U
nive
rsal
pre
caut
ions
CT
for
unt
este
d m
othe
rs in
clud
ing
bull D
eliv
ery
care
bull E
OC
-Em
erge
ncy
obst
etri
c ca
re
part
ner
bull R
efer
ral s
yste
m
AR
V p
roph
ylax
is
(mot
her
and
infa
nt)
AR
T C
TZ
pro
phyl
axis
Exc
lusi
ve b
reas
t fe
edin
g or
rep
lace
men
t fe
edin
g
Post
Na
tal
Ca
re
Infa
nt fe
edin
g co
unse
ling
bull B
reas
t hea
lth
Dia
gnos
is (
antib
ody)
if
bull Se
xual
hea
lth
expo
sure
unk
now
n bull
Fam
ily
plan
ning
D
NA
PC
R if
exp
osed
CT
Z p
roph
ylax
is I
FC-
infa
nt f
eedi
ng c
ouns
elin
g
CT
for
unt
este
d m
othe
rs
CT
for
par
tner
D
BS
resu
lt I
FC
IFC
Wea
ning
Bf
eedi
ng
cess
atio
n s
uppo
rt
bullBre
ast e
xam
D
iagn
osis
(an
tibod
y
bullPap
sm
ear
test
) C
T f
or n
egat
ive
wom
en a
nd p
artn
ers
Dia
gnos
is (
antib
ody
test
)
New
born
Ca
re
bull B
CG
bull P
olio
0
bull Is
sue
child
hea
th c
ard
bullEnt
er b
irth
wei
ght
HIV
an
d A
RV
Exp
osur
e st
atus
on
chi
ld h
ealth
car
d Tw
o w
eeks
Infa
nt fe
edin
g co
unse
ling
Six
wee
ks
Imm
uniz
atio
ngr
owth
mon
itori
ng
Ten
wee
ks
im
mun
izat
ion
GM
Fou
rtee
n w
eeks
Im
mun
izat
ion
grow
th m
onito
ring
Si
x m
onth
s
Com
plem
enta
ry fe
eds
Vita
min
A S
uppl
emen
tatio
n
9 m
onth
s
imm
uniz
atio
nG
M
12 amp
18
mon
ths
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
17
(c) I
t pro
mot
es a
cces
s to
ear
ly m
edic
al c
are
bull
Obs
tetr
ical
car
e
bull T
B th
erap
y
bull M
alar
ia t
reat
men
t
bull S
TI t
reat
men
t
bull A
RV
the
rapy
for
mot
her
and
fam
ily
(d) I
t hel
ps to
pla
n fo
r the
futu
re
bull In
fant
fee
ding
sup
port
sys
tem
s
bull F
amily
pla
nnin
g
bull P
erso
nal a
nd f
inan
cial
dec
isio
ns
(e) I
t ena
bles
pre
vent
ive
ther
apy
of m
alar
ia a
nd
othe
r opp
ortu
nist
ic in
fect
ions
suc
h a
PCP
(f) It
giv
es ti
me
to p
lan
for t
he fu
ture
eg
inf
ant
feed
ing
supp
ort s
yste
ms
TH
E F O
UR-P
RO
NG
ED A
PPR
OA
CH
TO P
MTC
T Th
e In
ter
Age
ncy
Task
Tea
m o
n Pr
even
tion
of H
IV T
rans
mis
sion
in p
regn
ant
wom
en
mot
hers
and
the
ir c
hild
ren
(IA
TT)
has
prop
osed
a f
our-
pron
ged
appr
oach
for
the
pre
shyve
ntio
n of
HIV
tra
nsm
issi
on t
hat
targ
ets
non-
preg
nant
and
pre
gnan
t w
omen
mot
hers
and
thei
r ch
ildre
n
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
1
26
The
four
pro
ngs
are
1 P
rimar
y pr
even
tion
of H
IV in
fect
ion
in w
omen
2 P
reve
ntio
n of
uni
nten
ded
preg
nanc
y am
ong
HIV
-inf
ecte
d w
omen
3 I
nter
vent
ions
to
redu
ce t
rans
mis
sion
fro
m H
IV-i
nfec
ted
preg
nant
and
la
ctat
ing
wom
en t
o th
eir
child
ren
4 C
are
and
supp
ort
of w
omen
ch
ildre
n an
d fa
mili
es in
fect
ed a
nd
affe
cted
by
HIV
and
AID
S (
The
PM
TC
T-p
lus)
Ove
rall
the
cov
erag
e of
PM
TCT
prog
ram
mes
and
the
upt
ake
of s
ervi
ces
prov
ided
thro
ugh
thes
e pr
ogra
mm
es
incl
udin
g H
IV
test
ing
and
coun
selli
ng
and
AR
V
prop
hyla
xis
are
still
ver
y lo
w I
n 20
06 w
orld
wid
e le
ss t
han
10
of
preg
nant
wom
ente
stin
g H
IV-p
ositi
ve r
ecei
ved
AR
V d
rugs
for
PMTC
T11
In K
enya
acc
ordi
ng to
the
2007
Ken
ya A
IDS
Indi
cato
r Su
rvey
(KA
IS) 7
the
re h
as b
een
a sm
all i
ncre
ase
in H
IV te
stin
g am
ong
wom
en a
nd m
en c
ompa
red
to th
e 20
03 K
DH
S
KA
IS s
how
s th
at t
houg
h a
vast
maj
ority
(83
)
of H
IV-in
fect
ed w
omen
and
men
in
Ken
ya d
o no
t kn
ow t
heir
HIV
sta
tus
the
re h
as b
een
a cl
ear
and
dram
atic
incr
ease
inco
vera
ge o
f HIV
-tes
ting
amon
g A
NC
clin
ic a
tten
dees
PMTC
T se
rvic
es a
re t
here
fore
im
port
ant
entr
y po
ints
for
HIV
pre
vent
ion
and
trea
tshym
ent
Ove
rall
AR
V c
over
age
for
HIV
infe
cted
peo
ple
who
nee
d tr
eatm
ent
in K
enya
ison
ly 3
5
bull 9
0
of K
enya
n w
omen
who
del
iver
ed in
the
last
4 y
ears
att
end
AN
C
bull 5
7 o
f th
ose
atte
ndin
g A
NC
tes
ted
for
HIV
bull A
mon
g H
IV in
fect
ed w
omen
with
rec
ent
birt
hs
47
wer
e te
sted
in
AN
C
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
(8)
HIV
dis
ease
sta
ging
in H
IV-in
fect
ed c
hild
ren
Dis
ease
sta
ging
with
or
with
out
labo
rato
ry s
uppo
rt f
ollo
ws
HIV
dia
gshyno
sis
Sta
ging
HIV
dis
ease
pro
vide
s a
guid
e to
the
prog
nosi
s an
d in
tershy
vent
ions
nee
ded
at th
e di
ffere
nt s
tage
s (R
efer
to C
hapt
er 5
and
8)
(9)
AR
V th
erap
y
Chi
ldre
n w
ho a
re e
ligib
le fo
r A
RT
shou
ld b
e lin
ked
with
the
AR
T pr
oshygr
am a
nd p
rovi
ded
with
trea
tmen
t acc
ordi
ng to
Nat
iona
l Gui
delin
es a
sso
on a
s an
HIV
dia
gnos
is i
s m
ade
Ear
ly t
reat
men
t si
gnifi
cant
ly r
eshydu
ces
mor
talit
y in
HIV
infe
cted
chi
ldre
n
(10)
C
omm
unic
atio
n
Com
mun
icat
ing
with
car
e-pr
ovid
ers
and
prov
idin
g ps
ycho
soci
al s
upshy
port
for
the
child
mot
her
care
give
r an
d fa
mily
are
a c
ruci
al c
ompo
nent
of
car
e
Pare
nts
care
give
rs a
ndo
r th
e ch
ild n
eed
to p
artic
ipat
e in
mak
ing
deci
shysi
ons
and
plan
ning
app
ropr
iate
car
e fo
r th
e ch
ild i
nclu
ding
dec
isio
nsab
out t
hera
py a
nd w
here
the
child
sho
uld
rece
ive
care
In
this
res
pect
he
alth
wor
kers
mus
t en
sure
tha
t th
e fa
mily
con
side
rs t
he s
ocia
l nee
ds
of H
IV in
fect
ed a
nd a
ffect
ed c
hild
ren
Hea
lth c
are
wor
kers
sho
uld
ensu
re th
at th
ey p
rovi
de a
dequ
ate
time
for
care
give
rs to
ask
que
stio
ns s
o th
at th
ey c
an fu
lly u
nder
stan
d th
e im
plishy
catio
ns o
f HIV
and
HIV
tes
ting
for
them
selv
es a
nd fo
r th
eir
child
ren
H
ealth
car
e w
orke
rs s
houl
d co
unse
l car
egiv
ers
on d
iscl
osur
e in
clud
ing
disc
losu
re to
the
child
(11)
R
efer
rals
Ref
erra
ls a
re a
n im
port
ant p
art o
f man
agin
g an
HIV
exp
osed
or
infe
cted
chi
ld
Thes
e in
clud
e re
ferr
als
to
bull H
ighe
r le
vels
of s
peci
alis
ed c
are
for
furt
her
inve
stig
atio
ns a
nd
trea
tmen
t
bull S
ocia
l sup
port
pro
gram
mes
bull C
omm
unity
-bas
ed c
are
prog
ram
mes
bull P
ITC
site
s fo
r pa
rent
s an
d si
blin
gs
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
7
80
Tabl
e 9
2 W
HO
Rec
omm
enda
tions
for
Follo
w-u
p of
an
HIV
-Exp
osed
Chi
ld
bull A
t birt
h (f
or in
fant
s de
liver
ed a
t ho
me)
bull A
t age
1 t
o 2
wee
ks (
mai
nly
for
infa
nt f
eedi
ng c
ouns
elin
g)
bull A
t ag
e 6
10
and
14
wee
ks (
for
imm
uniz
atio
n an
d in
fant
fee
ding
co
unse
ling)
bull A
fter
age
14
wee
ks
mon
thly
thr
ough
age
12
mon
ths
bull A
fter
age
12 m
onth
s e
very
3 m
onth
s th
roug
h 24
mon
ths
bull A
t 18
mon
ths
do
conf
irm
ator
y H
IV la
bora
tory
test
(if
ther
e ar
e no
re
sour
ces
for
an e
arlie
r an
tigen
-bas
ed t
est)
bull A
fter
2 ye
ars
a m
inim
um o
f ye
arly
vis
its
For t
he H
IV-in
fect
ed f
ollo
w th
ese
guid
elin
es
From
M
onito
r
6 w
eeks
ndash12
mon
ths
Mon
thly
12 ndash
24 m
onth
s Ev
ery
3 m
onth
s
24 m
onth
s an
d on
war
ds
Yea
rly i
f not
sym
ptom
atic
If sy
mpt
omat
ic f
ollo
w u
p as
nee
ded
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
18
OV
ERV
IEW
OF
THE
NEW
PM
TCT
GU
IDEL
INES
Ken
yarsquos
Min
istr
y of
Hea
lth (
MO
H)
thro
ugh
NA
SCO
P h
as t
aken
sev
eral
act
ions
to
expa
nd a
nd s
tren
gthe
n PM
TCT
inte
rven
tions
in
the
coun
try
In
2000
a
Nat
iona
lTe
chni
cal
Wor
king
Gro
up (
TWG
) on
PM
TCT
was
for
med
Th
e TW
G
co-c
hair
ed b
yN
ASC
OP
and
the
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
co
ordi
nate
s im
plem
enta
tion
and
prov
ides
tec
hnic
al s
uppo
rt t
o th
e N
atio
nal
PMTC
T Pr
ogra
m
The
TWG
ser
ves
as a
foru
m t
o up
date
sta
keho
lder
s an
d di
scus
s ch
alle
nges
and
upc
omin
g ac
tiviti
es
The
TWG
is
also
res
pons
ible
for
upd
atin
g na
tiona
l gu
idel
ines
for
PM
TCT
The
nat
iona
l PM
TCT
prog
ram
was
offi
cial
ly l
aunc
hed
in 2
002
NA
SCO
P al
so e
stab
lishe
d se
vera
lpi
lot P
MTC
T si
tes
thro
ugho
ut th
e co
untr
y an
d pr
epar
ed n
atio
nal P
MTC
T gu
idel
ines
The
goal
of t
he n
atio
nal P
MTC
T pr
ogra
m is
in li
ne w
ith th
e go
al s
et o
ut a
t the
Uni
ted
Nat
ions
Gen
eral
Ass
embl
y Sp
ecia
l Ses
sion
on
HIV
AID
S (U
NG
ASS
) in
2001
to
redu
ceth
e pr
opor
tion
of in
fant
s in
fect
ed w
ith H
IV b
y 20
b
y th
e ye
ar 2
005
and
50
by
2010
In
Ken
ya t
he n
atio
nal P
MTC
T pr
ogra
m p
lann
ed t
o ex
tend
its
serv
ices
to
at le
ast
80
of
all
heal
th f
acili
ties
by 2
0071
2 A
ccor
ding
to
the
2003
PM
TCT
serv
ice
stat
istic
sap
prox
imat
ely
9 o
f al
l pr
egna
nt w
omen
rec
eive
d PM
TCT
serv
ices
in
that
yea
rC
urre
ntly
mor
e th
an 5
0 o
f al
l pr
egna
nt w
omen
in
Ken
ya r
ecei
ve P
MTC
T se
rvic
es
Thes
e gu
idel
ines
are
bas
ed o
n a
publ
ic h
ealth
app
roac
h to
car
e t
akin
g in
to c
onsi
dera
shytio
n is
sues
of
feas
ibili
ty a
nd a
ccep
tabi
lity
in
addi
tion
to e
ffica
cy a
nd c
ost-
bene
fit i
ndi
ffere
nt s
ettin
gs
The
guid
elin
es a
re e
xpec
ted
to i
mpr
ove
the
upta
ke
qual
ity a
nd
effe
ctiv
enes
s of
PM
TCT
serv
ices
in th
e co
untr
y
19
OB
JEC
TIV
ESA
ND O
RG
AN
ISA
TIO
NO
FTH
E G
UID
ELIN
ES
The
PMTC
T gu
idel
ines
are
par
t of
the
impl
emen
tatio
n in
stru
men
ts t
owar
ds u
nive
rsal
ac
cess
to
PMTC
T se
rvic
es a
nd a
res
pons
e to
the
cal
l to
actio
n to
war
ds H
IV-fr
ee a
ndA
IDS-
free
gen
erat
ion
Tog
ethe
r w
ith tw
o ot
her
guid
elin
es (A
RV
Ther
apy
in A
dults
and
Ad
oles
cent
s an
d AR
V Th
erap
y in
Inf
ants
and
You
ng C
hild
ren)
th
ey f
orm
a t
rilo
gy
aim
ed a
t co
ntex
tual
isin
g an
d m
ains
trea
min
g th
e W
HO
tri
logy
of
guid
elin
es o
n H
IVA
IDS
prev
entio
n an
d tr
eatm
ent
The
cont
ext
reso
urce
s an
d de
man
ds o
f PM
TCT
prog
ram
mes
diff
er g
reat
ly a
cros
s co
unshy
trie
s an
d ev
en a
cros
s pr
ogra
mm
es w
ithin
the
sam
e co
untr
y C
onsi
deri
ng t
his
vari
abilshy
ity t
hese
gui
delin
es in
clud
e th
e cu
rren
t con
sens
us o
n be
st p
ract
ices
as
wel
l as
alte
rnashy
tives
whi
ch m
ight
be
mor
e ap
prop
riat
e in
par
ticul
ar s
ettin
gs E
xper
ts a
gree
tha
t th
e ldquos
tate
of
the
artrdquo
in
PMTC
T is
cha
ngin
g ra
pidl
y an
d th
at r
ecom
men
datio
ns w
ill c
ershy
tain
ly a
lter
with
adv
ance
s in
med
ical
sci
ence
and
as
mor
e pr
ogra
mm
e ex
peri
ence
is
docu
men
ted
and
diss
emin
ated
The
are
as o
f A
RV
pro
phyl
axis
and
inf
ant
feed
ing
are
part
icul
arly
sub
ject
to r
apid
cha
nge
In 2
005
the
WH
O is
sued
pro
pose
d re
visi
ons
to it
s re
com
men
datio
ns o
n th
e us
e of
ant
ishyre
trov
iral
dru
gs f
or P
MTC
T T
he r
ecom
men
datio
ns w
ere
the
prod
uct
of e
xper
ts w
ho
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
9
28
conv
ened
to
disc
uss
impo
rtan
t ne
w i
nfor
mat
ion
conc
erni
ng t
he d
evel
opm
ent
of r
esis
shyta
nce
in w
omen
and
chi
ldre
n us
ing
sing
le d
ose
nevi
rapi
ne (S
dNV
P) fo
r PM
TCT
as w
ell
as n
ew c
linic
al fi
ndin
gs o
n st
rate
gies
that
mig
ht r
educ
e th
e de
velo
pmen
t of r
esis
tanc
e
Bas
ed o
n th
e ne
w W
HO
gui
delin
es K
enya
rsquos TW
G h
as d
evel
oped
sim
ple
pra
ctic
al a
nd
evid
ence
-bas
ed r
ecom
men
datio
ns o
n PM
TCT
that
wou
ld w
ork
in a
var
iety
of r
esou
rce-
limite
d en
viro
nmen
ts a
nd c
linic
al s
ituat
ions
that
con
fron
t hea
lthca
re w
orke
rs n
ot o
nly
in K
enya
but
als
o in
oth
er d
evel
opin
g co
untr
ies
110
U
SIN
GTH
E G
UID
ELIN
ES
Thes
e gu
idel
ines
are
inte
nded
prim
arily
for u
se b
y PM
TCT
prov
ider
s Th
ese
inclu
de n
urse
sm
idw
ives
clin
ical o
ffice
rs d
octo
rs c
ouns
ello
rs n
utrit
ioni
sts
and
othe
r he
alth
care
pro
fesshy
sion
als
They
will
als
o be
use
ful a
s a re
fere
nce
for p
rogr
amm
e m
anag
ers a
t fac
ility
dis
trict
pr
ovin
cial
and
nat
iona
l lev
els
thro
ugho
ut th
e he
alth
sec
tor
The
guid
elin
es a
re d
ivid
ed in
tote
n ch
apte
rs a
s out
lined
in T
able
15
The
spec
ific
obje
ctiv
es o
f the
new
PM
TCT
guid
elin
es a
re to
bull O
utlin
e th
e po
licy
issu
es in
pro
vidi
ng P
MT
CT
serv
ices
bull R
ecom
men
d op
erat
iona
l gui
delin
es to
be
follo
wed
by
heal
th c
are
prov
ider
s of
PM
TC
T se
rvic
es
bull E
nabl
e pr
ovid
ers
of P
MT
CT
to s
elec
t an
d pr
escr
ibe
AR
Vs
for
prop
hyla
xis
agai
nst
MT
CT
and
for
trea
tmen
t of
pre
gnan
t w
omen
in
fant
s an
d yo
ung
child
ren
bull S
tand
ardi
se t
he c
are
and
coun
selli
ng g
iven
by
PM
TC
T s
ervi
ce
prov
ider
s re
gard
ing
risk
of
MT
CT
and
on
PM
TC
T
bull I
mpr
ove
PM
TC
T se
rvic
es u
sing
eas
y-to
-use
job
aids
and
a
stan
dard
ised
Mamp
E s
yste
m
Prev
entin
g TB
Fo
r chi
ldre
n ex
pose
d to
sm
ear p
ositi
ve tu
berc
ulos
is
bull E
xclu
de a
ctiv
e T
B th
roug
h ca
refu
l his
tory
ph
ysic
al e
xam
and
in
vest
igat
ions
bull
If
ther
e is
no
evid
ence
of
activ
e T
B
star
t on
IN
H f
or p
roph
ylax
is f
or 6
m
onth
s (I
PT
) bull
If
TB
is p
rese
nt
star
t on
TB
tre
atm
ent
as p
er N
atio
nal T
B g
uide
lines
If
a ch
ild is
bor
n to
a m
othe
r with
act
ive
TB
bull S
tart
on
INH
pro
phyl
axis
(IP
T)
and
give
for
3 m
onth
s bull
Afte
r 3
mon
ths
do a
man
toux
bull
If
man
toux
is n
egat
ive
sto
p IN
H a
nd g
ive
BC
G
bull I
f man
toux
is p
ositi
ve a
t 3
mon
ths
con
tinue
for
a f
urth
er 3
mon
ths
bull A
t the
end
of
prop
hyla
xis
re-v
alua
te f
or a
ctiv
e T
B
|
If no
evi
denc
e of
act
ive
TB d
o no
t tre
at fo
r TB
|
If th
ere
is e
vide
nce
of a
ctiv
e TB
tre
at fo
r TB
as
per N
atio
nal
TB g
uide
lines
(6)
Trea
tmen
t of a
cute
infe
ctio
ns a
nd o
ther
HIV
-rel
ated
con
ditio
ns
HIV
-exp
osed
chi
ldre
n ar
e su
scep
tible
to c
omm
on in
fect
ions
as
wel
l as
OIs
for
the
HIV
infe
cted
and
HIV
may
alte
r th
e in
cide
nce
pre
senshy
tatio
n an
d re
spon
se t
o co
nven
tiona
l th
erap
y I
n so
me
case
s m
ore
aggr
essi
ve a
nd lo
nger
tre
atm
ent
cour
ses
may
be
nece
ssar
y a
s tr
eatshy
men
t fai
lure
s ar
e m
ore
freq
uent
(7)
Reg
ular
follo
w-u
p ca
re amp
refe
rral
s
Reg
ular
follo
w-u
p is
the
back
bone
to c
arin
g fo
r th
e H
IV e
xpos
ed c
hilshy
dren
and
ens
ures
opt
imal
hea
lthca
re a
nd p
sych
osoc
ial s
uppo
rt to
the
fam
ily W
HO
has
mad
e re
com
men
datio
ns o
n fr
eque
ncy
of fo
llow
-up
as s
how
n in
Tab
le 9
2 T
his
is t
he m
inim
um a
nd m
ore
freq
uent
con
shyta
ct w
ith t
he h
ealth
car
e sy
stem
may
be
indi
cate
d fo
r H
IV in
fect
ed
child
ren
and
espe
cial
ly if
they
are
on
anti-
retr
ovir
al tr
eatm
ent
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
9
78
Pro
phyl
axis
aga
inst
Pne
umoc
ysti
s ji
rove
cii
Pne
umon
ia (
PC
P)
in c
hild
ren
whe
re C
otri
mox
azol
e is
con
trai
ndic
ated
Ta
ble
15
The
Fou
r-Pr
onge
d A
ppro
ach
App
lied
to th
e PM
TCT
Gui
delin
e
Alte
rnat
ive
drug
s to
use
if C
TX is
con
train
dica
ted
are
give
n be
low
A s
econ
d ch
oice
wou
ld b
e ei
ther
dap
sone
or
atov
aqui
ne
Dap
sone
bull C
hild
ren
gt 1
mon
th
2 m
gkg
24
hour
s or
ally
onc
e da
ily
bull I
f bot
h C
TX
and
Dap
sone
are
con
trai
ndic
ated
(e
g
in c
hilshy
dren
with
G6P
D d
efic
ienc
y w
ho g
et h
aem
olys
is w
ith C
TX
and
D
apso
ne)
the
n us
e ei
ther
Ato
vaqu
one
bull
30m
gkg
day
for
age
1-3
mon
ths
bull H
ighe
r do
se 4
5mg
kgd
ay f
or a
ge 4
-24
mon
ths
OR
Aer
osol
ized
Pen
tam
idin
e
bull 3
00 m
g in
6 m
l wat
er v
ia in
hala
tion
nebu
lizer
onc
e m
onth
ly
bull c
hild
ren
gt 5
year
s
Cha
pter
CH
AP
TER
1
Bac
kgro
und
CH
AP
TER
2
Ant
enat
al C
are
and
Pre
vent
ion
of M
TCT
of H
IV
CH
AP
TER
3
Intra
partu
m C
are
Pron
g 1
Prim
ary
prev
entio
n of
HIV
in
fect
ion
in w
omen
Pron
g 2
Prev
entio
n of
un
inte
nded
pr
egna
ncy
amon
g H
IV in
fect
ed w
omen
Pron
g 3
Inte
rven
tions
to
redu
ce
tran
smis
sion
from
H
IV in
fect
ed
preg
nant
and
la
ctat
ing
wom
en to
th
eir c
hild
ren
Pron
g 4
Car
e an
d su
ppor
t of
wom
en c
hild
ren
and
fam
ilies
in
fect
ed a
nd
affe
cted
by
HIV
A
IDS
C
HA
PTE
R 4
U
se o
f Ant
iretro
vira
l D
rugs
in P
regn
ancy
fo
r Tre
atm
ent a
nd
Pre
vent
ion
of M
othe
r to
Chi
ld
Tran
smis
sion
of H
IV
Infe
ctio
n
CH
AP
TER
5
Imm
edia
te P
ostn
atal
an
d N
eona
tal C
are
CH
AP
TER
6
Late
Pos
tnat
al C
are
and
Fam
ily P
lann
ing
CH
AP
TER
7
HIV
Dia
gnos
is in
C
hild
ren
CH
AP
TER
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
born
to
HIV
infe
cted
m
othe
rs
CH
AP
TER
9
Car
e an
d Fo
llow
-up
of C
hild
ren
of H
IV
infe
cted
mot
hers
C
HA
PTE
R 1
0
Mon
itorin
g an
d E
valu
atio
n of
PM
TCT
se
rvic
es
77
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
30
For
each
of t
hese
cha
pter
s (e
xcep
t ch
apte
r on
e on
bac
kgro
und)
the
gui
delin
es g
ive
anin
trod
uctio
n fo
llow
ed b
y po
licy
stat
emen
ts t
hen
oper
atio
nal g
uide
lines
of w
hat p
rovi
dshyer
s sh
ould
do
to r
educ
e m
othe
r-to
-chi
ld t
rans
mis
sion
of
HIV
and
or
to i
mpr
ove
thei
r pe
rfor
man
ce a
nd th
e ef
fect
iven
ess
of th
eir s
ervi
ces
A li
st o
f job
aid
s fo
r us
e by
the
hea
lthca
re p
rovi
der
follo
ws
the
oper
atio
nal g
uide
lines
and
whe
re n
eces
sary
a li
st o
f ap
pend
ices
and
add
ition
al d
ocum
ents
tha
t m
ay b
e re
shyfe
rred
to
but
are
cons
ider
ed t
oo b
ig o
r de
taile
d to
be
incl
uded
with
in t
he m
ain
body
of
the
guid
elin
es
Foo
tnot
es
1
UN
AID
S (
2004)
Rep
ort
on t
he
Glo
bal AID
S E
pid
emic
Ava
ilable
at
ww
wu
nai
ds
org
2
Ibid
2004
3
It
is
import
ant
to r
ecognis
e th
at t
he
use
of
the
phra
se M
TC
T in n
o w
ay is
inte
nded
to
pla
ce b
lam
e on t
he
moth
er
who m
ay o
r m
ay n
ot
know
her
HIV
sta
tus
who t
ransm
its
the
viru
s to
her
child
Pa
thfinder
ack
now
ledges
that
man
y tim
es p
regnant
wom
en
may
hav
e bee
n infe
cted
by
thei
r m
ale
par
tner
and d
o n
ot
hav
e th
e ab
ility
to n
egoti-
ate
safe
r se
x o
r to
see
k M
TC
T s
ervi
ces
for
fear
of
viole
nce
st
igm
a o
r ab
andonm
ent
if t
hei
r st
atu
s is
rev
eale
d
Path
finder
uphold
s th
e re
pro
duct
ive
rights
of
all w
om
en t
o
choose
if
and w
hen
to h
ave
child
ren
regar
dle
ss o
f H
IV-s
tatu
s
4
W
HO
CD
C
Dep
artm
ent
of
Hea
lth a
nd H
um
an S
ervi
ces
(2004)
Pre
vention o
f M
oth
er-t
o-C
hild
Tra
nsm
issi
on o
f H
IV
Gen
eric
Tra
inin
g P
acka
ge
Gen
eva
Sw
itze
r-la
nd
WH
O
5
U
NAID
S (
2004)
Rep
ort
on t
he
Glo
bal AID
S E
pid
emic
Ava
ilable
at
ww
wu
nai
ds
org
6
Polic
y Pro
ject
(2004)
Cove
rage
of
sele
cted
ser
vice
s fo
r H
IVA
IDS p
reve
ntion a
nd
care
in low
and m
iddle
-inco
me
countr
ies
in 2
003
Ava
ilable
at
ww
wp
olia
pro
ject
com
7
Cen
tral Bure
au o
f Sta
tist
ics
(CBS)
[Ken
ya]
Min
istr
y of
Hea
lth (
MO
H)
[Ken
ya]
and
ORC M
acro
(2004)
Ken
ya D
emogra
phic
and H
ealth S
urv
ey 2
003
Cal
vert
on
Mar
y-la
nd
CBSM
OH
an
d O
RC M
acr
o
8
Nat
ional AID
S C
ontr
ol Counci
l 2
007
8a
Ken
ya A
IDS I
ndic
ato
r Surv
ey 2
007
9
Ibid
2004
10
NASCO
P (
2002)
Surv
eilla
nce
data
as
cite
d in N
ASCO
PM
OH
(2
003)
Nat
ional
PM
CT
Str
ate
gic
Managem
ent
Pla
n 2
003-2
007
111
2 A
IDS in K
enya
Tre
nds
Inte
rven
tions
and I
mpact
7th
editio
n
(2005)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Who
Nee
ds P
CP
Prop
hyla
xis
bull A
ll in
fant
s bo
rn t
o H
IV-i
nfec
ted
mot
hers
irr
espe
ctiv
e of
any
ant
iret
rovi
ral
ther
apy
duri
ng p
regn
ancy
and
labo
ur
Pro
phyl
axis
con
tinue
s un
til th
e in
fant
is 1
2 m
onth
s or
is P
CR
neg
ativ
e or
ant
ibod
y ne
gativ
e w
hich
ever
co
mes
ear
lier
bull A
ll in
fant
s id
entif
ied
as H
IV-i
nfec
ted
duri
ng th
e fir
st y
ear
of li
fe b
y a
PC
R
test
or
by a
clin
ical
dia
gnos
is o
f H
IV in
fect
ion
and
a po
sitiv
e an
tibod
y te
st
bull C
hild
ren
olde
r th
an 1
2 m
onth
s w
ith s
ympt
omat
ic H
IV d
isea
se o
r an
A
IDS
-def
inin
g ill
ness
(W
HO
sta
ge I
I an
d III
se
e ch
apte
r 5)
or
with
CD
4 lt
15
or
TLC
150
0m
m3
bull A
ny c
hild
with
a h
isto
ry o
f P
CP
sho
uld
cont
inue
with
sec
onda
ry
prop
hyla
xis
(dai
ly C
T)
for
life
Clin
icia
ns s
houl
d cl
earl
y in
form
HIV
inf
ecte
d m
othe
rs a
t de
liver
y th
at t
heir
chi
ldre
n ne
ed p
roph
ylax
is a
gain
st P
CP
star
ting
at 6
wee
ks o
f age
unt
il it
is e
stab
lishe
d th
at th
e ch
ild i
s no
t H
IV i
nfec
ted
A p
ract
ical
way
to
ensu
re t
hat
mot
hers
and
oth
er h
ealth
wor
kers
are
inf
orm
ed i
s to
mak
e a
note
on
the
child
rsquos im
mun
izat
ion
card
at
birt
h st
atin
g ldquoP
leas
e gi
ve c
o-tr
imox
azol
e (5
mg
kgd
ay o
rally
dai
ly) f
rom
6 w
eeks
of a
gerdquo
Tabl
e 9
1 D
ose
of C
otrim
oxaz
ole
for P
CP
Prop
hyla
xis
Wei
ght o
f C
hild
(kg)
1ndash4
5ndash8
9ndash16
17ndash5
0
gt 50
CT
tabl
ets
20 m
g TM
P1
00
mg
SM
X p
edia
tric
stre
ngth
(120
mg)
1 ta
b
2 ta
bs
Cot
rimox
azol
e su
spen
sion
40
mg
TMP
200
mg
SM
X
5ml (
240
mg)
25
ml
5 m
l
10 m
l
CT
tabl
ets
80 m
g TM
P4
00 m
g S
MX
re
gula
r stre
ngth
(4
80 m
g)
frac14 ta
b
frac12 ta
b
1 ta
b
2 ta
bs
2 ta
bs
CT
Tabl
ets
160
mg
TMP
800
mg
SM
X
Dou
ble
stre
ngth
(9
60 m
g) -
frac14 ta
b
frac12 ta
b
1 ta
b
1 ta
b
In r
are
case
s a
s in
chi
ldre
n w
ith G
6PD
def
icie
ncy
CTX
may
be
cont
rain
dica
ted
G
uid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
1
76
(3)
Mon
itor
the
child
rsquos g
row
th a
nd d
evel
opm
ent
as a
mea
ns o
f id
entif
ying
the
ch
ild w
ho is
faili
ng to
thriv
e an
d al
so a
s a
tool
for m
onito
ring
the
effe
ct o
f int
ershy
vent
ions
(4)
Ens
ure
that
im
mun
isat
ions
are
sta
rted
and
com
plet
ed
acco
rdin
g to
the
re
com
men
datio
ns o
f the
nat
iona
l im
mun
isat
ion
sche
dule
|
Add
ition
al c
onsi
dera
tions
are
as
follo
ws
bull
Whe
n co
nsid
erin
g BC
G v
acci
natio
n at
a la
ter a
ge
(re-
vacc
inat
ion
for n
o sc
ar o
r mis
sed
earli
er v
acci
natio
n)
excl
ude
sym
ptom
atic
HIV
infe
ctio
n
bull
Do
not g
ive
yello
w fe
ver v
acci
ne to
sym
ptom
atic
HIV
-infe
cted
chi
lshydr
en H
owev
er a
sym
ptom
atic
chi
ldre
n in
end
emic
are
as s
houl
d re
shyce
ive
the
yello
w fe
ver v
acci
ne a
t 9 m
onth
s of
age
bull
Mea
sles
vac
cine
sho
uld
be g
iven
to H
IV in
fect
ed c
hild
ren
at 6
and
9
mon
ths
sinc
e H
IV in
fect
ed c
hild
ren
expe
rienc
e m
uch
mor
e se
vere
di
seas
e w
ith w
ild m
easl
es v
irus
whi
ch o
utw
eigh
s th
e ris
k of
a m
ilder
illn
ess
from
the
vacc
ine
(5)
Pro
vide
pro
phyl
axis
for o
ppor
tuni
stic
infe
ctio
ns
|
Pro
phyl
axis
aga
inst
Pne
umoc
ystis
jiro
veci
i Pne
umon
ia
bull
Pne
umoc
ystis
jiro
veci
i (fo
rmer
ly P
neum
ocys
tis c
arin
ii) p
neum
onia
(PC
P)
is a
sig
nific
ant c
ause
of m
orbi
dity
and
mor
talit
y am
ong
youn
g in
fant
s in
A
frica
Co-
trim
oxaz
ole
(CTX
) pro
phyl
axis
sig
nific
antly
redu
ces
the
inci
shyde
nce
and
seve
rity
of P
CP
Add
ition
al b
enef
its o
f co-
trim
oxaz
ole
incl
ude
prot
ectio
n ag
ains
t com
mon
bac
teria
l inf
ectio
ns t
oxop
lasm
osis
and
mashy
laria
All
child
ren
born
to H
IV in
fect
ed m
othe
rs s
houl
d re
ceiv
e pr
ophy
shyla
xis
agai
nst P
CP
at l
east
dur
ing
the
first
yea
r of l
ife o
r unt
il th
ey a
re
prov
en to
be
unin
fect
ed (s
ee b
ox b
elow
)
bull
CTX
is c
lear
ly th
e dr
ug o
f cho
ice
for p
roph
ylax
is b
ecau
se o
f its
hig
h
effic
acy
rela
tive
safe
ty l
ow c
ost a
nd b
road
ant
imic
robi
al s
pect
rum
In
cas
e of
CTX
hyp
erse
nsiti
vity
des
ensi
tizat
ion
is re
com
men
ded
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
CH
AP
TE
R 2
Ant
enat
al C
are
and
Prev
entio
n of
MTC
T of
HIV
21
INTR
OD
UC
TIO
N
HIV
inf
ectio
n ha
s em
erge
d in
Ken
ya a
s th
e m
ost
impo
rtan
t he
alth
ris
k fa
ctor
for
m
othe
rs a
nd t
heir
chi
ldre
n an
d ha
s a
grea
t im
pact
on
the
long
ter
m o
utco
me
ofpr
egna
ncy
and
child
sur
viva
l A
ll pr
egna
nt w
omen
sho
uld
be e
ncou
rage
d to
lear
n th
eir
HIV
infe
ctio
n st
atus
as
wel
l as
that
of t
heir
sex
ual p
artn
ers
O
nly
by k
now
ing
onersquos
H
IV s
tatu
s ca
n th
e he
alth
wor
kers
mak
e ap
prop
riat
e he
alth
car
e m
anag
emen
t re
com
men
datio
ns a
nd t
he c
oupl
e m
ake
appr
opri
ate
deci
sion
s ab
out
mai
ntai
ning
the
ir
heal
th a
nd t
hat
of t
heir
unb
orn
baby
Pr
e-co
ncep
tion
care
is
enco
urag
ed w
here
an
oppo
rtun
ity a
rise
s an
d a
birt
h pl
an is
dis
cuss
ed w
ith th
e pr
egna
nt w
oman
In m
ost
case
s t
he p
regn
ant
wom
an w
ill n
ot h
ave
HIV
infe
ctio
n P
regn
ancy
offe
rs a
n op
port
une
time
to d
iscu
ss p
reve
ntio
n of
HIV
inf
ectio
n as
man
y w
omen
com
e in
toco
ntac
t w
ith h
ealth
ser
vice
s fo
r th
e fir
st (
and
in s
ome
case
s th
e on
ly)
time
duri
ng
preg
nanc
y
In K
enya
50
o
f m
arri
ed H
IV p
ositi
ve p
erso
ns h
ave
an H
IV n
egat
ive
spou
se1
Ther
efor
e k
now
ing
the
HIV
inf
ectio
n st
atus
of
onersquos
par
tner
is
criti
cal
Add
ition
ally
th
is f
orm
s an
im
port
ant
entr
y po
int
for
esta
blis
hing
pre
vent
ion
with
po
sitiv
e (P
WP)
pro
gram
s am
ong
coup
les
as w
ell a
s pr
ovid
ing
acce
ss to
HIV
pre
vent
ion
ca
re a
nd tr
eatm
ent s
ervi
ces
for
the
who
le fa
mily
PMTC
T pr
ovid
es a
n op
port
unity
for
prev
entin
g ne
w p
aedi
atri
c H
IV in
fect
ions
as
wel
l as
for
reac
hing
the
10 to
20
of H
IV p
ositi
ve p
regn
ant w
omen
who
mee
t WH
O e
ligib
ilshyity
cri
teri
a fo
r in
itiat
ing
AR
T fo
r th
eir
own
heal
th N
ew in
fect
ions
and
hig
h vi
ral l
oads
duri
ng p
regn
ancy
pos
e th
e gr
eate
st r
isk
of M
TCT
to t
he u
nbor
n ba
by t
hus
prim
ary
prev
entio
n A
RV
pro
phyl
axis
as
wel
l as
trea
tmen
t at t
his
time
is c
ritic
al G
iven
that
25
perc
ent o
f wom
en in
Ken
ya h
ave
an u
nwan
ted
preg
nanc
y s
tren
gthe
ning
the
link
to F
P se
rvic
es a
nd c
ondo
m a
cces
s fo
r du
al p
rote
ctio
n of
fers
a c
hanc
e to
fur
ther
pre
vent
MTC
T2
22
OPE
RA
TIO
NA
L G
UID
ELIN
ES
Ant
enat
al c
are
and
prev
entio
n of
MTC
T du
ring
thi
s pe
riod
can
be
sum
mar
ised
usi
ngan
ess
entia
l pa
ckag
e of
int
egra
ted
ante
nata
l ca
re s
ervi
ces
as s
how
n in
Tab
le 2
1
This
ou
tline
s th
e pa
ckag
e of
ca
re
to
be
prov
ided
to
ev
ery
wom
an
atte
ndin
g A
NC
ser
vice
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
5
32
Tabl
e 2
1 Es
sent
ial P
acka
ge o
f Int
egra
ted
Ant
enat
al C
are
Serv
ices
Gro
up e
duca
tion
Incl
ude
info
rmat
ion
on fo
ur A
NC
vis
its b
reas
tfeed
ing
mat
erna
l and
infa
nt n
utrit
ion
per
sona
l hyg
iene
birt
h pr
epar
edne
ss d
ange
r sig
ns p
reve
ntio
n of
com
plic
atio
ns s
kille
d bi
rth a
ttend
ance
fam
ily p
lann
ing
imm
uniz
atio
n sc
hedu
le
post
-nat
al c
are
and
HIV
and
AID
S m
anag
emen
t
Clie
nt h
isto
ry O
btai
n ro
utin
e da
ta in
clud
ing
med
ical
obs
tetri
c a
nd p
sych
osoc
ial h
isto
ry D
eter
min
e dr
ug h
isto
ry k
now
n al
lerg
ies
and
use
of a
ltern
ativ
e m
edic
ines
suc
h as
her
bal p
rodu
cts
Phy
sica
l exa
min
atio
n In
clud
e vi
tal s
igns
ins
pect
ion
aus
culta
tion
and
palp
atio
n
Abd
omin
al a
nd g
enita
l exa
min
atio
n In
clud
e in
spec
tion
pal
patio
n fo
etal
aus
culta
tion
spe
culu
m a
nd b
iman
ual e
xam
inat
ions
w
here
indi
cate
d
AN
C P
rofil
e R
outin
e te
sts
for s
yphi
lis H
b b
lood
gro
up a
nd R
hesu
s fa
ctor
urin
alys
is a
nd p
rovi
de ra
pid
HIV
test
ing
to th
e pr
egna
nt w
oman
and
her
par
tner
if a
ccom
pany
ing
her
If in
dica
ted
chec
k sp
utum
for A
AFB
and
CD
4 co
unt
Cou
nsel
ing
on b
irth
prep
ared
ness
Sup
port
the
preg
nant
wom
an a
nd h
er p
artn
er to
dev
elop
an
indi
vidu
al b
irth
plan
that
in
clud
es p
lace
of d
eliv
ery
with
ski
lled
birth
atte
ndan
ce e
mer
genc
y tra
nspo
rt b
irth
com
pani
onsh
ip a
nd re
adin
ess
for i
nfan
t ca
re
Cou
nsel
ing
on p
regn
ancy
dan
ger s
igns
Pro
vide
wom
en w
ith in
form
atio
n an
d in
stru
ctio
ns o
n se
ekin
g ea
rly c
are
for p
regshy
nanc
y co
mpl
icat
ions
suc
h as
ble
edin
g fe
ver
seve
re h
eada
che
sw
olle
n fe
et f
its o
r con
vuls
ions
Cou
nsel
ing
on in
fant
feed
ing
All
wom
en re
quire
infa
nt-fe
edin
g co
unse
ling
and
supp
ort
Exc
lusi
ve b
reas
tfeed
ing
for s
ix
mon
ths
shou
ld b
e pr
omot
ed a
s th
e no
rm fo
r all
wom
en re
gard
less
of H
IV s
tatu
s W
omen
infe
cted
with
HIV
nee
d to
be
gu
ided
in th
e se
lect
ion
of s
afer
infa
nt-fe
edin
g op
tions
(ref
er to
WH
O g
uide
lines
and
MO
H c
ircul
ar o
n in
fant
and
you
ng c
hild
fe
edin
g)
Nut
ritio
nal a
sses
smen
t co
unse
ling
and
educ
atio
n In
clud
e iro
n m
ultiv
itam
in a
nd fo
late
sup
plem
enta
tion
mon
itor f
or a
naeshy
mia
ade
quat
e ca
loric
and
nut
rient
inta
ke a
nd re
com
men
d re
alis
tic d
iet a
djus
tmen
ts b
ased
on
loca
l res
ourc
es a
nd n
eeds
of
HIV
+ pr
egna
nt w
omen
(at l
east
10
mor
e of
the
RD
A)
Cou
nsel
ing
on H
IV a
nd A
IDS
Pro
vide
wom
en w
ith in
form
atio
n an
d in
stru
ctio
ns o
n se
ekin
g he
alth
car
e fo
r
sym
ptom
s of
HIV
dis
ease
pro
gres
sion
suc
h as
freq
uent
and
recu
rrent
illn
esse
s c
hron
ic p
ersi
sten
t dia
rrho
ea c
andi
dias
is
feve
r w
astin
g or
sig
ns o
f any
opp
ortu
nist
ic in
fect
ion
Lin
k w
omen
to A
IDS
trea
tmen
t and
oth
er s
uppo
rt pr
ogra
mm
es w
here
av
aila
ble
Cou
nsel
ing
the
HIV
neg
ativ
e w
oman
and
her
par
tner
Pro
vide
info
rmat
ion
on re
peat
test
ing
risk
redu
ctio
n an
d pa
rtner
test
ing
RTI
scr
eeni
ng A
ll w
omen
with
hig
h ris
k se
xual
his
tory
or p
rese
ntin
g w
ith s
igns
of R
TI s
uch
as a
bnor
mal
gen
ital d
isch
arge
ge
nita
l ulc
ers
and
pelv
ic in
flam
mat
ory
dise
ase
shou
ld b
e sc
reen
ed a
nd m
anag
ed a
ccor
ding
to K
enya
pro
toco
ls
Tube
rcul
osis
(TB
) A
ll w
omen
pre
sent
ing
for A
NC
ser
vice
s w
ith a
cou
gh o
f mor
e th
an 2
wee
ksrsquo d
urat
ion
shou
ld b
e sc
reen
ed
for T
B re
gard
less
of H
IV s
tatu
s F
ollo
w K
enya
pro
toco
ls fo
r scr
eeni
ng p
roph
ylax
is a
nd tr
eatm
ent
Teta
nus
toxo
id im
mun
isat
ions
Adm
inis
ter a
ccor
ding
to c
urre
nt K
EP
I TT
Imm
uniz
atio
n S
ched
ule
Dew
orm
ing
All
preg
nant
wom
en s
houl
d re
ceiv
e an
ti-he
lmin
thes
afte
r firs
t trim
este
r as
per t
he g
uide
lines
on
m
ater
nal n
utrit
ion
Ant
imal
aria
ls I
TNs
All
preg
nant
wom
en in
mal
aria
end
emic
are
as s
houl
d sl
eep
unde
r an
ITN
and
rece
ive
SP
inte
rmitt
ent
pres
umpt
ive
treat
men
t acc
ordi
ng to
the
Nat
iona
l Mal
aria
gui
delin
es
AR
V a
nd O
ppor
tuni
stic
Infe
ctio
ns p
roph
ylax
is (d
urin
g pr
egna
ncy)
Pro
vide
AR
V C
TX a
nd o
ther
pro
phyl
actic
m
edic
atio
ns a
ccor
ding
to th
e K
enya
AR
T pr
otoc
ol o
n O
I pro
phyl
axis
and
use
of A
RV
s in
pre
gnan
cy
AR
V tr
eatm
ent d
urin
g pr
egna
ncy
Pro
vide
HA
AR
T w
ithin
the
MC
H s
ettin
g ac
cord
ing
to th
e K
enya
pro
toco
l on
use
of A
RV
s
Est
ablis
h cl
ear r
efer
ral n
etw
orks
with
sen
ior c
linic
ians
Pre
vent
ion
with
Pos
itive
s E
ncou
rage
pos
itive
livi
ng d
iscl
osur
e c
orre
ct a
nd c
onsi
sten
t con
dom
use
and
pro
vide
psy
chos
oshyci
al s
uppo
rt to
the
affe
cted
fam
ilies
For
the
HIV
-infe
cted
and
affe
cted
fam
ilies
est
ablis
h an
dor
stre
ngth
en li
nkag
es to
car
e
treat
men
t and
sup
port
serv
ices
incl
udin
g po
st-p
artu
m fo
llow
up
Effe
ctiv
e co
ntra
cept
ion
plan
Cou
nsel
abo
ut o
ther
fam
ily p
lann
ing
met
hods
em
phas
izin
g on
par
tner
invo
lvem
ent
and
dual
pro
tect
ion
met
hods
to a
void
unw
ante
d pr
egna
ncy
new
infe
ctio
n re
-infe
ctio
n an
d fu
rther
tran
smis
sion
Sourc
e K
enya
Nat
ional PM
TC
T T
rain
ing C
urr
iculu
m
2005
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
92
OPE
RA
TIO
NA
L G
UID
ELIN
ES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed in
the
care
and
fo
llow
-up
of c
hild
ren
of H
IV-in
fect
ed m
othe
rs
bull A
ll ch
ildre
n bo
rn t
o H
IV in
fect
ed m
othe
rs s
houl
d be
see
n in
the
he
alth
car
e fa
cilit
y w
ithin
tw
o w
eeks
of
deliv
ery
bull F
or a
ll H
IV e
xpos
ed in
fant
s m
onth
ly f
ollo
w u
p vi
sits
are
re
com
men
ded
begi
nnin
g at
six
wee
ks t
hrou
gh 2
yea
rs
bull W
here
pos
sibl
e v
isits
sho
uld
be li
nked
to
the
imm
unis
atio
n an
d
grow
th m
onito
ring
vis
its
bull A
ll H
IV e
xpos
ed in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e
prop
hyla
xis
from
6 w
eeks
of
age
bull F
or in
fant
s w
ho te
st H
IV p
ositi
ve b
y D
NA
PC
R b
efor
e 18
mon
ths
or
by a
ntib
ody
test
aft
er 1
8 m
onth
s of
age
co
-trim
oxaz
ole
shou
ld b
e gi
ven
daily
for
life
bull F
or in
fant
s w
ho te
st H
IV n
egat
ive
|
If th
ey h
ave
stop
ped
brea
stfe
edin
g fo
r 2 m
onth
s or
mor
e s
top
C
otrim
oxaz
ole
|
If st
ill br
east
feed
ing
con
tinue
Cot
rimox
azol
e un
til tw
o m
onth
s af
ter
com
plet
e ce
ssat
ion
of b
reas
tfeed
ing
bull C
ompr
ehen
sive
car
e fo
r th
e H
IV e
xpos
ed o
r in
fect
ed in
fant
s sh
ould
be
pro
vide
d in
the
bro
ader
con
text
of
othe
r ch
ild h
ealth
car
e st
rate
gies
Hea
lth w
orke
rs s
houl
d pr
ovid
e th
e fo
llow
ing
pack
age
of c
are
as a
min
imum
to
thes
e ch
ildre
n
(1)
Con
firm
HIV
sta
tus
as e
arly
as
poss
ible
(R
efer
to C
hapt
er 7
)
(2)
M
othe
rs s
houl
d be
sup
porte
d to
pro
vide
opt
imal
infa
nt fe
edin
g an
d pa
rticu
larly
to
avoi
d m
ixed
feed
ing
in th
e fir
st 6
mon
ths
of li
fe I
t is
impo
rtant
that
infa
nt fe
edin
g ch
oice
s at
initi
atio
n of
feed
ing
follo
win
g ea
rly in
fant
dia
gnos
is a
t wea
ning
and
at
the
time
of in
trodu
ctio
n of
com
plem
enta
ry fe
eds
are
guid
ed b
y th
e A
FAS
S c
riter
ia
(Ref
er to
Cha
pter
8)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
3
74
Cha
pter
9
Car
e an
d Fo
llow
-up
of C
hild
ren
of H
IV-in
fect
ed M
othe
rs
91
INTR
OD
UC
TIO
N
PMTC
T in
terv
entio
ns re
duce
but
do
not e
limin
ate
the
risk
of H
IV tr
ansm
issi
on fr
om m
othshy
ers t
o th
eir i
nfan
ts a
nd y
oung
child
ren
Bot
h H
IV-in
fect
ed a
nd u
ninf
ecte
d ex
pose
d ch
ildre
n ha
ve in
crea
sed
risk
s of
infe
ctio
n an
d de
ath
from
com
mon
chi
ldho
od in
fect
ions
The
sur
shyvi
val o
f H
IV-e
xpos
ed c
hild
ren
whe
ther
or
not
they
are
inf
ecte
d i
s cl
osel
y lin
ked
to t
he
heal
th a
nd s
urvi
val o
f the
ir m
othe
rs T
here
fore
lon
g-te
rm b
enef
its o
f PM
TCT
prog
ram
s w
ill o
nly
be s
usta
ined
if t
here
is o
ngoi
ng c
ompr
ehen
sive
car
e fo
r th
e ch
ildre
n an
d th
eir
mot
hers
and
or c
are
give
rs
HIV
exp
osed
chi
ldre
n ar
e vu
lner
able
to
the
com
mon
illn
esse
s af
fect
ing
othe
r ch
ildre
n
Thes
e in
fect
ions
incl
ude
neon
atal
infe
ctio
ns m
alar
ia p
neum
onia
dia
rrho
ea m
easl
es a
nd
othe
r vac
cine
pre
vent
able
dis
ease
s H
IV in
fect
ed ch
ildre
n ar
e lik
ely
to s
uffe
r mor
e se
vere
ly
and
have
a h
ighe
r lik
elih
ood
of d
ying
from
com
mon
chi
ldho
od il
lnes
ses
than
non
-infe
cted
ch
ildre
n W
here
as m
alnu
triti
on c
ause
s 53
o
f all
child
hood
dea
ths
HIV
exp
osed
chi
ldre
n ar
e m
ore
vuln
erab
le to
it th
an n
on-in
fect
ed c
hild
ren
Thi
s is
bec
ause
HIV
exp
osed
child
ren
have
hig
her
calo
ric
requ
irem
ents
as
a re
sult
of th
eir
HIV
infe
ctio
n th
e pr
esen
ce o
f opp
orshy
tuni
stic
infe
ctio
ns a
nd o
ther
com
plic
atio
ns re
late
d to
AID
S
Regu
lar
follo
w u
p ca
re is
cri
tical
for
an in
fant
bor
n to
a m
othe
r w
ith H
IVA
IDS
The
com
shypr
ehen
sive
car
e of
HIV
exp
osed
chi
ldre
n in
clud
ing
nutr
ition
im
mun
isat
ion
mon
itori
ng o
f gr
owth
and
dev
elop
men
t pr
even
tion
and
trea
tmen
t of
opp
ortu
nist
ic in
fect
ions
and
ear
ly
infa
nt d
iagn
osis
of
HIV
is f
easi
ble
in r
esou
rce-
cons
trai
ned
sett
ings
and
sig
nific
antly
imshy
prov
es th
e su
rviv
al o
f the
se ch
ildre
n
23
JOB A
IDS
Prov
ider
s ar
e en
cour
aged
to re
fer t
o th
e ap
prop
riate
job
aid(
s) w
hen
deal
ing
with
spe
cific
issu
es
bull P
MT
CT
test
ing
and
coun
selli
ng t
ools
bull C
oupl
e co
unse
lling
tool
s
bull A
NC
alg
orith
ms
for
AR
V p
roph
ylax
is a
nd in
fant
fee
ding
gui
delin
es
as a
dapt
ed f
rom
WH
O g
uide
lines
bull P
reve
ntio
n w
ith p
ositi
ves
tool
kit
on d
iscl
osur
e
bull F
ocus
ed a
nte-
nata
l car
e
bull M
alar
ia in
pre
gnan
cy
bull T
B in
pre
gnan
cy
bull K
EP
I S
ched
ule
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
3
34
A ra
pid
HIV
test
ing
algo
rithm
for s
eria
l tes
ting
is il
lust
rate
d be
low
35
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Pre-Test Education and or Counselling
First HIV Rapid Test ndashDETERMINE
Negative TestResult
Counsel for Negative Result
Positive TestResult
Second HIV Rapid Test ndashBIOLINE
Positive Test ResultCounsel for
Positive Result
NegativeTestResult
Third HIV Rapid Test ndashUNIGOLD
Positive Test ResultCounsel for
Positive Result
Negative Test ResultCounsel for
Negative Result
Figure 32 Rapid HIV testing algorithm Serial testing
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
72
M
othe
r and
Chi
ld H
ealth
Boo
klet
71
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
36
Cha
pter
ref
eren
ces
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
National G
uid
e-lin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
atal Car
e (
2004)
WH
O
UN
FPA
UN
ICEF
World B
ank
Manag
ing C
om
plic
atio
ns
in P
regnan
cy a
nd C
hild
birth
A g
uid
e fo
r m
idw
ives
and d
oct
ors
(2003)
WH
O
Sta
ndar
ds
for
Mat
ernal
and N
eonat
al C
are
(2006)
WH
O
Antire
trovi
ral dru
gs
for
trea
ting p
regnan
t w
om
en a
nd p
reve
nting H
IV infe
ctio
ns
in
infa
nts
in r
esourc
e lim
ited
set
tings
Tow
ard
s U
niv
ersa
l Acc
ess
Rec
om
men
dations
for
a public
hea
lth a
ppro
ach (
2006)
Min
istr
y of
Hea
lth
Nat
ional AID
S amp
STD
Contr
ol Pro
gra
mm
e (N
ASCO
P)
Guid
elin
es f
or
Antire
trovi
ral dru
g t
her
apy
in K
enya
(2005)
Min
istr
y of
Hea
lth
Ken
ya N
atio
nal
Rep
roduct
ive
Hea
lth I
nst
ruct
ional M
anual
for
Ser
vice
Pro
vider
s (M
arch
2005)
Nat
ional AID
S amp
STD
Contr
ol Pro
gra
mm
e K
enya
AID
S I
ndic
ator
Syr
vey
Foo
tnot
es
1
2Ken
ya D
emogra
phic
and H
ealth S
urv
ey (
KD
HS)
2003
37
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
70
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
CH
AP
TE
R 3
Intr
apar
tum
Car
e 3
1 IN
TRO
DU
CTI
ON
Intr
apar
tum
car
e is
the
man
agem
ent
of w
omen
fro
m t
he o
nset
of
labo
ur t
o de
liver
y T
his
peri
od p
oses
the
grea
test
ris
k fo
r tr
ansm
issi
on o
f HIV
from
the
mot
her
to th
e ch
ild (M
TCT)
w
ith 1
0 to
20
perc
ent o
f exp
osed
infa
nts
beco
min
g in
fect
ed a
t thi
s tim
e in
the
abse
nce
of a
ny
inte
rven
tion
1 In
the
con
text
of
HIV
AID
S it
is t
here
fore
im
port
ant
to e
stab
lish
the
HIV
stat
us o
f wom
en p
rior
to o
r du
ring
labo
ur a
nd d
eliv
ery
and
prov
ide
inte
rven
tions
aim
ed a
t re
duci
ng th
e ri
sk o
f tra
nsm
issi
on W
ith a
ppro
pria
te in
terv
entio
ns t
he r
isk
of M
TCT
can
bere
duce
d si
gnifi
cant
ly
32
OPE
RA
TIO
NA
L G
UID
ELIN
ES
a) O
ptim
al In
trap
artu
m C
are
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed fo
r all
wom
en a
dmitt
ed
to la
bour
and
del
iver
y un
its 2
3
1 M
inim
ise
vagi
nal e
xam
inat
ions
2 U
se a
sept
ic t
echn
ique
s in
con
duct
ing
deliv
ery
3 A
void
rou
tine
artif
icia
l rup
ture
of m
embr
anes
(A
RM
)
4 A
void
pro
long
ed la
bour
5 A
void
unn
eces
sary
trau
ma
duri
ng d
eliv
ery
6 M
inim
ise
the
risk
of p
ostp
artu
m h
aem
orrh
age
7 U
se s
afe
bloo
d tr
ansf
usio
n pr
actic
es
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
9
38
b) S
peci
fic M
anag
emen
t of H
IV P
ositi
ve P
regn
ant W
omen
Pro
phyl
acti
c A
ntir
etro
vira
l the
rapi
es4
The
AR
V p
roph
ylac
tic r
egim
en d
epen
ds o
n w
heth
er th
e m
othe
r ha
d A
RV
s du
ring
pre
gshyna
ncy
or n
ot T
hus
the
heal
th c
are
wor
ker s
houl
d es
tabl
ish
the
regi
men
use
d du
ring
th
e A
NC
whe
ther
the
wom
an h
ad ta
ken
the
SdN
VP
and
AZT
at t
he o
nset
of l
abou
r an
d de
term
ine
the
appr
opri
ate
intr
a-pa
rtum
AR
V c
are
as p
er th
e al
gori
thm
s on
pag
e80
(App
endi
x II
I) p
age
81 (A
ppen
dix
IV) a
nd a
s su
mm
aris
ed b
elow
No
AR
Vs t
aken
in p
regn
ancy
Mot
her i
n ea
rly la
bour
(up
to 4
cm c
ervi
cal d
ilata
tion)
bull
Int
rapa
rtum
per
iod
Giv
e m
othe
r S
dNV
P 2
00m
g A
ZT
600
mg
and
3T
C 1
50m
g st
at
bull P
ostp
artu
m m
othe
r G
ive
mot
her
AZ
T 3
00m
g an
d 3T
C 1
50m
g B
D
for
7 da
ys
bull P
ostp
artu
m p
erio
d G
ive
infa
nt S
d N
evir
apin
e 2
mg
kg w
ithin
72
hour
s of
birt
h P
LUS
3T
C 4
mg
kg B
D fo
r 1
wee
k an
d A
ZT
syr
up 4
mg
kg
BD
for
6 w
eeks
Mot
her r
ecei
ved
AZT
300
mg
BD
in P
regn
ancy
bull P
ostp
artu
m
Giv
e in
fant
Sd
Nev
irap
ine
2mg
kg w
ithin
72
hour
s of
birt
h
PLU
S 3
TC
4m
gkg
BD
for
1 w
eek
and
AZ
T sy
rup
4 m
gkg
BD
for
6 w
eeks
Mot
her r
ecei
ved
HA
AR
T in
Pre
gnan
cy
Reg
ardl
ess
of d
urat
ion
rece
ived
HA
AR
T bull
Giv
e m
othe
r A
RV
dos
e as
per
reg
imen
bull P
ostp
artu
m
Giv
e In
fant
Sd
Nev
irap
ine
2mg
kg w
ithin
72
hour
s of
bir
th
PLU
S 3
TC
4m
gkg
BD
for
1 w
eek
and
AZ
T sy
rup
4 m
gkg
BD
for
6 w
eeks
Mod
e of
del
iver
y E
lect
ive
caes
area
n se
ctio
n (C
S) r
educ
es t
he r
isk
of H
IV M
TCT
as c
ompa
red
to v
agin
al
deliv
ery
but
will
not
be
avai
labl
e in
man
y se
ttin
gs in
our
cou
ntry
Whe
re C
S is
per
shyfo
rmed
(ele
ctiv
e or
em
erge
ncy)
in H
IV p
ositi
ve w
omen
the
y sh
ould
rec
eive
pro
phyl
actic
an
tibio
tics
If
the
CS
is p
erfo
rmed
aft
er p
rolo
nged
lab
our
or r
uptu
re o
f m
embr
anes
lo
nger
cour
ses
of a
ntib
iotic
s sh
ould
be
cons
ider
ed
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
9
68
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Supp
ort d
urin
g la
bour
E
mot
iona
l su
ppor
t du
ring
lab
our
is i
mpo
rtan
t fo
r al
l w
omen
and
may
be
even
mor
ene
cess
ary
for
an H
IV p
ositi
ve w
oman
who
is c
once
rned
abo
ut h
er c
ondi
tion
and
risk
of
HIV
tran
smis
sion
to c
hild
Whe
neve
r po
ssib
le d
urin
g la
bour
war
d st
aff m
ust b
e se
nsishy
tive
to t
he fe
ars
and
conc
erns
of t
he H
IV p
ositi
ve m
othe
r ab
out
her
infe
ctio
n a
nd h
owm
uch
she
had
told
her
par
tner
Indu
ctio
n of
labo
ur
Indu
ctio
n of
labo
ur m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f H
IV M
TCT
Car
eful
asshy
sess
men
t of
the
nee
d fo
r an
d de
sira
bilit
y of
ind
uctio
n ra
ther
tha
n C
S is
nec
essa
ry
Whe
n in
duct
ion
of la
bour
is c
hose
n m
embr
anes
sho
uld
be le
ft in
tact
for
as lo
ng a
s po
sshysi
ble
Syn
toci
non
shou
ld n
ot b
e us
ed w
ith in
tact
mem
bran
es
Indi
catio
ns fo
r ele
ctiv
e C
S A
lthou
gh e
lect
ive
CS
will
not
be
avai
labl
e in
mos
t hea
lth fa
cilit
ies
as a
rou
tine
for
HIV
posi
tive
wom
en t
here
may
be
som
e ca
ses
that
mer
it co
nsid
erat
ion
for
CS
The
se i
nshycl
ude
preg
nanc
ies
whe
re l
abou
r is
exp
ecte
d to
be
prol
onge
d or
whe
re o
ther
obs
tetr
ic
com
plic
atio
ns m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f tra
nsm
issi
on (e
g a
brup
tio p
lashy
cent
ae
plac
enta
pra
evia
pr
e-te
rm r
uptu
re o
f m
embr
anes
pr
evio
us C
S an
d br
eech
pr
esen
tatio
n)
Man
agem
ent o
f lab
our a
nd d
eliv
ery
Labo
ur a
nd d
eliv
ery
man
agem
ent
shou
ld fo
llow
opt
imal
obs
tetr
ic m
anag
emen
t gu
ideshy
lines
(R
efer
to
Opt
imal
Int
rapa
rtum
car
e ab
ove
and
Nat
iona
l G
uide
lines
for
Qua
lity
Obs
tetr
ics
and
IMPA
C C
are
Man
ual)
RO
LEO
FTH
E C
OM
MU
NIT
Y
A la
rge
prop
ortio
n (6
0) o
f wom
en in
Ken
ya is
del
iver
ed o
utsid
e th
e he
alth
sys
tem
s by
fam
ilym
embe
rs n
eigh
bour
s and
TBA
s
bull T
here
is n
eed
to e
duca
te th
e co
mm
unity
on
the
risk
of M
TC
T an
d w
ays
of
prev
entio
n
bull T
hose
ass
istin
g th
e de
liver
ies
need
to u
nder
stan
d th
eir
own
risk
of in
fect
ion
and
how
to p
rote
ct th
emse
lves
bull T
he c
omm
unity
sho
uld
be e
ncou
rage
d to
faci
litat
e m
othe
rs to
del
iver
in
heal
th fa
cilit
ies
bull T
he c
omm
unity
sho
uld
be e
ncou
rage
d to
ref
er to
hea
lth fa
cilit
ies
all c
hild
ren
born
at h
ome
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
7
40
Fi
gure
81
Gui
delin
es fo
r Cou
nsel
ling
on H
IV a
nd In
fant
feed
ingJ
ob A
ids
Cha
pter
ref
eren
ces
an
d IE
C M
ater
ials
on
Infa
nt a
nd Y
oung
Chi
ld F
eedi
ng
1R
epublic
of
Ken
ya
Min
istr
y of
Hea
lth
Ess
ential
Obst
etric
Car
e M
anual
for
Hea
lth
Ser
vice
Pro
vider
s in
Ken
ya (
3rd
Editio
n J
an 2
006)
Foo
tnot
es
1 D
e Cock
KM
2002
2 K
enya
National
Rep
roduct
ive
Hea
lth I
nst
ruct
ion M
anual
for
Ser
vice
Pro
vider
s (2
006)
3 D
ivis
ion o
f Rep
roduct
ive
Hea
lth
Guid
elin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
ata
l Car
e
(2004)
4 W
HO
Antire
tovi
ral dru
gs
for
trea
ting p
regnan
t w
om
en a
nd p
reve
nting H
IV infe
ctio
n in
infa
nts
to
ward
s univ
ersa
l acc
ess
(2006)
41
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
66
85
EXTR
AC
TSFR
OM
RES
EAR
CH
ON
I NFA
NT
F EED
ING
A
ND H
IVA
IDS
Evid
ence
ava
ilabl
e fr
om c
urre
nt re
sear
ch d
ata
show
s th
at
bull I
ncre
ased
ris
k of
mor
talit
y w
ith r
epla
cem
ent
feed
ing
is s
igni
fican
t
bull H
IV f
ree
surv
ival
rat
e at
18
mon
ths
of a
ge d
oes
not
sign
ifica
ntly
var
y be
twee
n a
brea
stfe
d an
d re
plac
emen
t fed
chi
ld
bull M
odifi
ed a
nim
alrsquos
milk
doe
s no
t pr
ovid
e ad
equa
te n
utrit
ion
for
ch
ildre
n le
ss t
han
6 m
onth
s he
nce
mic
ronu
trie
nts
shou
ld b
e gi
ven
un
der
thes
e ci
rcum
stan
ces
bull A
brup
t ce
ssat
ion
of b
reas
tfee
ding
is n
o lo
nger
rec
omm
ende
d
bull E
xclu
sive
bre
astf
eedi
ng u
p to
6 m
onth
s is
rec
omm
ende
d un
less
re
plac
emen
t fee
ding
can
mee
t AF
AS
S c
rite
ria
Cha
pter
4
Use
of A
ntire
trov
iral D
rugs
in P
regn
ancy
for T
reat
men
t and
for
Prev
entio
n of
Mot
her-
to-C
hild
Tra
nsm
issi
on o
f HIV
Infe
ctio
n
41
INTR
OD
UC
TIO
N
With
out
any
inte
rven
tion
up
to 4
0 pe
rcen
t of
HIV
pos
itive
wom
en w
ill t
rans
mit
the
infe
ctio
n to
the
ir c
hild
ren
duri
ng p
regn
ancy
lab
our
and
brea
stfe
edin
g U
se o
f ant
iret
shyro
vira
l dru
gs (A
RV
s) o
bste
tric
inte
rven
tions
and
avo
idan
ce o
f all
brea
stfe
edin
g fo
r pr
eshyve
ntio
n of
mot
her
to c
hild
tran
smis
sion
of H
IV in
fect
ion
(PM
TCT)
has
red
uced
the
risk
of m
othe
r to
chi
ld tr
ansm
issi
on o
f HIV
infe
ctio
n (M
TCT)
to le
ss th
an 2
per
cent
in d
evel
shyop
ed c
ount
ries
Shor
t cou
rse
effic
acio
us A
RV
dru
g re
gim
ens
can
redu
ce th
e ri
sk o
f MTC
T to
2-4
per
cent
and
can
be i
mpl
emen
ted
in r
esou
rce-
limite
d se
ttin
gs o
n a
popu
latio
n-ba
sed
publ
ic
heal
th s
cale
AR
Vs
are
used
bot
h fo
r th
e tr
eatm
ent
of H
IV d
isea
se a
nd fo
r PM
TCT
in
HIV
-infe
cted
pre
gnan
t w
omen
and
the
ir n
eona
tes
Ant
iret
rovi
ral t
reat
men
t (A
RT)
for
wom
en w
ho q
ualif
y fo
r it
pro
long
s an
d im
prov
es t
he q
ualit
y of
the
ir l
ives
The
sur
shyvi
val
of t
he c
hild
is
clos
ely
inte
rlin
ked
with
the
hea
lth a
nd s
urvi
val
of t
he m
othe
r
Wom
en e
ligib
le fo
r A
RT
shou
ld b
e st
arte
d on
trea
tmen
t as
soon
as
poss
ible
Pre
gnan
cy
is n
ot a
rea
son
to d
elay
AR
T W
omen
who
are
alr
eady
on
AR
T be
fore
bec
omin
g pr
egshy
nant
sho
uld
cont
inue
with
thei
r tr
eatm
ent
In c
erta
in s
ituat
ions
mod
ifica
tions
may
be
need
ed to
mak
e tr
eatm
ent s
afer
for
the
mot
her
and
the
unbo
rn b
aby
The
bene
fits
of u
sing
AR
Vs
to t
reat
HIV
-infe
cted
pre
gnan
t w
omen
and
or
PMTC
T ou
tshyw
eigh
the
ris
ks H
owev
er w
hen
AR
T or
oth
er s
hort
cou
rse
AR
V r
egim
ens
are
used
ba
selin
e ev
alua
tion
and
mon
itori
ng is
enc
oura
ged
to e
nsur
e th
e sa
fety
of t
he m
othe
rsan
d th
eir
new
born
s L
inka
ges
of H
IV-in
fect
ed p
regn
ant
wom
en a
nd t
heir
chi
ldre
n to
ot
her
care
and
sup
port
pro
gram
s at
hea
lth f
acili
ty a
nd c
omm
unity
lev
els
shou
ld b
e en
sure
d
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
5
42
42
OPE
RA
TIO
NA
L G
UID
ELIN
ES
All
HIV
-infe
cted
pre
gnan
t w
omen
sho
uld
be c
ouns
elle
d on
com
preh
ensi
ve H
IV c
are
incl
udin
g us
e of
AR
Vs
for
thei
r ow
n he
alth
and
for
PMTC
T
All
HIV
-infe
cted
pre
gnan
t wom
en s
houl
d ha
ve th
eir H
IV d
isea
se
stag
ed u
sing
bull W
HO
clin
ical
sta
ging
(se
e A
ppen
dix
1) a
nd
bull I
mm
unol
ogic
al s
tagi
ng (
CD
4 co
unt)
(se
e ta
ble
1)
The
wom
en s
houl
d al
so b
e sc
reen
ed a
nd tr
eate
d fo
r op
port
unis
tic in
fect
ions
(OIs
) inc
ludi
ngTu
berc
ulos
is (T
B)
All
HIV
-infe
cted
pre
gnan
t wom
en s
houl
d ha
ve b
asel
ine
labo
rato
ry a
nd o
ther
nec
essa
rydi
agno
stic
eva
luat
ions
Thes
e di
agno
stic
s sh
ould
incl
ude
bull R
outin
e an
tena
tal c
are
labo
rato
ry in
vest
igat
ions
that
are
nor
mal
ly
done
for
all
preg
nant
wom
en
haem
oglo
bin
(Hb)
rh
esus
blo
od
grou
p an
d A
BO
typ
ing
VD
RL
uri
ne a
naly
sis
and
scre
enin
g fo
r S
TI
bull A
LT a
nd c
reat
inin
e le
vels
for
wom
en e
ligib
le f
or H
AA
RT
Prop
hyla
xis
amp m
icro
nutr
ient
sup
plem
enta
tion
bull
Cot
rimox
azol
e (C
TX) o
ne d
oubl
e st
reng
th o
r tw
o si
ngle
stre
ngth
tabl
ets
once
dai
ly
bull
Mul
tivita
min
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
83
OPE
RA
TIO
NA
L G
UID
ELIN
ESO
N F
EED
ING
CH
ILD
REN
6 M
ON
THS
AN
DO
LDER
The
follo
win
g sh
ould
gui
de fe
edin
g fo
r chi
ldre
n 6
mon
ths
and
olde
r
bull A
t 6
mon
ths
oth
er f
orm
s of
milk
alo
ne a
re n
ot a
dequ
ate
to m
eet
the
baby
rsquos n
utrit
iona
l req
uire
men
ts
bull C
ompl
emen
tary
foo
ds s
houl
d be
intr
oduc
ed w
ith c
ontin
ued
br
east
feed
ing
or w
ith r
epla
cem
ent
feed
ing
until
a n
utrit
iona
lly
adeq
uate
die
t ca
n be
sus
tain
ed w
ithou
t m
ilk
bull A
brup
t ces
satio
n of
bre
astf
eedi
ng s
houl
d be
dis
cour
aged
to
avoi
d
trau
ma
for
both
the
mot
her
and
the
baby
bull M
ilk s
houl
d co
ntin
ue a
s an
impo
rtan
t co
mpo
nent
of
the
diet
bull C
ompl
emen
tary
foo
ds s
houl
d be
enr
iche
d fr
om lo
cally
ava
ilabl
e
fam
ily f
oods
84
NU
TRIT
ION
AL
CA
RE
AN
D S
UPP
OR
TO
F H
IV
INFE
CTE
DC
HIL
DR
EN
bull E
nerg
y ne
eds
for
asym
ptom
atic
HIV
infe
cted
chi
ldre
n in
crea
se b
y 10
pe
rcen
t to
mai
ntai
n gr
owth
as
com
pare
d to
the
non-
infe
cted
chi
ldre
n
bull T
here
is n
o ev
iden
ce o
f in
crea
sed
prot
ein
requ
irem
ents
The
re
quir
emen
ts s
houl
d be
bas
ed o
n in
divi
dual
sym
ptom
s an
d ne
eds
bull M
icro
nutr
ient
req
uire
men
ts d
o no
t ch
ange
W
HO
rec
omm
ends
not
m
ore
than
one
RD
A
(For
fur
ther
det
ails
re
fer
to K
enya
n G
uide
lines
on
nutr
ition
and
HIV
A
IDS
)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
3
64
82
OPE
RA
TIO
NA
L G
UID
ELIN
ESO
N I N
FAN
TFE
EDIN
G (0
-6 M
ON
THS)
The
follo
win
g sh
ould
gui
de in
fant
feed
ing
for t
he fi
rst 6
mon
ths
bull A
ll w
omen
and
men
irre
spec
tive
of th
eir
HIV
sta
tus
shou
ld r
ecei
ve
coun
selin
g an
d de
mon
stra
tions
on
how
to s
afel
y fe
ed t
heir
babi
es
duri
ng t
he a
nten
atal
and
pos
tnat
al f
ollo
w u
p
bull T
he m
ost
appr
opria
te in
fant
fee
ding
opt
ion
for
an H
IV in
fect
ed
mot
her
shou
ld c
ontin
ue t
o de
pend
on
indi
vidu
al c
ircu
mst
ance
s an
d
the
av
aila
ble
supp
ort
bull E
very
HIV
infe
cted
wom
an s
houl
d be
eva
luat
ed a
t ev
ery
visi
t to
ch
eck
whe
ther
her
soc
ial
econ
omic
and
hea
lth s
tatu
s ha
s ch
ange
d
suff
icie
ntly
eno
ugh
to a
ffec
t he
r in
fant
fee
ding
opt
ion
bull E
xclu
sive
bre
astf
eedi
ng fo
r H
IV in
fect
ed w
omen
for
the
firs
t 6
mon
ths
of t
he in
fant
rsquos li
fe is
adv
isab
le
unle
ss r
epla
cem
ent f
eedi
ng is
ac
cept
able
fea
sibl
e a
ffor
dabl
e s
usta
inab
le a
nd s
afe
for
them
and
th
eir
infa
nts
befo
re t
hat t
ime
bull W
hen
repl
acem
ent
feed
ing
is a
ccep
tabl
e f
easi
ble
aff
orda
ble
su
stai
nabl
e an
d sa
fe
avoi
danc
e of
exc
lusi
ve b
reas
tfee
ding
by
HIV
in
fect
ed w
omen
is r
ecom
men
ded
bull I
f th
e co
nditi
ons
for
repl
acem
ent
feed
ing
are
still
not
met
for
6
mon
ths
then
co
ntin
uatio
n of
bre
astf
eedi
ng w
ith a
dditi
onal
co
mpl
emen
tary
fee
ding
is r
ecom
men
ded
giv
ing
prio
rity
to t
he lo
cally
av
aila
ble
food
s
bull I
nfan
t fe
edin
g de
cisi
ons
for
all H
IV e
xpos
ed in
fant
s sh
ould
be
base
d on
the
AF
AS
S c
riter
ia e
ven
whe
re e
arly
infa
nt d
iagn
osis
(E
ID)
is
avai
labl
e
bull B
reas
tfeed
ing
mot
hers
of
infa
nts
and
youn
g ch
ildre
n w
ho a
re k
now
n to
be
HIV
infe
cted
sho
uld
be s
tron
gly
enco
urag
ed to
con
tinue
bre
ast
feed
ing
How
ever
br
east
feed
ing
HIV
infe
cted
mot
hers
sho
uld
be
give
n nu
triti
on s
uppo
rt (
nutr
ition
al c
ouns
elin
g e
duca
tion
foo
d an
d nu
triti
onal
sup
plem
ents
)
63
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
44
Sulp
hur-
base
d in
term
itten
t pr
esum
ptiv
e m
alar
ia t
reat
men
t (I
PT) s
houl
d no
t be
giv
en
to w
omen
who
are
on
CTX
pro
phyl
axis
AR
V us
e
bull A
RV
s ar
e us
ed fo
r tr
eatin
g H
IV-i
nfec
ted
elig
ible
wom
en a
ndo
r fo
r pr
even
tion
of m
othe
r-to
-chi
ld tr
ansm
issi
on
bull H
IV-i
nfec
ted
preg
nant
wom
en e
ligib
le f
or A
RT
sho
uld
initi
ate
AR
T
as s
oon
as p
ossi
ble
as s
how
n in
Tab
le 4
1
bull H
IV-i
nfec
ted
preg
nant
wom
en a
lread
y on
AR
T b
efor
e be
com
ing
preg
nant
sho
uld
cont
inue
AR
T
The
bab
y sh
ould
be
give
n A
RV
pr
ophy
laxi
s so
on a
fter
birt
h as
sho
wn
in T
able
42
Tabl
e 4
1 R
ecom
men
datio
ns fo
r ini
tiatin
g A
RV
trea
tmen
t in
preg
nant
w
omen
bas
ed o
n cl
inic
al s
tage
and
ava
ilabi
lity
of C
D4
Cou
nt
WH
O
CD
4 te
stin
g
CD
4 te
stin
g
Clin
ical
Sta
ge
not a
vaila
ble
avai
labl
e
1 D
o no
t Tre
at
Trea
t if C
D4le
350
cells
mm
3
2 D
o no
t Tre
at
Trea
t if C
D4 le
350
cells
mm
3
3 Tr
eat
Trea
t irre
spec
tive
of C
D4
coun
t (c
onsi
der C
D4
valu
es fo
r bet
ter
man
agem
ent)
4 Tr
eat
Trea
t irre
spec
tive
of C
D4
cell
coun
t
Sourc
e A
dopte
d f
rom
WH
O
Anti-r
etro
vira
l dru
gs
for
trea
ting p
regnant
wom
en a
nd p
re-
venting H
IV infe
ctio
ns
Tabl
e 4
2 R
ecom
men
ded
first
-line
AR
T re
gim
en fo
r tre
atin
g pr
egna
nt w
omen
and
pro
phyl
actic
regi
men
for i
nfan
ts
Mot
her
Ant
epar
tum
AZ
T +
3TC
+ N
VP D
aily
Intra
partu
m
AZT
+ 3T
C +
NVP
Dai
ly
Pos
tpar
tum
AZ
T +
3TC
+ N
VP D
aily
Infa
nt p
roph
ylax
is
Sd
NV
P 2
mg
kg s
tat w
ithin
72
hour
s 3T
C X
1 w
eek
(4
mg
kg B
ID)
AZT
X 6
wee
ks (4
mg
kg B
ID)
Mat
erna
l dos
ages
AZT
300
mg
BID
3TC
150
mg
BID
NV
P 2
00 m
g O
D fo
r tw
o w
eeks
the
reaf
ter 2
00 m
g B
ID
Infa
nt D
osag
es
NV
P
2mg
kg s
tat w
ithin
72
hour
s
AZT
4mg
kg B
ID X
6 w
eeks
3TC
4m
gkg
BID
X 1
wee
k
Cha
pter
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
Bor
n to
HIV
Infe
cted
Mot
hers
81
INTR
OD
UC
TIO
N T
RA
NSM
ISSI
ON
OF
HIV
THR
OU
GH
B
REA
STFE
EDIN
G
In A
fric
a 3
to 4
out
of e
very
10
infa
nts
born
to H
IV in
fect
ed w
omen
acq
uire
HIV
infe
cshytio
n T
here
is t
here
fore
a 5
ndash 2
0 pe
rcen
t ri
sk o
f inf
ants
bor
n to
HIV
pos
itive
mot
hers
ac
quir
ing
infe
ctio
n th
roug
h br
east
-fe
edin
g if
ther
e ar
e no
inte
rven
tions
in
pla
ce
For
wom
en w
ho a
re i
nshyfe
cted
with
HIV
for
the
first
tim
e or
w
ho a
re r
e-in
fect
ed w
ith a
diff
eren
t st
rain
of H
IV d
urin
g th
e br
east
feed
shyin
g ph
ase
the
ris
k in
crea
ses
up t
o29
per
cen
t H
alf (
12)
of H
IV b
reas
t m
ilk t
rans
mis
sion
tak
es p
lace
by
6 w
eeks
and
thre
e qu
arte
rs (3
4) b
y 6
mon
ths
Mix
ed fe
edin
g in
crea
ses
the
risk
of
brea
st m
ilk t
rans
mis
sion
of
HIV
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
5
62
For
prop
hyla
xis
the
reco
mm
enda
tions
are
ran
ked
and
will
dep
end
on t
ime
of fi
rst
conshy
tact
with
the
wom
an H
IV-in
fect
ed p
regn
ant w
omen
who
are
not
elig
ible
for
AR
T or
in
72
3 C
OM
PREH
ENSI
VE
CA
RE
FOR H
IV-E
XPO
SED
CH
ILD
REN
w
hom
it is
not
pos
sibl
e to
sta
rt A
RT
imm
edia
tely
and
the
mot
her
is b
eing
see
n be
twee
n28
and
38
wee
ks o
f pr
egna
ncy
sho
uld
be s
tart
ed o
n re
com
men
ded
mor
e ef
ficac
ious
shor
t co
urse
pro
phyl
actic
AR
V r
egim
ens
as s
how
n in
Tab
le 4
3a
The
bab
y sh
ould
als
obe
giv
en A
RV
pro
phyl
axis
soo
n af
ter
birt
h as
sho
wn
in th
e sa
me
tabl
e T
he r
egim
ens
asou
tline
d be
low
are
for
prop
hyla
xis
and
not f
or tr
eatm
ent
MINI
STRY
OF H
EAL
TH
Tabl
e 4
3a R
ecom
men
ded
Firs
t Lin
e A
RV
prop
hyla
xis
ALGO
RITH
M FO
R EA
RLY
INFA
NTDI
AGNO
SISFO
R HI
VEX
POSE
DCH
ILDRE
N
to p
reve
nt H
IV in
fect
ion
in in
fant
s A
mon
g Pr
egna
nt W
omen
Pr
esen
ting
Bef
ore
38 W
eeks
Ran
king
Ti
me
of A
dmin
istr
atio
n
WEL
L CHI
LD
SICK
CHI
LD
(Man
age
pres
entin
g ill
ness
and
stab
ilize
)
STAR
T CO
TRIM
OXAZ
OLE
PROP
HYLA
XIS
FOR M
OR E
INFOR
MATIO
N C ON
TACT
THE N
ATI O
NAL A
IDS S
TD CO
NTRO
L PRO
GRAM
ME ( N
ASCO
P) PO
BOX
19 36
1-00
20 2 N
AIRO
BI TE
L 02
02 72
95 02
FAX 0
2 0 2 7
1 05 1
8
Exp
osur
e sta
tus s
houl
d be
det
erm
ined
for a
ll in
fants
of u
nkno
wn s
tatu
s at t
he
6 we
ek v
isit o
r firs
t con
t act
Coun
sel o
n inf
ant f
eedi
ng a
s per
nat
iona
l gui
delin
es
Conf
irma
tory
ABt
est
at 1
8 M
onth
s
Eval
uate
for
ART
star
t on
ARV
if el
igibl
e
If HI
V+ a
t 12
Mont
hs
Evalu
ate f
or A
RT
Start
on
ARV
if eli
gible
6 Wee
ks D
BS (P
CR)
HIV
+
If HI
V-sto
p CT
X if
not
BF
for a
t lea
st 2
Mont
hs
HI
V-
Antib
ody
test
ing
12 M
onth
s
Conf
irmat
ory
ABte
st at
18 M
onth
s
Conf
irmat
ory A
B te
st at
18 M
onth
s
Eval
uate
for A
RT
star
t on
ARV
if el
igible
If HIV
+ at
12
Mon
ths
Eval
uate
for A
RT
Star
t on
ARV
if el
igibl
e
If lt1
2 Mon
ths D
BS (P
CR)
If gt
12m
o An
tibod
y te
st
HIV
+
If HIV-
stop
CTX
if n
ot
BF
for a
t lea
st 2
Mont
hs
HI
V-
Antib
ody
testi
ng
12 M
onth
s
Conf
irma
tory
AB
test
at 1
8 Mo
nths
Exp
osur
e sta
tus s
hould
be de
term
ined
for a
ll in
fant
s of u
nkno
wn st
atus
at th
e 6w
eek
visit
or fi
rst c
onta
ct
Co
unse
l on
infa
nt fe
edin
g as
per n
atio
nal g
uideli
nes
Pre
gnan
cy
Labo
ur
Pos
tpar
tum
Mat
erna
l In
fant
Rec
omm
ende
d
AZT(
28-3
8 w
eeks
ge
stat
ion)
sd
NV
P
+ AZ
T+3T
C
AZT+
3TC
X
7 da
ys
sdN
VP
PL
US
3TC
X1
wee
k +
AZT
X
6 w
eeks
Tabl
e 4
3b b
elow
sho
ws
alte
rnat
ive
prop
hyla
ctic
regi
men
s fo
r w
omen
pre
sent
ing
befo
re 3
8 w
eeks
of p
regn
ancy
Ran
king
Ti
me
of A
dmin
istr
atio
n
Alte
rnat
ive
Min
imum
Pre
gnan
cy
AZT(
28-3
8 w
eeks
)
Labo
ur
sd N
VP
+
AZT(
600m
gs
stat
)
sdN
VP
+ A
ZT+3
TC
Pos
tpar
tum
AZT+
3TC
X
7 da
ys
Infa
nt
sdN
VP
+
3TC
X 7
da
ys +
AZT
X
6 w
eeks
sdN
VP
+
3TC
day
s +
AZT
X 6
wee
ks
HIV
-infe
cted
pre
gnan
t w
omen
who
are
see
n fo
r th
e fir
st t
ime
afte
r 38
wee
ks o
f pr
egshy
nanc
y or
in la
bour
sho
uld
be g
iven
AR
V p
roph
ylac
tic r
egim
ens
as s
how
n in
Tab
le 4
4
The
baby
sho
uld
also
be
give
n A
RV
pro
phyl
axis
soo
n af
ter
birt
h as
sho
wn
in t
he s
ame
Bot
h H
IV-in
fect
ed a
nd u
ninf
ecte
d ch
ildre
n re
quir
e co
mpr
ehen
sive
car
e (R
efer
to C
hap-
tabl
ete
r 8
and
9)
61
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
46
Tabl
e 4
4 A
RV
prop
hyla
xis
for P
MTC
T am
ong
preg
nant
wom
en w
ho
have
not
rece
ived
ant
enat
al A
RT
or p
roph
ylax
is
Ran
king
Ti
me
of A
dmin
istr
atio
n
La
bour
P
ostp
artu
m
Mat
erna
l In
fant
Rec
omm
ende
d
sdN
VP
AZ
T+3T
C
SdN
VP
+
X 7
days
P
LUS
3TC
X 1
wee
k +
AZT+
3TC
AZ
T X
6 w
eeks
Min
imum
sd
NV
P
-S
dNV
P
PLU
S 3
TC X
1 w
eek
+
AZT
X 6
wee
ks
Dos
ages
Mot
her
Bab
y
NV
P
200
mg
stat
2m
gkg
sta
t with
in 7
2 ho
urs
AZT
300
mg
BID
4m
gkg
BID
X 6
wee
ks
3TC
15
0 m
g BI
D
4mg
kg B
ID X
1 w
eek
Tabl
e 4
5 R
ecom
men
ded
HA
AR
T fo
r Pre
gnan
t Wom
en
base
d on
CD
4 C
ount
and
Sta
ge o
f Pre
gnan
cy
CD
4 C
ount
H
AA
RT
Trim
este
r C
ells
mm
3
72
2 H
IV P
OSI
TIV
EIN
FAN
TB
Y D
NA
PC
R
bull A
ll H
IV p
ositi
ve in
fant
s sh
ould
be
eval
uate
d fo
r el
igib
ility
for
antishy
retr
ovir
al tr
eatm
ent
and
linke
d to
car
e an
d tr
eatm
ent
as a
ppro
pria
te
bull W
HO
clin
ical
sta
ging
sho
uld
be d
one
for
all H
IV p
ositi
ve in
fant
s
Chi
ldre
n w
ho a
re a
t W
HO
Clin
ical
sta
ge 3
or
4 ar
e el
igib
le f
or
antir
etro
vira
l tre
atm
ent
bull A
ll H
IV p
ositi
ve in
fant
s sh
ould
be
asse
ssed
for
CD
4 co
unt
whe
re
poss
ible
and
ava
ilabl
e R
efer
to
AR
T g
uide
lines
for
CD
4 co
unts
tha
t de
term
ine
elig
ibili
ty f
or A
RT
for
chi
ldre
n of
diff
eren
t ag
e br
acke
ts
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
hav
e a
visi
ble
guar
dian
or
care
-tak
er
befo
re t
hey
can
be s
tart
ed o
n A
RT
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e fr
om 6
w
eeks
or
on f
irst
cont
act t
here
afte
r
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
be
star
ted
on A
RT
if el
igib
le
bull B
reas
tfeed
ing
shou
ld b
e en
cour
aged
for
all
HIV
-pos
itive
infa
nts
for
a
min
imum
of t
wo
year
s (
Ref
er t
o C
hapt
er 8
)
bull F
or a
ll H
IV-p
ositi
ve in
fant
s p
erfo
rm a
ntib
ody
test
ing
at 9
mon
ths
12
mon
ths
and
conf
irm
at
18 m
onth
s
1st T
rimes
ter
2nd T
rimes
ter
3rd T
rimes
ter
lt250
A
ZT+
3TC
+NV
P
AZ
T+3T
C+N
VP
AZT+
3TC
+NVP
250-
350
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
gt 35
0
A
ZT+3
TC+L
PVr
OR
A
BC
+3TC
+LPV
r
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
47
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
60
72
OPE
RA
TIO
NA
L G
UID
ELIN
ES
72
0 G
UID
ELIN
ESFO
R H
IV D
IAG
NO
SIS
INC
HIL
DR
EN
bull P
erfo
rm r
outin
e ra
pid
HIV
ant
ibod
y te
sts
for
all m
othe
rs o
f 6
wee
k ol
d in
fant
s pr
esen
ting
with
unk
now
n st
atus
bull P
erfo
rm r
outin
e dr
y bl
ood
spot
s (D
BS
) fo
r D
NA
PC
R f
or a
ll in
fant
s kn
own
to b
e H
IV-e
xpos
ed a
t 6
wee
ks
bull P
erfo
rm r
outin
e an
tibod
y te
stin
g fo
r al
l sic
k in
fant
s in
out
patie
nt a
nd
paed
iatr
ic w
ards
to
esta
blis
h H
IV e
xpos
ure
infe
ctio
n st
atus
bull P
erfo
rm D
BS
for
all
HIV
-exp
osed
sic
k in
fant
s un
der
12 m
onth
s
bull A
ll H
IV-e
xpos
ed in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e fr
om 6
w
eeks
of
age
or o
n fir
st c
onta
ct th
erea
fter
bull R
efer
to
chap
ter
on c
are
and
follo
w u
p of
the
HIV
-exp
osed
infe
cted
in
fant
72
1 H
IV N
EGA
TIV
EIN
FAN
TA
TA
GE
6 W
EEK
SO
RFI
RST
CO
NTA
CT
Perf
orm
ant
ibod
y te
stin
g at
9 m
onth
s an
d 12
mon
ths
of a
ge
bull I
f H
IV n
egat
ive
at 1
2 m
onth
s an
d st
ill b
reas
tfee
ding
co
ntin
ue
Cot
rim
oxaz
ole
bull I
f not
bre
astf
eedi
ng f
or a
t le
ast
2 m
onth
s s
top
Cot
rim
oxaz
ole
bull P
erfo
rm c
onfir
mat
ory
antib
ody
test
ing
at 1
8 m
onth
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Mat
erna
l dos
ages
AZT
30
0 m
g B
ID
3TC
15
0 m
g BI
D
NVP
200
mg
OD
for t
wo
wee
ks t
here
afte
r 200
mg
BID
AB
C
300m
g B
ID
LPV
r (4
001
00)
2 ta
blet
s B
ID
EFV
60
0mg
QID
Not
es I
mpo
rtan
t con
side
ratio
ns th
at m
odify
cho
ice
of A
RV
s du
ring
pre
gnan
cy in
clud
e C
D4
coun
t m
ater
nal a
naem
ia a
nd
stag
e of
pre
gnan
cy
bull 2
NR
TIs
(A
ZT
and
3TC
) ac
ting
as a
ldquotr
eatm
ent
back
bone
rdquo w
ith a
dditi
on o
f an
N
NR
TI (
NV
P)
rem
ains
the
pre
ferr
ed fi
rst-
line
AR
V t
hera
py in
res
ourc
e-po
or
sett
ings
bull P
rote
ase
inhi
bito
rs b
ased
reg
imen
s ar
e pr
efer
able
whe
n C
D4
coun
t is
high
er
than
250
bull R
epla
ce A
ZT
with
d4T
if H
blt 8
gm
dL
bull
EF
V m
ay b
e us
ed in
stea
d of
NV
P a
fter
first
trim
este
r
bull
Usu
ally
AR
V s
houl
d be
with
held
if C
D4
coun
t is
not
ava
ilabl
e or
not
don
e
AR
V is
how
ever
use
d fo
r P
MT
CT
and
or in
adv
ance
d H
IV d
isea
se (
WH
O
Sta
ge 3
or
4) ir
resp
ectiv
e of
CD
4 co
unt
Bab
ies
who
se
mot
hers
di
d no
t re
ceiv
e an
tepa
rtum
or
in
trap
artu
m
AR
Vpr
ophy
laxi
s sh
ould
be
give
n A
RV
pro
phyl
axis
as
show
n in
Tab
le 4
6
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
9
48
Tabl
e 4
6 A
RV
prop
hyla
ctic
regi
men
s fo
r inf
ants
bor
n to
H
IV-p
ositi
ve w
omen
who
hav
e no
t rec
eive
d an
tepa
rtum
or
intr
apar
tum
AR
T or
AR
V pr
ophy
laxi
s
Ran
king
T
ime
of a
dmin
istr
atio
n an
d In
fant
dos
age
sdN
VP (2
mg
kg s
tat)
PLU
S 3T
C (4
mg
kg B
ID) X
1 w
eek
+ AZ
T (4
mg
kg
BID
) X 6
wee
ks
Rec
omm
ende
d
sdN
VP (2
mg
kg s
tat)
Min
imum
sdN
VP
is g
iven
to th
e in
fant
with
in 7
2 ho
urs
of b
irth
Plea
se n
ote
A
t fir
st c
onta
ct a
ll H
IV i
nfec
ted
preg
nant
wom
en s
houl
d be
giv
en s
dNV
P ta
blet
s to
take
hom
e w
ith t
hem
The
y sh
ould
be
inst
ruct
ed t
o ta
ke t
he t
able
ts a
t th
e on
set
of la
shybo
ur i
f lab
our
occu
rs o
utsi
de h
ealth
faci
lity
sett
ings
The
y sh
ould
als
o be
giv
en N
VP
3T
C a
nd A
ZT s
yrup
for
thei
r ba
bies
to b
e ad
min
iste
red
soon
aft
er b
irth
Som
e w
omen
with
a C
D4
coun
t gr
eate
r th
an 2
50 c
ells
microl
on
Nev
irap
ine
(NV
P)-b
ased
AR
T m
ay d
evel
op N
VP
hype
rsen
sitiv
e re
actio
ns t
hat
can
be li
fe t
hrea
teni
ng I
n th
ese
guid
elin
es it
is r
ecom
men
ded
that
for
preg
nant
wom
en w
ith C
D4
mor
e th
an 2
50 N
VP-
base
d re
gim
en m
ay s
till
be u
sed
but
with
clo
se m
onito
ring
O
ther
wis
e th
e re
com
shym
ende
d re
gim
en to
use
with
CD
4 co
unt a
bove
250
is a
PI-
base
d H
AA
RT
regi
men
Whe
n si
ngle
dos
e N
VP
(sdN
VP)
is u
sed
in P
MTC
T s
ome
wom
en a
nd c
hild
ren
may
deshy
velo
p re
sist
ance
to
NV
P th
at m
ay l
imit
futu
re u
se o
f N
on-N
ucle
osid
e R
ever
se T
ranshy
scri
ptas
e In
hibi
tors
(NN
RTI
s) t
o tr
eat
them
Th
e ri
sk o
f NN
RTI
res
ista
nce
is p
artic
ushyla
rly
high
if
two
dose
s of
sdN
VP
are
give
n T
here
fore
SdN
VP
shou
ld n
ever
be
used
mor
e th
an o
nce
in a
ny o
ne p
regn
ancy
Whe
re p
ossi
ble
AZT
3TC
sho
uld
be g
iven
for
7 da
ys t
o co
ver
the
NV
P ta
il bo
th in
the
mot
her
and
the
baby
Th
e ba
by is
the
n co
ntin
shyue
d on
AZT
for
a to
tal o
f 6 w
eeks
for
prop
hyla
xis
agai
nst M
TCT
HIV
-infe
cted
pre
gnan
t w
omen
sta
rtin
g zi
dovu
dine
(A
ZT)
cont
aini
ng r
egim
ens
shou
ld
have
hae
mog
lobi
n (H
b) le
vels
abo
ve 8
gm
dl
The
Hb
leve
l sho
uld
be c
heck
ed m
onth
ly
for
the
first
thr
ee m
onth
s W
here
pos
sibl
e A
ZT s
houl
d be
use
d in
stea
d of
sta
vudi
ne(d
4T)
Clin
ical
judg
emen
t can
be
used
to e
stim
ate
Hb
leve
ls a
nd in
itiat
e AR
V pr
ophy
laxi
s if l
aboshy
rato
ry te
sts a
re u
nava
ilabl
e
Efa
vire
nz (
EFV
) m
ay b
e te
rato
geni
c if
used
in t
he f
irst
tri
mes
ter
If t
he p
atie
nt is
on
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Cha
pter
7
HIV
Dia
gnos
is in
Chi
ldre
n 7
1 IN
TRO
DU
CTI
ON
In g
ener
al
a ch
ild m
ay b
e te
sted
und
er a
num
ber
of c
ircu
mst
ance
s T
hese
inc
lude
sh
ortly
aft
er b
irth
for
earl
y di
agno
sis
of H
IV f
or th
e pu
rpos
es o
f ind
ivid
ual d
iagn
osis
in
a ch
ild w
ho is
ill (
eg
tho
se p
rese
ntin
g w
ith a
n H
IV r
elat
ed il
lnes
s) i
n ca
ses
whe
re a
child
has
eith
er b
een
expo
sed
or is
pot
entia
lly e
xpos
ed t
o H
IV e
g t
hrou
gh m
othe
r-to
shych
ild t
rans
mis
sion
se
xual
abu
se
sexu
al a
ctiv
ity
with
in a
hea
lthca
re s
ettin
g (e
g
thro
ugh
cont
amin
ated
nee
dles
or
rece
ipt
of p
oten
tially
infe
ctio
us b
lood
) th
roug
h ot
her
mea
ns a
nd in
orp
hans
Ear
ly i
nfan
t di
agno
sis
(EID
) re
fers
to
the
mak
ing
of H
IV d
iagn
osis
in
infa
nts
and
youn
g ch
ildre
n be
fore
18
mon
ths
of a
ge E
ID g
ives
an
oppo
rtun
ity fo
r ea
rly
iden
tific
ashytio
n of
HIV
infe
cted
infa
nts
(des
pite
PM
TCT)
and
ear
ly li
nkag
e to
car
e an
d tr
eatm
ent
Dis
ease
pro
gres
sion
in H
IV in
fect
ed in
fant
s is
fast
with
a h
igh
mor
talit
y ra
te (gt
50
)by
2 y
ears
of a
ge T
he m
edia
n ag
e of
dea
th in
the
first
two
year
s is
6 m
onth
s H
IV a
ntishy
body
tes
ting
amon
g ch
ildre
n ag
ed 1
8 m
onth
s or
mor
e is
abl
e to
det
erm
ine
whe
ther
a
child
is in
fect
ed o
r no
t
Dur
ing
preg
nanc
y m
othe
rs g
ive
thei
r ba
bies
ant
ibod
ies
to in
fect
ions
the
y ha
ve e
xper
ishyen
ced
and
thes
e an
tibod
ies
wan
e w
ith ti
me
Ant
ibod
y te
stin
g in
chi
ldre
n ag
ed le
ss th
an
18 m
onth
s id
entif
ies
child
ren
who
hav
e be
en e
xpos
ed to
thei
r m
othe
rsrsquo H
IV in
fect
ion
or
who
may
be
trul
y in
fect
ed a
nd a
re m
akin
g H
IV a
ntib
odie
s C
urre
ntly
the
re is
no
test
to
diff
eren
tiate
the
mot
herrsquos
ant
ibod
ies
from
tho
se p
rodu
ced
by t
he b
aby
In
orde
r to
id
entif
y th
e H
IV-in
fect
ed c
hild
age
d le
ss t
han
18 m
onth
s a
sec
ond
test
is r
equi
red
for
all b
abie
s te
stin
g po
sitiv
e on
ant
ibod
y te
stin
g or
kno
wn
to b
e H
IV-e
xpos
ed (m
othe
r is
H
IV-p
ositi
ve)
Infa
nt D
NA
(or
RN
A) P
CR
tes
ting
is t
he c
urre
nt r
ecom
men
ded
met
hod
for
EID
Sinc
e m
ost b
abie
s lo
se m
ater
nal a
ntib
odie
s (A
b) b
y 12
mon
ths
a n
egat
ive
antib
ody
test
will
ide
ntify
uni
nfec
ted
babi
es a
s lo
ng a
s th
ey a
re n
ot s
till
brea
stfe
edin
g A
pos
itive
antib
ody
test
at
12 m
onth
s a
lthou
gh h
ighl
y lik
ely
to b
e di
agno
stic
may
stil
l be
due
topa
ssiv
ely
carr
ied
mat
erna
l ant
ibod
ies
Suc
h te
sts
need
to
be c
onfir
med
by
PCR
tes
ting
or r
epea
t ant
ibod
y te
st a
t 18
mon
ths
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
9
58
CARE
SU
PPO
RTAN
DTR
EATM
ENT
FOR
HIV
PO
SITI
VEM
OTH
ERAN
DCH
ILD
HIV
-pos
itive
mot
hers
requ
ire c
are
and
supp
ort w
hich
incl
udes
bull
Cou
nsel
ing
bull P
roph
ylax
is a
nd tr
eatm
ent
bull L
ink
to s
uppo
rt g
roup
s an
d as
sess
men
t of
the
nee
d fo
r A
RT
bull E
arly
infa
nt d
iagn
osis
sho
uld
be p
rovi
ded
at s
ix w
eeks
usi
ng D
NA
shyP
CR
tes
ting
Cha
pter
ref
eren
ces
1
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
Pla
nnin
g
Guid
elin
es f
or
serv
ice
pro
vider
s
Rev
ised
in M
arch
2006
Foo
tnot
es
1
Pre
ble
and P
iwoz
2001
2
WH
O
Contr
ace
ptive
Elig
ibili
ty C
rite
ria
Guid
e
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
EFV
bef
ore
beco
min
g pr
egna
nt i
t sho
uld
be s
ubsi
tute
d w
ith N
VP
in th
e 1s
t tri
mes
ter
In c
ase
of s
ever
e hy
pere
mes
is g
ravi
daru
m A
RT
may
nee
d to
be
brie
fly in
terr
upte
d
On
aver
age
mot
her-
to-c
hild
tra
nsm
issi
on r
ates
are
15
for
sdN
VP
65
fo
r m
ore
effishy
caci
ous
dual
reg
imen
s an
d 2
4 fo
r 3-
drug
AR
V c
ombi
natio
n
Futu
re P
ersp
ectiv
es
Ext
ende
d pr
ophy
laxi
s w
ith 3
AR
V d
rug
com
bina
tions
sta
rtin
g du
ring
pre
gnan
cy a
nd
cont
inui
ng a
fter
del
iver
y fo
r a
peri
od o
f up
to
6 m
onth
s a
mon
g H
IV-in
fect
ed b
reas
t-fe
edin
g m
othe
rs h
as b
een
show
n in
a f
ew r
ecen
t an
d is
olat
ed s
tudi
es a
nd p
ilot
proshy
gram
me
to le
ad to
low
er b
reas
tfee
ding
-rel
ated
pos
tnat
al M
TCT
Thi
s ap
proa
ch m
ay b
e co
nsid
ered
whe
re th
is is
feas
ible
acc
epta
ble
saf
e an
d w
here
adh
eren
ce c
an b
e as
sure
d
Mor
e st
udie
s on
this
issu
e ar
e ex
pect
ed
Thre
e A
RV
dru
g co
mbi
natio
ns g
iven
to
HIV
pos
itive
pre
gnan
t w
omen
who
are
not
yet
el
igib
le fo
r in
itiat
ion
of A
RTs
for
thei
r ow
n he
alth
als
o le
ad to
low
er M
TCT
and
may
be
cons
ider
ed in
pro
gram
mes
with
the
capa
city
to in
itiat
e th
e re
gim
en a
nd fo
llow
up
such
wom
en S
uch
inte
rven
tion
is in
itiat
ed a
t ar
ound
28
wee
ks o
r so
on a
fter
and
sto
pped
af
ter
birt
h if
CD
4 co
unt i
s st
ill a
bove
350
cel
lsm
m3
App
endi
ces
Appen
dix
I
Appen
dix
II
Appen
dix
III
Appen
dix
IV
WH
O C
linic
al S
tagin
g o
f H
IVA
IDS f
or
Adults
and A
dole
scen
ts
w
ith c
onfirm
ed H
IV infe
ctio
n
Contr
acep
tive
Options
for
Peo
ple
Liv
ing w
ith H
IV
Sum
mar
y of
ARV D
rug U
se f
or
PMTCT o
f H
IV
In
tegra
ted M
onitori
ng a
nd E
valu
ation R
eport
Form
MO
H 7
26
Cha
pter
ref
eren
ces
1
Sum
mar
y of
ARV D
rugs
Adve
rse
Effec
ts a
nd M
anag
emen
t T
able
6-1
0
pages
101-1
12 o
f G
uid
elin
es f
or
Antire
trovi
ral D
rug T
her
apy
in K
enya
3rd
Editio
n
De-
cem
ber
2005
2
Dru
g I
nte
ract
ions
Tab
le 7
-10
pag
es 1
12-1
22 o
f G
uid
elin
es f
or
Antire
trovi
ral
Dru
g T
her
apy
in K
enya
3rd
editio
n
Dec
2005
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
7
50
Cha
pter
5
Imm
edia
te P
ostn
atal
and
Neo
nata
l Car
e 5
1 IN
TRO
DU
CTI
ON
Imm
edia
te p
ostn
atal
and
neo
nata
l car
e re
fers
to th
e pa
ckag
e of
ser
vice
s pr
ovid
ed to
the
mot
her
and
infa
nt b
efor
e th
ey le
ave
the
heal
th fa
cilit
y (u
p to
48
hour
s) a
fter
del
iver
yTh
e pe
riod
pro
vide
s an
opp
ortu
nity
to e
duca
te a
ll m
othe
rs a
bout
HIV
to
prov
ide
coun
shyse
lling
and
tes
ting
if it
was
not
don
e pr
evio
usly
and
to
rein
forc
e th
e ed
ucat
ion
proshy
vide
d du
ring
the
ant
enat
al p
erio
d B
oth
HIV
inf
ecte
d an
d H
IV u
ninf
ecte
d m
othe
rs
shou
ld r
ecei
ve th
is e
duca
tion
and
coun
selli
ng b
efor
e di
scha
rge
52
OPE
RA
TIO
NA
L G
UID
ELIN
ES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed fo
r all
wom
en a
nd
infa
nts
in th
e im
med
iate
pos
t par
tum
per
iod
a)
Opt
imal
pos
tpar
tum
car
e
bull R
outin
e ca
re in
clud
ing
brea
st e
xam
inat
ion
exa
min
atio
n of
the
ute
rus
ex
amin
atio
n of
the
per
ineu
m a
nd lo
chia
pa
ssag
e of
uri
ne r
egul
arly
pr
oper
hyg
iene
to
prev
ent
infe
ctio
n c
heck
ing
for
sign
s of
ana
emia
fe
ver
and
tach
ycar
dia
bull D
iscu
ss m
ater
nal n
utri
tion
bull E
stab
lish
the
HIV
sta
tus
of t
he m
othe
rs in
clud
ing
thos
e gi
ving
birt
h ou
tsid
e th
e he
alth
inst
itutio
n se
tting
bull P
rovi
de H
IV C
T f
or m
othe
rs w
ith u
nkno
wn
HIV
sta
tus
bull E
ncou
rage
HIV
res
ults
dis
clos
ure
and
part
ner
test
ing
bull F
ollo
w t
he s
tand
ard
guid
elin
es o
n th
e ca
re o
f a n
ewbo
rn (
IMP
AC
C
are
Man
ual)
bull A
ll ba
bies
sho
uld
rece
ive
thei
r ro
utin
e im
mun
izat
ion
(OP
V a
nd B
CG
) in
th
eir
first
hou
rs o
f lif
e1
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Con
trac
eptio
n A
ll m
othe
rs r
egar
dles
s of
the
ir H
IV s
tatu
s h
ave
a ri
ght
to r
ecei
ve a
dequ
ate
info
rmashy
tion
on a
vaila
ble
met
hods
of f
amily
pla
nnin
g an
d to
mak
e an
info
rmed
cho
ice
on w
hat
is b
est
for
them
H
IV-in
fect
ed w
omen
who
are
not
bre
astf
eedi
ng s
houl
d in
itiat
e a
relia
ble
cont
race
ptiv
e m
etho
d by
2-4
wee
ks p
ostp
artu
m
This
is
in a
dditi
on t
o th
epr
oper
and
con
sist
ent
use
of t
he c
ondo
m a
s a
form
of
dual
pro
tect
ion
All
met
hods
of
cont
race
ptio
n ca
n be
use
d by
HIV
pos
itive
wom
en b
ased
on
stan
dard
med
ical
elig
ibili
tycr
iteri
a in
clud
ing
taki
ng c
are
of d
rug
inte
ract
ions
as
outli
ned
belo
w2
bull L
acta
tiona
l Am
enor
rhoe
a M
etho
d (L
AM
) S
uita
ble
for
excl
usiv
ely
brea
stfe
edin
g H
IV in
fect
ed w
omen
who
hav
e no
t re
sum
ed m
ense
s
bull H
orm
onal
con
trac
eptio
n A
ll ho
rmon
al c
ontr
acep
tives
can
be
used
in
HIV
pos
itive
wom
en in
clud
ing
thos
e on
HA
AR
T
Com
bine
d or
al
cont
race
ptiv
es a
re c
ontr
aind
icat
ed f
or u
se w
ith d
rugs
that
indu
ce
hepa
tic m
icro
-enz
yme
that
may
red
uce
the
effe
ctiv
enes
s of
hor
mon
al
cont
race
ptiv
es
Som
e an
ti-T
Bs
ant
iret
rovi
rals
an
tifun
gals
and
ant
i-ep
ilept
ics
and
in c
ondi
tions
tha
t ca
use
mal
abso
rptio
n8
bull I
ntra
-ute
rine
con
trac
eptiv
e de
vice
s (I
UC
Ds)
IU
CD
s ar
e no
t co
ntra
indi
cate
d in
HIV
pos
itive
wom
en
In s
ever
ely
imm
uno
supp
rese
d w
omen
use
sho
uld
not
be d
isco
ntin
ued
but
new
inse
rtio
n is
dis
cour
aged
as
it m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f in
fect
ion
duri
ng t
he in
sert
ion
proc
ess
bull S
urgi
cal m
etho
ds S
urgi
cal c
ontr
acep
tion
shou
ld b
e of
fere
d to
HIV
po
sitiv
e w
omen
and
the
ir pa
rtne
rs
bull B
arri
er m
etho
ds
Fem
ale
and
mal
e co
ndom
s pr
ovid
e pr
otec
tion
agai
nst
ST
Ds
and
redu
ce t
he r
isk
of H
IV t
rans
mis
sion
and
sho
uld
be
enco
urag
ed a
lone
or
toge
ther
with
oth
er c
ontr
acep
tive
met
hods
bull S
perm
icid
es
Use
d in
con
junc
tion
with
bar
rier
met
hods
spe
rmic
ides
w
ill p
rovi
de a
dditi
onal
con
trac
eptiv
e pr
otec
tion
How
ever
sp
erm
icid
es s
houl
d no
t be
use
d al
one
as t
hey
can
incr
ease
the
ris
k of
HIV
acq
uisi
tion
bull E
mer
genc
y co
ntra
cept
ion
HIV
pos
itive
wom
en s
houl
d be
info
rmed
ab
out
emer
genc
y co
ntra
cept
ion
whe
re it
is a
vaila
ble
and
how
to
obta
in a
nd u
se it
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
1
56
Bre
ast c
are
in b
reas
tfeed
ing
mot
hers
bull E
ncou
rage
dai
ly c
lean
ing
of t
he b
reas
ts a
nd a
void
ing
the
appl
icat
ion
of lo
tions
bull T
reat
mat
erna
l vag
inal
can
didi
asis
and
infa
nt o
ral c
andi
dias
is
bull E
duca
te m
othe
r on
opt
imal
bre
astf
eedi
ng te
chni
que
incl
udin
g la
tchi
ng
on t
echn
ique
ex
lusi
ve b
reas
tfee
ding
and
rem
ovin
g ba
by f
rom
bre
ast
bull E
duca
te th
e m
othe
r on
bre
ast c
are
to p
reve
nt c
ompl
icat
ions
(cr
acki
ng
and
engo
rgem
ent)
bull E
xpre
ss a
nd h
eat
trea
t th
e m
ilk if
bre
ast
has
mas
titis
or
absc
ess
Opt
imal
pos
tpar
tum
car
e fo
r HIV
pos
itive
wom
en
Loch
ia
bull P
ut e
mph
asis
on
good
per
inea
l hyg
iene
and
pro
per
hand
ling
of b
ody
fluid
s
bull A
void
con
tam
inat
ing
the
baby
with
bod
y flu
ids
or w
ith b
eddi
ng s
oile
d w
ith lo
chia
bull S
hari
ng o
f be
ds b
y m
othe
rs in
the
hos
pita
l sho
uld
be d
isco
urag
ed
Cae
sare
an S
ectio
n
Bro
ad s
pect
rum
ant
ibio
tics
shou
ld b
e us
ed r
outin
ely
afte
r C
S
Esse
ntia
l mat
erna
l edu
catio
n an
d fo
llow
-up
bull M
onito
r fo
r br
east
and
pel
vic
infe
ctio
n at
all
post
nat
al c
linic
vis
its
bull E
duca
te o
n pr
ompt
hea
lth s
eeki
ng b
ehav
iour
bull H
ealth
edu
catio
n on
hyg
iene
lo
chia
and
bre
ast
care
bull A
void
sex
ual i
nter
cour
se f
or a
t lea
st 2
wee
ks a
fter
birt
h or
unt
il th
ere
is
no lo
nger
any
loch
ia r
ubra
or
sero
sa
bull D
o pa
p sm
ear
or V
IA a
t 4-
6 w
eeks
bull F
or e
very
sex
ual a
ctiv
ity
the
coup
le s
houl
d us
e co
ndom
s
bull D
iscu
ss f
amily
pla
nnin
g at
eve
ry o
ppor
tuni
ty a
nd p
rovi
de t
he
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Supp
ort
infa
nt fe
edin
g op
tions
For
all
HIV
neg
ativ
e w
omen
wom
en o
f unk
now
n H
IV
stat
us a
nd H
IV p
ositi
ve m
othe
rs o
ptin
g fo
r ex
clus
ive
brea
stfe
edin
g in
itiat
e br
east
feed
shyin
g w
ithin
hal
f hou
r of
bir
th a
nd fo
llow
oth
er g
uide
lines
as
per
Bab
y Fr
iend
ly H
ospi
tal
Initi
ativ
e2 (B
FHI)
bull G
ive
info
rmat
ion
on fa
mily
pla
nnin
g an
d du
al p
rote
ctio
n
bull C
ouns
el o
n H
IV r
isk
redu
ctio
n
bull S
ched
ule
post
nata
l clin
ic v
isits
at
2 w
eeks
and
at
4-6
wee
ks a
nd
com
plet
e m
othe
r-ch
ild b
ookl
et (
refe
r to
DR
H m
anua
l)
(b) S
peci
fic p
ostp
artu
m c
are
for H
IV p
ositi
ve w
omen
bull S
uppo
rt e
xclu
sive
bre
astf
eedi
ng u
nles
s m
othe
r ha
s ap
prop
riat
ely
opte
d fo
r an
d be
en c
ouns
elle
d on
rep
lace
men
t fe
edin
g an
tena
tally
bull I
nitia
te o
r co
ntin
ue c
o-tr
imox
azol
e pr
ophy
laxi
s -1
dou
ble
stre
ngth
tab
shyle
t da
ily
bull F
or H
IV p
ositi
ve m
othe
rs t
hat
rece
ived
sd
nevi
rapi
ne in
trap
artu
m
initi
shyat
e A
ZT
300m
g an
d 3T
C 1
50 m
g B
D f
or 1
wee
k
bull F
or n
ewly
dia
gnos
ed m
othe
rs
do H
IV s
tagi
ng
CD
4 co
unt
and
refe
r ap
prop
riat
ely
for
cont
inue
d ca
re
(c)
Spec
ific
care
for H
IV e
xpos
ed in
fant
s
bull F
or H
IV e
xpos
ed in
fant
s a
dmin
iste
r sd
NV
P 2
mg
kg s
tat
with
in 7
2 ho
urs
Giv
e A
ZT
4 m
gkg
BID
for
6 w
eeks
and
3T
C 4
mg
kg B
ID f
or 1
w
eek
Ref
er t
o C
hapt
er 4
bull R
efer
to C
hapt
er 8
for
deta
ils o
n in
fant
fee
ding
opt
ions
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
5
52
Cha
pter
ref
eren
ces
1
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
Nat
ional
Guid
elin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
ata
l Car
e (2
004)
2
2R
epublic
of
Ken
ya M
inis
try
of
Hea
lth
Ess
ential
Obst
etri
c C
are
Man
ual
for
Hea
lth
Ser
vice
Pro
vider
s in
Ken
ya 3
rd E
ditio
n (
Jan 2
006)
Foo
tnot
es
1
WH
O r
ecom
men
ds
that
all
vacc
ines
should
be
giv
en t
o H
IV-s
ero-n
egat
ive
child
ren
and t
o a
sym
pto
mat
ic s
ero-p
osi
tive
s
The
only
vac
cines
to b
e w
ithhel
d f
rom
child
ren w
ith s
ympto
mat
ic A
IDS a
re B
CG
and
Yel
low
fev
er v
acc
ines
2
The
ldquoTen
Ste
psrdquo
of
BFH
I R
ecom
men
ded
Pra
ctic
es f
or
Mat
ernity
Ser
vice
s ad
apte
d f
or
W
HO
UN
ICEF
1989
Cha
pter
6
Late
Pos
tnat
al C
are
and
Fam
ily P
lann
ing
61
INTR
OD
UC
TIO
N
Late
pos
tnat
al c
are
is p
rovi
ded
to t
he m
othe
r an
d th
e ch
ild 4
8 ho
urs
to 6
wee
ks a
fter
deliv
ery
Dur
ing
this
per
iod
the
heal
th o
f the
mot
her
and
child
is a
sses
sed
and
clos
ely
mon
itore
d
The
risk
of M
TCT
duri
ng th
e po
stpa
rtum
per
iod
can
be r
educ
ed b
y pr
ovid
ing
HIV
cou
nshyse
lling
and
test
ing
pos
t-ex
posu
re p
roph
ylax
is fo
r ex
pose
d ba
bies
cou
nsel
ling
on a
ppro
shypr
iate
infa
nt fe
edin
g op
tions
and
bre
ast c
are
Pos
tpar
tum
car
e fo
r H
IV p
ositi
ve w
omen
shou
ld in
clud
e cl
inic
al s
tagi
ng C
D4
coun
t and
AR
T fo
r th
ose
who
qua
lify
Fam
ily p
lann
ing
serv
ices
are
am
ong
the
core
inte
rven
tions
of P
MTC
T pr
ovid
ed to
hel
pw
omen
det
erm
ine
futu
re c
hild
bear
ing
patt
erns
inc
ludi
ng t
he p
reve
ntio
n of
HIV
-in
fect
ed b
irth
s
Rep
rodu
ctiv
e he
alth
cou
nsel
ling
can
help
a w
oman
pra
ctis
e sa
fer
sex
and
dete
rmin
e he
r fu
ture
ch
ildbe
arin
g pa
tter
ns
on
a m
ore
resp
onsi
ble
and
info
rmed
bas
is1
62
OPE
RA
TIO
NA
L G
UID
ELIN
ES
Opt
imal
pos
tpar
tum
car
e fo
r all
wom
en
This
ent
ails
rou
tine
care
inc
ludi
ng b
reas
t ex
amin
atio
n e
xam
inat
ion
of t
he u
teru
s
exam
inat
ion
of t
he p
erin
eum
and
loch
ia p
assa
ge o
f uri
ne r
egul
arly
pro
per
hygi
ene
topr
even
t in
fect
ion
che
ckin
g fo
r si
gns
of a
nem
ia
feve
r an
d ta
chyc
ardi
a an
d do
ing
peri
neal
exe
rcis
es
Add
ition
al c
are
incl
udes
bull C
ouns
ellin
g an
d te
stin
g fo
r m
othe
rs o
f un
know
n H
IV s
tatu
s bull
Pro
visi
on o
f co
ndom
s an
d ris
k re
duct
ion
coun
selli
ng
bull C
ouns
ellin
g on
con
trac
eptiv
e op
tions
in
clud
ing
dual
met
hod
use
bull D
iscu
ssin
g m
ater
nal n
utrit
ion
bull M
alar
ia p
reve
ntio
n bull
Scr
eeni
ng f
or S
TI a
nd c
ervi
cal c
ance
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
3
54
Enq
uiri
es r
egar
ding
thes
e PM
TCT
Gui
delin
es s
houl
d be
add
ress
ed to
Dire
ctor
N
atio
nal A
IDS
and
STI C
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Third
edi
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Cop
yrig
ht copy
200
9 M
inis
try o
f Hea
lth G
over
nmen
t of K
enya
105
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
A
ppen
dix
VII
I Li
st o
f Con
trib
utor
s
Dr
Ayi
si R
ober
t K
Dep
uty
Hea
d N
ASC
OP
PMTC
T Pr
grm
Mng
r
MO
H-N
ASC
OP
Dr
Abd
alla
h S
aade
H
IV T
rain
er J
HPI
EG
O
Ms
Ake
lola
Rut
h
Nut
ritio
n amp
HIV
Man
ager
MO
H-N
ASC
OP
Mr
Dey
a J
osph
at
PMTC
T Pr
ogra
m O
ffice
r M
OH
-NA
SCO
P
Dr
Die
lem
ans
Pau
l
Mat
erna
l Neo
nata
l Hea
lth (M
NH
) Adv
isor
EH
SD
RH
Ms
Gitu
to A
nnie
W
Prog
ram
Offi
cer
MO
H-D
RH
Dr
Inw
ani
Iren
e
Paed
iatr
icia
n IC
AR
T K
NH
Mr
Isav
wa
Ant
hony
D
ata
Prog
ram
Man
ager
CD
C K
enya
Dr
Kar
anja
Dom
inic
PM
TCT
Prog
ram
Man
ager
PA
THFI
ND
ER
Inte
rnat
iona
l
Dr
Kia
rie
Jam
es N
PM
TCT
Prog
ram
Man
ager
KN
HU
ON
Dr
Kig
en B
atile
l Pr
ogra
m M
anag
er M
OH
-DR
H
Ms
Koe
ch R
osel
ine
Pr
ogra
m O
ffice
r M
OH
-DR
H
Dr
Mac
hari
a S
heila
R
H S
ervi
ces
Spec
ialis
t U
SAID
K
Dr
Mat
u L
ucy
PM
TCT
Prog
ram
Man
ager
USA
IDK
Ms
Mau
a J
udith
Pr
ogra
m O
ffice
r D
RH
-MO
H
Prof
Mbo
ri-N
gach
a D
Se
nior
Tec
hnic
al A
dvis
or A
ssoc
iate
Pro
fess
or
of P
aedi
atri
cs C
DC
Ken
ya U
oN
Dr
Mud
any
Mild
red
Te
chni
cal A
dvis
or C
DC
Ken
ya
Ms
Muh
enje
Ody
lia
Beh
avio
ral S
cien
tist
CD
C K
enya
Ms
Mut
sots
o W
infr
ed
PMTC
T Te
chni
cal A
dvis
orP
rogr
am M
anag
er C
DC
Ken
ya
Ms
Mut
uku
Ter
esia
H
IV T
rain
er J
HPI
EG
O
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
104
App
endi
x V
II
103
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Ms
Mw
anga
ngi
Alic
e Pr
ogra
m O
ffice
r D
RH
-MO
H
Ms
Mw
angi
Nan
cy
PMTC
T A
dmin
istr
ativ
e A
ssis
tant
CD
C K
enya
Mr
Ndw
iga
Fra
ncis
Pr
ogra
m O
ffice
r M
OH
-NA
SCO
P
Prof
Ndu
ati
Rut
h
Ass
ocia
te P
rofe
ssor
of P
aedi
atri
cs U
oN
Dr
Nju
guna
Cha
rles
Pr
ogra
m A
ssoc
iate
MSH
RPM
Plu
s
Mr
Nya
beri
Dav
id
Prog
ram
Offi
cer
MO
H-D
RH
Mr
Ode
ra J
W
Prog
ram
Coo
rdin
ator
GTZ
Ms
Olu
och
Pat
rici
a Te
chni
cal A
dvis
or C
DC
Ken
ya
Mr
Olu
och
Tom
Te
chni
cal A
dvis
or C
DC
Ken
ya
Dr
Onrsquo
gech
Joh
n
Prog
ram
Coo
rdin
ator
KN
H
Dr
Otie
no-N
yuny
a B
Se
nior
Lec
ture
rH
ead
of D
epar
tmen
t PM
TCT
Dir
ecto
rM
oi U
nive
rsity
AM
PATH
Dr
Oum
a C
hris
PM
TCT
Prog
ram
Offi
cer
UN
ICE
F
Dr
Saw
e F
redr
ick
K
Dep
uty
Dir
ecto
r W
RP
Mr
Soo
Leo
nard
Pr
ogra
m M
anag
er W
RP
Dr
Vak
il S
obha
N
Tech
nica
l Adv
isor
AR
T Pr
ogra
m N
ASC
OP
Ms
Way
ua R
uth
Prog
ram
Offi
cer
MO
H-D
RH
Dr
Yon
ga I
sabe
lla
PMTC
T Te
chni
cal A
dvis
or E
GPA
F
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
Tabl
e of
Con
tent
s Li
st o
f con
trib
utor
s 3
Tabl
e of
con
tent
s 5
Ack
now
ledg
emen
ts
10
Fore
wor
d 11
Abb
revi
atio
ns a
nd A
cron
yms
12
Exe
cutiv
e Su
mm
ary
16
Cha
pter
1
Bac
kgro
und
20
11T
he G
loba
l Pan
dem
ic
20
12
Mag
nitu
de o
f HIV
in P
regn
ancy
in
22
13
Ris
ks o
f Tra
nsm
issi
on o
f MTC
T at
Diff
eren
t Tim
e Pe
riod
s 23
14
Ris
k Fa
ctor
s of
MTC
T of
HIV
24
15
Ben
efits
of P
MTC
T of
HIV
25
16
Ben
efits
of H
IV C
ouns
ellin
g amp
Tes
ting
25
17
The
Four
-pro
nged
App
roac
h to
PM
TCT
26
18
Ove
rvie
w o
f the
New
PM
TCT
Gui
delin
es
28
19
Obj
ectiv
es amp
Org
anis
atio
n of
the
Gui
delin
es
28
110
U
sing
the
Gui
delin
es
29
Cha
pter
2 A
nten
atal
Car
e an
d Pr
even
tion
of M
TCT
of H
IV
32
21
Intr
oduc
tion
32
5
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4 B
acte
riolo
gica
l con
firm
atio
n
App
ropr
iate
clin
ical
sam
ples
incl
ude
sput
um
gast
ric
aspi
rate
s an
d ce
rtai
n ot
her
mat
eria
ls
Sin
ce m
ost
TB
in c
hild
ren
is in
infa
nts
and
youn
g ch
ildre
n s
putu
m
indu
ctio
n m
ay b
e do
ne fi
rst
or g
astr
ic a
spira
tions
and
exp
ecto
ratio
ns
a S
putu
m In
duct
ion
Spu
tum
indu
ctio
n is
saf
e an
d ef
fect
ive
in c
hild
ren
of a
ll ag
es a
nd t
he b
acte
rial
yi
elds
a]r
e as
goo
d or
bet
ter
that
for
gas
tric
asp
irate
s
b G
astr
ic a
spira
tion
Thi
s is
per
form
ed in
you
ng c
hild
ren
who
are
una
ble
or u
nwill
ing
to
expe
ctor
ate
sput
um
A g
astr
ic a
spir
ate
shou
ld b
e ob
tain
ed o
n ea
ch o
f th
e th
ree
cons
ecut
ive
mor
ning
s
c E
xpec
tora
tions
S
putu
m s
houl
d al
way
s be
obt
aine
d in
adu
lts a
nd o
lder
chi
ldre
n gt1
0 ye
ars
of
age
susp
ecte
d of
hav
ing
pulm
onar
y T
B
Bac
teri
al y
ield
s ar
e hi
gher
in o
lder
chi
ldre
n
Thr
ee s
putu
m s
peci
men
s sh
ould
be
obta
ined
an
on-
the
ndashspo
t sp
ecim
en (
at t
he
first
eva
luat
ion)
an
ear
ly m
orni
ng s
peci
men
and
a s
econ
d on
-the
-spo
t sp
ecim
en
Spu
tum
indu
ctio
n is
saf
e an
d ef
fect
ive
in c
hild
ren
of a
ll ag
es a
nd t
he b
acte
rial
yi
elds
are
as
good
or
bett
er t
han
for
gast
ric a
spira
tes
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
102
NO
TES
1 H
isto
ry
bull A
sk f
or s
ympt
oms
cons
iste
nt w
ith T
B in
clud
ing
chro
nic
coug
hgt 2
wee
ks
feve
r- b
ody
tem
pera
ture
of
38 o C
for
14 d
ays
afte
r co
mm
on c
ause
s su
ch a
s m
alar
ia a
nd p
neum
onia
hav
e be
en e
xclu
ded
wei
ght
loss
or
failu
re t
o th
rive
(
also
look
at
the
grow
th c
hart
) a
nd o
r ni
ght
swea
ts
Enq
uire
whe
ther
the
pat
ient
has
bee
n in
clo
se c
onta
ct w
ith s
mea
r-po
sitiv
e pu
lshym
onar
y T
B (
usua
lly a
par
ent
or o
ther
mem
ber
of th
e fa
mily
)
2 C
linic
al e
xam
inat
ion
a P
hysi
cal s
igns
hig
hly
sugg
estiv
e of
ext
ra p
ulm
onar
y T
B
bull O
ften
the
mai
n cl
inic
al f
indi
ng is
just
fai
lure
to
thriv
e
bull G
ibus
es
peci
ally
of
rece
nt o
nset
(re
sulti
ng f
rom
ver
tebr
al T
B)
bull N
on-p
ainf
ul e
nlar
ged
cerv
ical
lym
phad
enop
athy
with
fis
tula
for
mat
ion
b P
hysi
cal s
igns
req
uiri
ng in
vest
igat
ions
to
excl
ude
extr
a pu
lmon
ary
TB
bull M
enin
gitis
not
res
pond
ing
to a
ntib
iotic
s tr
eatm
ent
bull P
leur
al e
ffus
ion
bull P
eric
ardi
al e
ffus
ion
bull D
iste
nded
abd
omen
with
asc
itis
bull N
on-p
ainf
ul e
nlar
ged
lym
ph n
odes
with
out
fistu
la f
orm
atio
n
bull N
on-p
ainf
ul e
nlar
ged
join
t
Sig
ns o
f tu
berc
ulin
hyp
erse
nsiti
vity
3 M
anto
ux te
st
A m
anto
ux t
est
shou
ld b
e re
gard
ed p
ositi
ve a
s fo
llow
s
bull I
n hi
gh-r
isk
child
ren
(inc
lude
s H
IV-i
nfec
ted
child
ren
and
seve
rely
mal
shyno
uris
hed
child
ren
) gt
5mm
dia
met
er o
f in
dura
tion
bull I
n al
l oth
er c
hild
ren(
whe
ther
the
y ha
ve r
ecei
ved
BC
G o
r no
t)
gt10m
m d
ishyam
eter
of i
ndur
atio
n
101
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
22
Ope
ratio
nal G
uide
lines
32
23
Job
Aid
s 34
24
App
endi
ces
13
Cha
pter
3 I
ntra
part
um C
are
38
31
Intr
oduc
tion
38
32
Ope
ratio
nal G
uide
lines
38
Cha
pter
4
Use
of A
RVs
in P
regn
ancy
for T
reat
men
t amp P
MTC
T of
HIV
infe
ctio
n 42
41
Intr
oduc
tion
42
42
Ope
ratio
nal G
uide
lines
43
Cha
pter
5 I
mm
edia
te P
ostn
atal
and
Neo
nata
l Car
e
51
51
Intr
oduc
tion
51
52
Ope
ratio
nal G
uide
lines
51
Cha
pter
6 L
ate
Post
nata
l Car
e an
d Fa
mily
Pla
nnin
g
54
61
Intr
oduc
tion
54
62
Ope
ratio
nal G
uide
lines
54
Cha
pter
7 H
IV D
iagn
osis
in C
hild
ren
58
71
Intr
oduc
tion
58
72
Ope
ratio
nal G
uide
lines
59
72
0 G
uide
lines
for
HIV
Dia
gnos
is in
Chi
ldre
n
59
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
72
1 H
IV N
egat
ive
Infa
nt a
t 6 w
eeks
or
Firs
t Con
tact
59
72
2 H
IV P
ositi
ve In
fant
by
DN
A P
CR
60
72
3 C
ompr
ehen
sive
Car
e fo
r H
IV-e
xpos
ed In
fant
61
D
IAG
NO
STIC
ALG
OR
ITH
MFO
R P
ULM
ON
AR
Y T
B IN
CH
ILD
REN
Cha
pter
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
Bor
n to
HIV
infe
cted
mot
hers
62
81
Intr
oduc
tion
62
82
Ope
ratio
nal G
uide
lines
on
Infa
nt F
eedi
ng (0
-6 m
onth
s)
63
83
Ope
ratio
nal G
uide
lines
on
Feed
ing
Chi
ldre
n 6
mon
ths
and
olde
r 64
84
Nut
ritio
nal C
are
and
Supp
ort o
f HIV
infe
cted
Chi
ldre
n 64
85
Ext
ract
s fr
om R
esea
rch
on In
fant
Fee
ding
and
HIV
AID
S 65
Cha
pter
9
Car
e an
d Fo
llow
up
of C
hild
ren
of H
IV-in
fect
ed m
othe
rs 7
3
91
Intr
oduc
tion
73
92
Ope
ratio
nal G
uide
lines
74
Cha
pter
10
Mon
itorin
g an
d Ev
alua
tion
of P
MTC
T se
rvic
es
83
101
In
trod
uctio
n 83
102
O
pera
tiona
l Gui
delin
es
85
Bib
liogr
aphy
91
Job
Aid
sR
efer
ence
s
91
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
App
endi
x V
I
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
100
App
endi
x V
C
OM
MO
N A
DV
ERSE
EFF
ECTS
OF
AR
V U
SE D
UR
ING
PR
EGN
AN
CY
Cla
ss
Adv
erse
effe
cts
Nuc
leos
ide
Nuc
leot
ide
Rev
erse
Tra
nscr
ipta
se In
hibi
tors
( NR
TIs)
Zido
vudi
ne(A
ZT)
Nau
seau
La
miv
idin
e (3
TC)
Dia
rhoe
a
Stav
udin
e (d
4T)
Hyp
erse
nsiti
vity
(AB
C)
Aba
cavi
r(A
BC
) A
naem
ia(A
ZT)
Teno
fovi
r(TF
VTD
F)
Emitr
icita
bine
(FTC
)
Non
- Nuc
leos
ide
Rev
erse
Tra
nscr
ipta
se In
hibi
tors
(NN
RTI
s)
Nev
irapi
ne(N
VP)
Del
avird
in
Efav
irenz
(EFV
)
Pro
teas
e In
hibi
tors
(PIs
)
Saqu
inav
ir(SQ
V)
Indi
navi
r(ID
V)
Rito
navi
r(R
TV)
Nel
finav
ir(N
LF)
Lopi
navi
rrito
navi
r(LP
Vr)
A
taza
navi
r(A
TV)
Fose
mpr
enav
ir Ti
pana
vir(
TPV)
D
arun
avir(
DR
V)
Ras
h
Elev
ated
live
r enz
ymes
(c
omm
on w
ith N
VP in
hig
h C
D4
co
unt)
EFV
CN
S ef
fect
s(se
datio
n in
-so
mni
a v
ivid
dre
ams
diz
zine
ss
conf
usio
n fe
elin
g of
lsquod
isen
gage
men
trsquo
Tera
toge
nici
ty
GI i
ntol
eran
ce
Hep
atot
oxic
ity
Lipo
dyst
roph
y
Dys
lipid
emia
s
Insu
lin re
sist
ance
Hyp
ergl
ycae
mia
La
ctic
aci
dosi
s an
d he
patic
ste
a-to
sis
Cou
nsel
ing
and
Follo
w-u
p Ti
ps
May
not
be
wel
l-tol
erat
ed in
ear
l pr
egna
ncy
whe
n
mor
ning
sic
knes
s is
com
mon
M
ay in
crea
se ri
sk o
f non
-ad
here
nce
May
hav
e in
adeq
uate
blo
od le
vels
A
ll A
RVs
sho
uld
be d
isco
ntin
ued
and
rest
arte
d w
hen
Namp
V is
gon
e or
effe
ctiv
ely
trea
ted
Fo
llow
-up
labs
CB
C L
FTs
If ra
sh in
1st
2 w
ks d
o no
t inc
reas
e N
VP d
ose
and
cont
act c
linic
ian
Mild
rash
may
be
man
aged
with
an
tihis
tam
ines
A
void
cor
ticos
tero
ids
durin
g N
VP
dose
esc
alat
ion
EFV
shou
ld b
e ta
ken
initi
ally
at
bed
time
Avo
id E
FV in
wom
en o
f hig
h ch
ild-b
earin
g po
tent
ial
Do
not o
pera
te h
eavy
mac
hine
ry
Mon
itor g
luco
se le
vels
A
sk re
gula
rly fo
r sym
ptom
s of
hy
perg
lyca
emia
M
onito
r hep
atic
tran
sam
inas
es
(ALT
and
AST
) par
ticul
arly
dur
ing
the
first
18
wee
ks o
f the
rapy
w
hen
this
toxi
city
is m
ost l
ikel
y Ta
ke w
ith fo
od
Ant
iem
etic
s A
ntim
otili
ty
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
App
endi
ces
92
App
endi
x I
WH
O C
linic
al S
tagi
ng o
f HIV
AID
S fo
r A
dults
and
A
dole
scen
ts w
ith C
onfir
med
HIV
infe
ctio
n 92
App
endi
x II
C
ontr
acep
tive
Opt
ions
for
Peop
le L
ivin
g w
ith H
IV
95
App
endi
x II
I U
se o
f AR
Vs
for
Trea
tmen
t and
PM
TCT
of H
IV in
AN
C
97
App
endi
x IV
Use
Of A
RV
s fo
r PM
TCT
of H
IV in
Lab
our
And
Del
iver
y U
nit
98
App
endi
x V
Com
mon
Adv
erse
Effe
cts
of A
RV
Use
Dur
ing
Preg
nanc
y 99
App
endi
x V
I D
iagn
ostic
alg
orith
m fo
r pu
lmon
ary
TB in
Chi
ldre
n 10
0
App
endi
x V
II I
nteg
rate
d M
onito
ring
and
Eval
uatio
n Re
port
For
m M
OH
726
10
3
App
endi
x V
III
Rep
rodu
ctiv
e H
ealth
HIV
AID
S R
epor
t For
m M
OH
711
10
4
Lis
t of T
able
s
Tabl
e 1
1 A
dult
HIV
-pre
vale
nce
Est
imat
e by
Pro
vinc
e in
200
6 21
Tabl
e 1
2 E
stim
ated
Mag
nitu
de o
f MTC
T in
Ken
ya 2
007
22
Tabl
e 1
3 Tr
ansm
ission
Pat
tern
s in
Brea
stfee
ding
and
Non
bre
astfe
edin
g Pop
ulat
ions
23
Tabl
e 1
4 R
isk
Fact
ors
for
MTC
T of
HIV
24
Tabl
e 1
5 Th
e Fo
ur-p
rong
ed A
ppro
ach
App
lied
to th
e PM
TCT
Gui
delin
es
30
Tabl
e 2
1 E
ssen
tial P
acka
ge o
f Int
egra
ted
Ant
enat
al C
are
Serv
ices
33
Tabl
e 4
1 R
ecom
men
datio
ns fo
r In
itiat
ing
AR
V T
reat
men
t in
Preg
nant
Wom
en B
ased
on
Clin
ical
Sta
ge a
nd A
vaila
bilit
y of
CD
4 co
unt
44
Tabl
e 4
2 R
ecom
men
ded
Firs
t Lin
e A
RT
Reg
imen
for
Trea
ting
Preg
nant
Wom
en a
nd P
roph
ylac
tic R
egim
en fo
r In
fant
s 45
Tabl
e 4
3a R
ecom
men
ded
Firs
t Lin
e A
RV
Pro
phyl
axis
to P
reve
nt H
IV
46
Infe
ctio
n in
Infa
nts
Am
ong
preg
nant
Wom
en P
rese
ntin
gB
efor
e 38
Wee
ks
Tabl
e 4
3b A
ltern
ativ
e A
RV
Pro
phyl
axis
to P
reve
nt H
IV In
fect
ion
in In
fant
s 4
6 A
mon
g Pr
egna
nt W
omen
Pre
sent
ing
Bef
ore
38 W
eeks
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
9
9
47
IV
Wom
en w
ho h
ave
not r
ecei
ved
Intr
apar
tum
AR
T or
A
RV
Pro
phyl
axis
with
H
IV
Infe
ctio
n
Tabl
e 4
4 A
RV
Pro
phyl
axis
for
PMTC
T am
ong
Preg
nant
Wom
en w
ho h
ave
not r
ecei
ved
Ant
enat
al A
RT
or P
roph
ylax
is
App
endi
x Ta
ble
45
Cho
ice
of H
AA
RT
for
Preg
nant
Wom
en b
ased
on
CD
4 co
unt
47
Tabl
e 4
6 A
RV
Pro
phyl
actic
Reg
imen
s fo
r In
fant
s B
orn
to H
IV-p
ositi
ve
49
Tabl
e 9
1 D
ose
of C
o-tr
imox
azol
e fo
r PC
P pr
ophy
laxi
s 76
Tabl
e 9
2 W
HO
Rec
omm
enda
tions
for
Follo
w-u
p of
an
HIV
-exp
osed
Chi
ld
79
Tabl
e 10
1 C
ontr
acep
tive
Met
hods
for
Use
in C
oupl
es a
nd W
omen
Liv
ing
96
Figu
re 2
1 R
apid
HIV
Ser
ial T
estin
g A
lgor
ithm
35
Figu
re 8
1 G
uide
lines
for
Cou
nsel
ling
on H
IV a
nd In
fant
feed
ing
66
Job
Aid
s an
d IE
C M
ater
ials
on
Infa
nt a
nd Y
oung
Chi
ld F
eedi
ng
67
List
of F
igur
es
Figu
re 1
01
Mon
itori
ng a
nd E
valu
atio
n D
ata
Flow
in K
enya
84
September 0 8
USE OF ARVs FOR PMTCT OF HIV IN LABOUR AND DELIVERY UNITSALL MOTHERS
1 History 2 Examination3 Establish motherrsquos HIV status4 Offer HIV counseling and testing for mother with unknown HIV status5 Provide standard obstetrical management and care
HIV NEGATIVECounsel on risk reduction
HIV POSITIVE
Establish Motherrsquos use of ARVs in pregnancy and give appropriate ARVs as shown in boxesbelow
Regardless of Duration received HAART
Action
i Give mother ARV dose as per regimen
ii Post partu m Infant Give Infant sd Nevi rapine 2mgkg with in 72 hours of birthPL US 3T C 4mgkg BD for 1 w eek an d AZT syrup 4 m gkg BD for 6 w eeks
iii Post partum mother Continue w ith AR Vs as per regimen
MOTHE R RECEIVED HAART IN PREGNANCY
F OR MORE INFORMAT ION CONT ACT THE NATIONAL AIDSSTD CONTROL PROGRAMME (NASCOP)PO BO X 19361-00202 NAIROBI TEL 0202729502 FAX 020 2710518
MINISTRY OF HEALTH
bull G ive mo ther sd Nevirap ine 200m g AZT 600mg and 3TC 150 mg stat
bull Post partum Infant Give Infant sd Nevirapine 2mgkg within 72 ho urs of birth PL US
3TC syrup 4mg kg BD for 1 week and AZT syrup 4 mg kg BD fo r 6 w eeks
bull Post partum mother Give moth er AZT 300mg amp 3TC 150 mg BID for 7 d ays
MO THER RECEIVED AZT IN PREGNANCY OR NO ARVs TAKE N IN PREGNANCY
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
98
MINISTRY OF HEALTH
USE OF ARVs FOR TREATMENT AND PMTCT OF HIV IN ANC
App
endi
x II
I
Ack
now
ledg
emen
ts
ALL M O THERS1 History 2 Health Information3 Examination4 In vestigations (with informed consent for HIV test)
HIV NEGATIVE1 P rov id e pos t-te s t HIV pr ev e nti v e
i nter ve ntion s defi ned i n na tion alHT C gui de li nes
2 Re fe r for othe r p os t-te st HIVp re ve ntive inte rv e nti ons no tavai lable in the cli nic b ut avail ab le w ithi n the fa c ili ty
HIV PO SI TI VE1 C ounsel on risk reduction2 Per form WH O clinical staging for H IV disease3 D etermine CD 4 level (if testing facilities available)4 D etermine Gestation age and HB level5 Give ARVrsquos as shown below6 Provide or refer for other post-test HIV interventions defined in national HTC
guidelines
1 WHO clin ica l stage I o r II w ith CD4 cell co unt gt 350mm3 OR 2 WHO clin ica l stage I o r II no CD4 cell co unt do ne3 HB =8 gdl OR n o clinical feat ures of anaemia
bull Initiate AZT 30 0mg BD daily at 28 weeks gestation or any time periodimmediately there after
bull Monitor for clinical featur es of anemia and treatbull Dispense ANC Nev ir apine 200mg PLUS AZT 600mg + 3TC 1 50mg for
moth er to tak e at onset of labourbull Dispense NVP syrup to give infant at birth
bull At on set o f l abo uro Administer Nevirapine 20 0mg AZT 600mg 3TC 150 mg
stat to moth erbull Post p artum
o Give Infa nt sd Nevirapine 2mgk g within 72 hours ofbirth PLUS 3TC 4mg BD for 1 w eek and AZT syrup 4 mgkg BD for 6 w eeks
o Give mother AZT30 0 mg 3 TC 150 BID for 7 day s
1 WHO clinical stag e I or II with CD4 c ell count gt 35 0 mm3 OR 2 WHO clinical stag e I or II w ith no C D4 c ell c ount done
bull Dispense ANC Nevirapine 2 00mg PLUS AZ T 600 mg + 3TC 150mgfo r mo ther to take at onse t of labour
bull Dispense NVP sy rup to give infant at birthbull At Onset of lab our
o Administe r sd Nevirapine AZT 6 00 mg and 3TC1 50mg stat
bull Po st Par tu mo G iv e Infant sd Nev ir apine 2mg kg w ithin 72
h ours of bir th PLUS 3T C 4mgkg BD fo r 1 week a nd AZT syrup 4mgkg BD for 6 we eks
o G iv e mother AZ T300 mg 3TC 1 50 mg BID for 7d ays
1 Any gest ational age2 WHO clin ica l stage III or IV of HIV dis ease regardles s of CD4 cell count OR3 WHO clin ica l stages I or II of HIV d is ease with CD4 cell count =350mm3 ()
bull Refer to Clinician for Evaluation and initiation of NNRTI based ART as pernation al ART guidelines
bull At O nset of Lab ou ro G ive mo ther ARV dos e as per r egimen
bull Post par tumo G ive Infan t sd Nev ira pine 2mgkg within 72 hours of b irth PLUS
3TC 4mgkg and AZT syr up 4 mgkg BD for 6 weeks o G ive mo ther ARVs as per regimen
4 If no HAART av ailable man age the wo man as ind icated in box no2 a nd refer to ARTsite appro priately
F O R M OR E IN FOR M AT IO N CO N T AC T T H E N ATI ON A L A IDS STD C O NTR O L PR O G RAM ME ( N ASC O P)P O B OX 19361-00202 N AIR OBI TEL 0202729502 FAX 020 2710518
EL IGIBL E FO R T R EATMEN T
N O T E LIG IBLE FO R TR EA TM ET AN D PR ESE NTING B ELO W 3 8 W EE KSGESTA TIO N N OT ELIGIB LE FOR TREA TMEN T AN D PR ESE NTING gt 3 8 W EEK S
GE STATIO N
Plea se notebull Pregnan t w omen with WHO clinical stag e I or II plus CD4 cell co unt gt250 mm3 and = 350 mm3 can be initiated on ART wher e a PI based HAART re gimen is av ailable NVP hypersen sitivity h as been previously r eported amon g women in this gr oup initiated on N NRT I based
ART re gimens Where PI ba sed ART reg imen is not av ailab le r efer the patient to a site whe re th e regimen is availab le or c ontinue to ma nage th e w oman a s is indicated in box No 2bull The grading of ana emia in pregna ncy is gt 8-10 Milda nemia gt 6 -8 Moderate anem ia lt 6 Sever e anemiabull Treatment if common p ath ologies ruled out Mild anae mia haematinics irrespectiv e of gestatio n Moder ate a naemia tr ansfusion if close to term gt36 weeks otherwise give haema tinics Severe an aemia transfus ion irr espe ctive of ge statio n Do not stop AZT if Hb dr op s but
would manage it as above and only stop if continues to fall or fails to res pon d des pite transfusion
The
thir
d ed
ition
of
Gui
delin
es f
or P
reve
ntio
n of
Mot
her-
to-C
hild
Tra
nsm
issi
on o
f H
IV A
IDS
in K
enya
is a
res
ult o
f effo
rts
of m
any
indi
vidu
als
and
orga
niza
tions
in th
eco
untr
y T
he T
echn
ical
Wor
king
Gro
up o
n PM
TCT
led
thes
e ef
fort
s M
embe
rs o
f the
te
am r
evie
wed
all
the
mod
ules
rev
ised
and
in s
ome
case
s re
-wro
te th
e m
odul
es b
ased
on
the
seco
nd e
ditio
n to
mak
e th
em u
p to
dat
e an
d in
line
with
cur
rent
sci
entif
ic e
vishy
denc
e an
d ex
peri
ence
We
ackn
owle
dge
the
cont
ribu
tors
and
rev
iew
ers
of t
he c
urre
ntan
d pr
evio
us e
ditio
ns O
f sp
ecia
l m
entio
n ar
e th
e fo
llow
ing
Ken
ya O
bste
tric
al a
nd
Gyn
aeco
logi
cal S
ocie
ty (K
OG
S) t
he U
nive
rsity
of N
airo
bi a
nd M
oi U
nive
rsity
We
wou
ld l
ike
to t
hank
the
fol
low
ing
inst
itutio
ns f
or t
echn
ical
as
wel
l as
fin
anci
al
supp
ort
duri
ng t
he r
evis
ion
of t
he g
uide
lines
N
atio
nal A
IDS
and
STD
Con
trol
Pro
shygr
amm
e (N
ASC
OP)
the
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
Cen
ters
for
Dis
ease
Con
trol
and
Prev
entio
n (C
DC
) It
is n
ot p
ossi
ble
to m
entio
n al
l ind
ivid
uals
and
org
aniz
atio
ns
that
par
ticip
ated
in th
is im
port
ant e
xerc
ise
To
all o
f you
Asa
nte
Sana
Min
istr
y of
Hea
lth
September 2008
97
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
10
Fore
wor
d
The
Min
istr
y of
Hea
lth (
MoH
) is
com
mitt
ed t
o de
velo
pmen
t of
effe
ctiv
e PM
TCT
proshy
gram
mes
Gui
delin
es a
re a
n im
port
ant
part
of t
he G
over
nmen
t st
rate
gy t
o re
duce
MTC
Tan
d is
in
line
with
the
Nat
iona
l H
ealth
Sec
tor
Stra
tegi
c Pl
an I
I (N
HSS
PII)
and
Ken
yaN
atio
nal A
IDS
Stra
tegi
c Pl
an (K
NA
SP) 2
000-
2010
whi
ch fo
cuse
s on
pri
ority
are
as o
f pre
shyve
ntio
n of
new
infe
ctio
ns i
mpr
ovin
g qu
ality
of l
ife o
f tho
se in
fect
ed a
nd a
ffect
ed a
nd m
itishy
gatio
n of
soc
ial a
nd e
cono
mic
impa
ct o
f the
infe
ctio
n
MTC
T is
the
pre
dom
inan
t m
ode
of t
rans
mis
sion
of
HIV
in
infa
nts
and
youn
g ch
ildre
n
This
tra
nsm
issi
on o
ccur
s du
ring
pre
gnan
cy
labo
ur a
nd d
eliv
ery
and
am
ong
brea
stfe
d ba
bies
in
the
post
-par
tum
per
iod
Mem
bers
of t
he T
echn
ical
Wor
king
Gro
up (T
WG
) on
PMTC
T re
view
ed t
he m
odul
es o
f the
se
cond
edi
tion
rev
ised
and
in s
ome
case
s re
-wro
te th
e m
odul
es b
ased
on
up to
dat
e kn
owlshy
edge
and
in
line
with
cur
rent
sci
entif
ic e
vide
nce
and
expe
rien
ce T
he T
WG
con
sist
s of
agr
oup
of p
rofe
ssio
nals
dra
wn
from
var
ious
dis
cipl
ines
tha
t ar
e im
plem
entin
g an
dor
man
shyag
ing
PMTC
T T
he g
roup
ado
pted
and
ada
pted
the
late
st r
ecom
men
datio
ns o
f the
WH
O o
nPM
TCT
as w
ell a
s va
riou
s na
tiona
l gui
delin
es o
n H
IV p
reve
ntio
n tr
eatm
ent a
nd c
are
A f
our-
pron
ged
appr
oach
thr
ough
the
var
ious
rep
rodu
ctiv
e lif
e cy
cles
as
prop
osed
by
the
Inte
r-A
genc
y Ta
sk T
eam
(IA
TT)
on c
hild
ren
and
HIV
and
AID
S w
as a
dopt
ed i
n th
ese
guid
elin
es w
ith e
mph
asis
bei
ng p
lace
on
all t
he fo
ur p
rong
s
For
any
of t
he P
MTC
T in
terv
entio
ns t
o be
suc
cess
fully
impl
emen
ted
coun
selin
g an
d te
stshy
ing
(CT)
mus
t fir
st b
e do
ne R
outin
e H
IV te
stin
g w
ith o
pt-o
ut o
ptio
n is
rec
omm
ende
d T
his
is fo
llow
ed b
y ap
prop
riat
e m
edic
al s
urgi
cal i
nter
vent
ions
incl
udin
g an
tiret
rovi
ral p
roph
yshyla
xis
saf
er o
bste
tric
pra
ctic
es a
s w
ell a
s in
fant
feed
ing
coun
selin
g an
d pr
ovis
ion
of a
ppro
shypr
iate
infa
nt fe
edin
g H
IV-p
ositi
ve w
omen
are
ass
esse
d cl
inic
ally
usi
ng W
HO
sta
ging
and
whe
re f
easi
ble
imm
unol
ogic
al a
sses
smen
t us
ing
CD
4 ce
ll co
unt
HIV
exp
osed
infa
nts
are
test
ed th
roug
h ea
rly
infa
nt d
iagn
osis
(EID
)
In th
ese
guid
elin
es m
ore
effic
acio
us r
egim
ens
are
intr
oduc
ed fo
r th
e fir
st ti
me
whi
le in
forshy
mat
ion
and
coun
selin
g on
inf
ant
feed
ing
follo
ws
the
AFA
SS (
Ava
ilabl
e f
easi
ble
acc
eptshy
able
saf
e an
d su
stai
nabl
e) c
rite
ria
The
mod
ule
on m
onito
ring
and
eva
luat
ion
addr
esse
s is
sues
of d
ata
colle
ctio
n c
olla
tion
and
repo
rtin
g as
wel
l as
use
of d
ata
for
deci
sion
-mak
ing
at th
e fa
cilit
y-le
vel
We
hope
that
app
ropr
iate
impl
emen
tatio
n in
stru
men
ts w
ill b
e us
ed to
ope
ratio
naliz
e th
ese
guid
elin
es
Tabl
e 11
1
Con
trac
eptiv
e M
etho
ds fo
r Use
in
Cou
ples
and
Wom
en L
ivin
g w
ith H
IV In
fect
ion
MET
HO
D
CO
MM
ENTS
Con
dom
s bull
M
ale
amp f
emal
e co
ndom
s av
aila
ble
bull
P
rovi
de d
ual p
rote
ctio
n ag
ains
t STI
sH
IV
amp p
regn
ancy
bull
R
equi
re a
ttent
ion
amp ca
re
for c
orre
ct u
se e
ach
time
bull
M
ay re
quire
co-
oper
atio
n of
par
tner
Hor
mon
al
bull V
ery
effe
ctiv
e an
d ea
sy to
use
M
etho
ds
bull S
uita
ble
for s
hort-
or lo
ng-
term
use
bull
Rev
ersi
ble
bull A
ssoc
iate
d w
ith n
on-
cont
race
ptiv
e he
alth
ben
efits
bull
Ser
ious
com
plic
atio
ns
extre
mel
y ra
re
Intra
uter
ine
bull
H
ighl
y ef
fect
ive
long
-term
C
ontra
cept
ive
reve
rsib
le m
etho
d
Dev
ice
bull
Rem
ains
in p
lace
up
to 1
2 ye
ars
bull
A
lmos
t 100
per
cent
ef
fect
ive
bull
H
as n
o ef
fect
on
ferti
lity
whe
n us
ed b
y nu
llipar
ous
wom
en
bull
Sho
uld
not b
e pr
ovid
ed to
w
omen
with
hig
h ris
k se
xual
life
styl
e bull
B
acte
rial S
TIs
shou
ld b
e sc
reen
ed fo
r and
or
treat
ed a
s a
prec
autio
n pr
ior t
o in
serti
on o
f IU
CD
Ste
riliz
atio
n bull
Goo
d v
ery
effe
ctiv
e fo
r co
uple
s or
indi
vidu
als
who
w
ant n
o m
ore
child
ren
bull S
afe
sim
ple
surg
ical
pr
oced
ure
Con
side
red
perm
anen
t
US
E IN
HIV
PO
SITI
VE
PA
TIE
NTS
bull
Can
and
sho
uld
be u
sed
at a
ll st
ages
of H
IV
infe
ctio
n bull
C
an a
nd s
houl
d be
use
d by
pat
ient
s on
AR
T
bull
Cor
rect
and
con
sist
ent u
se b
y H
IV in
fect
ed p
atie
nts
is
reco
mm
ende
d re
gard
less
of t
he u
se o
f oth
er m
etho
ds
of c
ontra
cept
ion
(dua
l con
trace
ptio
n)
bull C
an b
e us
ed w
ithou
t res
trict
ion
in H
IV+
wom
en n
ot o
n AR
T bull
Can
be
used
with
out r
estri
ctio
n in
all
HIV
+ w
omen
for
emer
genc
y co
ntra
cept
ion
bull S
ome
AR
V dr
ugs
may
redu
ce m
etho
d ef
fect
iven
ess
bull
DM
PA
Im
plan
ts c
an h
owev
er b
e us
ed w
ith A
RT
reshy
inje
ctio
n of
DM
PA
sho
uld
be d
one
at 1
0-12
wee
ks
bull If
horm
onal
met
hod
is c
hose
n c
ondo
ms
shou
ld s
till b
e us
ed c
orre
ctly
and
con
sist
ently
bull
Attr
activ
e m
etho
d fo
r wom
en w
ith H
IV w
ho d
esire
ver
y re
liabl
e pr
egna
ncy
prot
ectio
n bull
C
an b
e in
serte
d in
HIV
+ w
omen
who
do
not h
ave
WH
O
Sta
ge 4
dis
ease
AID
S d
efin
ing
illne
ss
bull
For w
omen
with
sta
ge 4
dis
ease
IUD
can
be
inse
rted
once
they
are
on
ART
and
have
con
trolle
d sy
mpt
oms
of s
ever
e ill
ness
bull N
o m
edic
al re
ason
s to
den
y st
eriliz
atio
n to
clie
nts
w
ith H
IV
bull P
roce
dure
may
be
dela
yed
in e
vent
of a
cute
HIV
-rel
ated
in
fect
ion
or s
tage
4 d
isea
se p
endi
ng im
mun
e re
cons
titut
ion
bull E
ncou
rage
con
dom
use
as
wel
l
DM
PA =
Dep
ot M
edro
xypr
oges
tero
ne A
ceta
te (D
epo-
Prov
era)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
1
96
App
endi
x II
CO
NTR
AC
EPTI
VE
OPT
ION
SFO
R P
EOPL
E L I
VIN
G W
ITH
HIV
It
has
bee
n sh
own
in a
num
ber
of s
tudi
es o
f coh
orts
of H
IV p
ositi
ve w
omen
tha
t so
me
choo
se t
o co
ntin
ue s
exua
l act
ivity
des
pite
kno
wle
dge
of t
heir
sta
tus
Evi
denc
e of
con
shyce
ptio
n ha
s de
mon
stra
ted
that
fert
ility
in H
IV p
ositi
ve w
omen
for
the
mos
t pa
rt is
unshy
affe
cted
H
owev
er c
erta
in c
ondi
tions
may
affe
ct fe
rtili
ty s
uch
as lo
w b
ody
mas
s in
dex
A
IDS
and
inte
rcur
rent
illn
ess
esp
ecia
lly t
uber
culo
sis
Put
ting
wom
en w
ho a
re H
IV
infe
cted
on
cont
race
ptiv
es is
one
of t
he m
eans
of p
reve
ntin
g m
othe
r to
chi
ld t
rans
mis
shysi
on o
f HIV
(PM
TCT)
It is
the
rig
ht o
f HIV
infe
cted
wom
en t
o m
ake
thei
r ow
n de
cisi
ons
rega
rdin
g re
prod
ucshy
tion
The
y m
ay w
ish
to h
ave
mor
e ba
bies
lim
it th
eir
fam
ilies
or
avoi
d pr
egna
ncy
alto
shyge
ther
The
hea
lth c
are
prov
ider
s th
ey c
onsu
lt sh
ould
ena
ble
them
to
mak
e in
form
edch
oice
s by
them
selv
es
The
follo
win
g co
ntra
cept
ive
met
hods
are
ava
ilabl
e in
Ken
ya -
pro
gest
eron
e on
ly p
ills
lo
w d
ose
com
bine
d or
al c
ontr
acep
tives
de
pot
med
roxy
prog
este
rone
ace
tate
(D
MPA
shyde
po)
levo
norg
estr
el a
nd e
tono
gest
rel i
mpl
ants
Em
erge
ncy
cont
race
ptiv
e pi
lls c
oppe
rin
trau
teri
ne c
ontr
acep
tive
devi
ces
bar
rier
met
hods
fem
ale
and
mal
e st
erili
satio
n ar
e al
so a
vaila
ble
Som
e dr
ugs
inte
ract
with
hor
mon
al c
ontr
acep
tives
A
nd c
oncu
rren
t us
e sh
ould
be
avoi
ded
The
se d
rugs
incl
ude
bull P
rote
ase
inhi
bito
rs ndash
Rito
navi
r N
elfin
avir
Lop
inav
ir w
ith R
itona
vir
bull N
on-n
ucle
otid
e re
vers
e tr
ansc
ript
ase
inhi
bito
rs (
NN
RT
Is)
ndash N
evir
apin
e
bull E
favi
renz
bull A
nti-T
B d
rugs
ndash R
ifam
pici
n an
d R
ifabu
tin
bull O
ther
dru
gs ndash
Gris
eofu
lvin
P
heno
barb
itone
C
arba
maz
epin
e P
heny
toin
All
the
abov
e do
not
app
ly i
n th
e fa
ce o
f ot
her
med
ical
con
ditio
ns t
hat
are
cont
ra-
indi
catio
ns f
or t
he v
ario
us m
etho
ds e
g k
now
n ca
rdio
vasc
ular
dis
ease
hep
atic
con
dishy
tions
sm
okin
g h
igh
bloo
d pr
essu
re a
nd th
rom
boem
bolic
dis
orde
rs
The
follo
win
g ta
ble
sum
mar
ises
maj
or is
sues
reg
ardi
ng u
se o
f diff
eren
t co
ntra
cept
ives
by H
IV-p
ositi
ve w
omen
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Abb
revi
atio
ns a
nd A
cron
yms
AFA
SS
Acc
epta
ble
Fea
sibl
e A
fford
able
Sus
tain
able
and
Saf
e
Ab
Ant
i-bod
y
AID
S A
cqui
red
Imm
une
Def
icie
ncy
Synd
rom
e
ALT
Ala
nine
Tra
nsfe
rase
AN
C
Ant
enat
al C
are
AR
M
Art
ifici
al R
uptu
re o
f Mem
bran
es
AR
T
Ant
iret
rovi
ral T
hera
py
A
RV
A
ntir
etro
vira
l
AZT
A
zido
thym
idin
e (Z
idov
udin
e or
ZD
V)
AZT
3TC
Com
bivi
r
3TC
Lam
ivud
ine
BC
C
Beh
avio
ur C
hang
e C
omm
unic
atio
n
BC
G
Bac
ille
Cal
met
te G
ueri
ne v
acci
ne
BFH
I B
aby
Frie
ndly
Hos
pita
l Ini
tiativ
e
BID
BD
ldquoT
wic
e a
dayrdquo
CD
C (K
) C
entr
es fo
r D
isea
se C
ontr
ol a
nd P
reve
ntio
n K
enya
CN
S C
entr
al N
ervo
us S
yste
m
CS
Cae
sare
an S
ectio
n
CT
Cou
nsel
ling
and
Test
ing
CTX
CTZ
Cot
rim
oxaz
ole
d4T
Stav
udin
e
D
ASC
O
Dis
tric
t AID
SST
I Coo
rdin
ator
G
uid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
5
12
DB
S D
ried
Blo
od S
pot s
peci
men
DN
A
Deo
xyri
bonu
clei
c A
cid
DR
H
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
EC
V
Ext
erna
l Cep
halic
Ver
sion
EFV
Efa
vire
nz
EID
E
arly
Infa
nt D
iagn
osis
ELI
SA
Enz
yme
Link
ed Im
mun
osor
bent
Ass
ay
FBC
Fu
ll B
lood
Cou
nt
GTZ
G
erm
an T
echn
ical
Coo
pera
tion
HA
AR
T
Hig
hly
Act
ive
Ant
iret
rovi
ral T
hera
py
Hb
Hae
mog
lobi
n
HIV
H
uman
Imm
unod
efic
ienc
y Vi
rus
IATT
Inte
r-A
genc
y Ta
sk T
eam
IMC
I In
tegr
ated
Man
agem
ent o
f Chi
ldho
od Il
lnes
s
IPPT
Inte
rmitt
ent P
resu
mpt
ive
Trea
tmen
t for
Mal
aria
ITN
s In
sect
icid
es T
reat
ed N
ets
IUC
D
Intr
a U
teri
ne C
ontr
acep
tive
Dev
ice
KD
HS
Ken
ya D
emog
raph
ic a
nd H
ealth
Sur
vey
KE
PI
Ken
ya E
xpan
ded
Prog
ram
me
on Im
mun
izat
ion
KO
GS
Ken
ya O
bste
tric
al a
nd G
ynae
colo
gica
l Soc
iety
KN
H
Ken
yatt
a N
atio
nal H
ospi
tal
LAM
Lact
atio
nal A
men
orrh
oea
Met
hod
Mamp
E
Mon
itori
ng a
nd E
valu
atio
n
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
Cyt
omeg
alov
irus
infe
ctio
n (r
etin
itis
or in
fect
ion
of o
ther
org
ans)
9
Cen
tral
ner
vous
sys
tem
tox
opla
smos
is
10
HIV
enc
epha
lopa
thy
11
Ext
rapu
lmon
ary
cryp
toco
ccos
is in
clud
ing
men
ingi
tis
12
Dis
sem
inat
ed n
on-t
uber
culo
us m
ycob
acte
rial
infe
ctio
n
13
Pro
gres
sive
mul
tifoc
al le
ukoe
ncep
halo
path
y
14
Chr
onic
cry
ptos
pori
dios
is
15
Chr
onic
isos
poria
sis
16
Dis
sem
inat
ed m
ycos
is (
extr
apul
mon
ary
hist
opla
smos
is
or c
occi
diom
ycos
is)
17
Rec
urre
nt s
eptic
aem
ia (
incl
udin
g no
n-ty
phoi
dal S
alm
onel
la)
18
Lym
phom
a (c
ereb
ral o
r B
-cel
l non
-Hod
gkin
s)
19
Inv
asiv
e ce
rvic
al c
arci
nom
a
20
Aty
pica
l dis
sem
inat
ed le
ishm
ania
sis
21
Sym
ptom
atic
HIV
-ass
ocia
ted
neph
ropa
thy
or s
ympt
omat
ic H
IV-
asso
ciat
ed
22
Car
diom
yopa
thy
Ple
ase
note
S
igns
and s
ympto
ms
of
HIV
was
ting s
yndro
me
incl
ude
Unex
pla
ined
invo
lunta
ry w
eight
loss
(gt
10
base
line
body
wei
ght)
with o
bvi
ous
was
ting o
f body
mas
s in
dex
lt185
PLU
S
unex
pla
ined
chro
nic
dia
rrhoea
(lo
ose
or
wat
ery
stools
thre
e or
more
tim
es d
aily
) re
port
ed
for
longer
than
one
month
OR r
eport
s of
feve
r or
nig
ht
swea
ts f
or
more
than
one
month
w
ithout
oth
er c
ause
and lack
of
resp
onse
to a
ntibio
tics
or
antim
ala
rial ag
ents
M
ala
ria
must
be
excl
uded
in m
ala
ria
pro
ne
area
s
Fo
r th
e purp
ose
of
the
WH
O s
tagin
g s
yste
m
adole
sents
and a
dults
are
def
ined
as
adults
aged
ge15 y
ears
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
3
94
CLI
NIC
AL
STA
GE
3 1
Une
xpla
ined
sev
ere
wei
ght
loss
(gt1
0 o
f pr
esum
ed o
r m
easu
red
bo
dy w
eigh
t)
2
Une
xpla
ined
chr
onic
dia
rrho
ea fo
r lo
nger
tha
n on
e m
onth
3
Une
xpla
ined
per
sist
ent
feve
r (a
bove
37
5degC
inte
rmitt
ent
or c
onst
ant
for
long
er t
han
one
mon
th)
4
Per
sist
ent
oral
can
didi
asis
5
Ora
l hai
ry le
ukop
laki
a
6
Pul
mon
ary
tube
rcul
osis
7
Tub
ercu
lous
Lym
phad
enop
athy
8
Sev
ere
bact
eria
l inf
ectio
ns (
such
as
pneu
mon
ia
empy
ema
pyo
myo
sitis
bo
ne o
r jo
int
infe
ctio
n m
enin
gitis
or
bact
erae
mia
)
9
Acu
te n
ecro
tizin
g ul
cera
tive
stom
atiti
s g
ingi
vitis
or
perio
dont
itis
10
Une
xpla
ined
ana
emia
(lt8
gdl
) n
eutr
opae
nia
(lt0
5 times1
09 pe
rlitr
e) a
ndo
r ch
roni
c th
rom
bocy
topa
enia
(lt5
0times10
9 per
litr
e)
CLI
NIC
AL
STA
GE
4 1
HIV
was
ting
synd
rom
e
2
Pne
umoc
ystis
pne
umon
ia
3
Rec
urre
nt s
ever
e ba
cter
ial p
neum
onia
4
Chr
onic
her
pes
sim
plex
infe
ctio
n (o
rola
bial
ge
nita
l or
anor
ecta
l of
mor
e th
an o
ne
mon
thrsquos
dur
atio
n or
vis
cera
l at
any
site
)
5
Oes
opha
geal
can
didi
asis
(or
can
didi
asis
of
trac
hea
bro
nchi
or
lung
s)
6
Ext
rapu
lmon
ary
tube
rcul
osis
exc
ept
Tub
ercu
lous
Lym
ph a
deno
path
y
7
Kap
osirsquos
sar
com
a
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
MC
H
Mat
erna
l and
Chi
ld H
ealth
MoH
M
inis
try
of H
ealth
MSF
M
edic
ins
Sans
Fro
ntie
rs
M
TCT
Mot
her-
To-C
hild
Tra
nsm
issi
on
NA
SCO
P N
atio
nal A
IDS
and
STD
Con
trol
Pro
gram
me
NV
P
Nev
irap
ine
OD
ldquoO
nce
a D
ayrdquo
OI
Opp
ortu
nist
ic In
fect
ion
OPV
O
ral P
olio
Vac
cine
PASC
O
Prov
inci
al A
IDS
STI C
oord
inat
or
PCP
Pneu
moc
ystis
jiro
veci
i pne
umon
ia
PCR
Po
lym
eras
e C
hain
Rea
ctio
n
PI
Prot
ease
Inhi
bito
r
PLW
HA
Pe
rson
sPe
ople
Liv
ing
With
HIV
AID
S
PMTC
T
Prev
entio
n of
Mot
her
To C
hild
Tra
nsm
issi
on
RD
A
Rec
omm
ende
d D
aily
Allo
wan
ce
RH
Rep
rodu
ctiv
e H
ealth
RN
A
Rib
onuc
leic
Aci
d
SdN
VP
Si
ngle
dos
e N
evir
apin
e
SRH
Se
xual
and
Rep
rodu
ctiv
e H
ealth
STD
Se
xual
ly T
rans
mitt
ed D
isea
se
STI
Sexu
ally
Tra
nsm
itted
Infe
ctio
n
TB
Tube
rcul
osis
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
3
14
TBA
s Tr
aditi
onal
Bir
th A
tten
dant
s
TLC
To
tal L
ymph
ocyt
e C
ount
TT
Teta
nus
Toxo
id v
acci
ne
UN
ICE
F U
nite
d N
atio
ns C
hild
renrsquo
s Fu
nd
UN
GA
SS
Uni
ted
Nat
ions
Gen
eral
Ass
embl
y Sp
ecia
l Ses
sion
on
HIV
AID
S
UoN
Uni
vers
ity o
f Nai
robi
VC
T V
olun
tary
Cou
nsel
ling
and
Test
ing
VIA
V
isua
l Ins
pect
ion
usin
g A
ceto
ne
VD
RL
Ven
erea
l Dis
ease
Res
earc
h La
bora
tory
(tes
t for
syp
hilis
)
WH
O
Wor
ld H
ealth
Org
anis
atio
n
WR
P W
alte
r R
eed
Prog
ram
App
endi
x I
WH
O C
LIN
ICA
L S T
AG
ING
OF
HIV
AID
S FO
R A
DU
LTS
AN
D A
DO
LES-
CEN
TSW
ITH
CO
NFI
RM
ED H
IV IN
FEC
TIO
N
CLI
NIC
AL
STA
GE
1
bull
Asy
mpt
omat
ic
bull
Per
sist
ent
gene
raliz
ed ly
mph
aden
opat
hy
CLI
NIC
AL
STA
GE
2 1
Une
xpla
ined
mod
erat
e w
eigh
t lo
ss (
lt10
of
pres
umed
or
mea
sure
d bo
dy w
eigh
t)
2
Rec
urre
nt u
pper
res
pira
tory
tra
ct in
fect
ions
(si
nusi
tis
tons
illiti
s
otiti
s m
edia
and
pha
ryng
itis)
3
Her
pes
Zos
ter
4
Ang
ular
Che
ilitis
5
Rec
urre
nt o
ral u
lcer
atio
n
6
Pap
ular
pru
ritic
eru
ptio
ns
7
Seb
orrh
oeic
der
mat
itis
8
Fun
gal n
ail i
nfec
tions
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
5
92
Bib
liog
raph
y 1
Offic
e of
the
Pres
iden
t N
ational
AID
S C
ontr
ol Counci
l K
enya
Nat
ional H
IVA
IDS
Str
ate
gic
pla
n 2
0056
-20091
0
2
Rep
ublic
of
Ken
ya
Nat
ional AID
S C
ontr
ol C
ounci
l N
atio
nal H
IVA
IDS M
onitori
ng
and E
valu
atio
n F
ram
ework
3
Rep
ublic
of
Ken
ya
Nat
ional AID
S C
ontr
ol C
ounci
l N
atio
nal H
IVA
IDS M
onitori
ng
and E
valu
atio
n I
mple
men
tation M
anual
Job
Aid
sR
efer
ence
s 1
MoH
AN
C R
egis
ters
2
MoH
Mat
ernity
Reg
iste
rs
3
MoH
Post
-nata
l Reg
iste
rs
4
Mat
ernal
and C
hild
Wel
fare
Han
dbook
5
Rep
roduct
ive
Hea
lth S
ervi
ces
month
ly r
eport
6
MoH
Form
726
(Appen
dix
IV)
7
MoH
Form
727
8
MO
H F
orm
711
Exec
utiv
e Su
mm
ary
The
Rev
ised
Gui
delin
es (3
rd
editi
on) f
or P
reve
ntio
n of
Mot
her
to C
hild
Tra
nsm
issi
on(P
MTC
T) o
f H
IV a
nd A
IDS
addr
esse
s th
e ri
sks
of m
othe
r-to
-chi
ld t
rans
mis
sion
(MTC
T) o
f H
IV a
nd A
IDS
usin
g m
ore
effic
acio
us in
terv
entio
ns t
han
in t
he p
revi
ous
editi
ons
The
Gui
delin
es a
re i
n lin
e w
ith K
enya
rsquos N
atio
nal
Hea
lth S
ecto
r St
rate
gic
Plan
II
(NH
SSP
II)
and
are
anch
ored
on
the
Ken
ya N
atio
nal
AID
S St
rate
gic
Plan
(KN
ASP
) 20
00-2
010
whi
ch f
ocus
es o
n th
e pr
iori
ty a
reas
of
prev
entio
n of
new
inf
ecshy
tions
im
prov
ing
the
qual
ity o
f life
of p
eopl
e in
fect
ed a
nd a
ffect
ed b
y H
IV a
nd A
IDS
and
miti
gatio
n of
the
soc
ial a
nd e
cono
mic
impa
ct o
f the
infe
ctio
n O
ne o
f the
pri
ority
ar
eas
of N
HSS
P II
is
adhe
renc
e to
set
clin
ical
and
pub
lic h
ealth
sta
ndar
ds
The
Gui
delin
es w
ere
deve
lope
d th
roug
h a
part
icip
ator
y an
d co
nsul
tativ
e pr
oces
s th
at
drew
par
ticip
ants
fro
m p
ublic
hea
lth i
nstit
utio
ns
NG
Os
FB
Os
aca
dem
ic a
nd r
eshyse
arch
ins
titut
ions
and
dev
elop
men
t pa
rtne
rs
The
proc
ess
was
co-
ordi
nate
d by
N
ASC
OP
with
tech
nica
l and
fina
ncia
l sup
port
from
CD
C (K
)
HIV
infe
ctio
n ha
s re
vers
ed g
ains
rea
lised
in c
hild
hea
lth a
nd s
urvi
val i
n th
e la
st d
ecshy
ade
in K
enya
The
infe
ctio
n ha
s al
so c
ontr
ibut
ed s
igni
fican
tly t
o th
e co
mm
on c
ompl
ishyca
tions
of
preg
nanc
y in
man
y co
untr
ies
Glo
bally
mor
e th
an 6
300
00 c
hild
ren
wer
ein
fect
ed w
ith H
IV t
hrou
gh M
TCT
in 2
003
In
2007
K
enya
had
a p
opul
atio
n es
tishym
ated
at
34 m
illio
n t
he n
umbe
r of
bir
ths
per
annu
m w
as 1
73
mill
ion
the
HIV
prev
alen
ce a
mon
g pr
egna
nt m
othe
rs w
as 6
7 p
er c
ent
and
the
tota
l num
ber
of b
irth
s to
HIV
-infe
cted
mot
hers
exp
osed
to
MTC
T w
as 1
638
00
Ass
umin
g a
tran
smis
sion
rate
of 4
0 pe
r ce
nt a
nd in
the
abs
ence
of a
ny in
terv
entio
n t
he n
umbe
r of
HIV
pos
ishytiv
e in
fant
s pe
r an
num
wou
ld b
e 65
520
Ken
ya A
IDS
Indi
cato
r su
rvey
(KA
IS) 2
007
HIV
ser
opre
vale
nce
amon
g ad
ults
age
d 15
-49
year
s is
78
Var
ious
inte
rven
tions
hav
e be
en p
ut in
pla
ce t
o re
spon
d to
the
em
ergi
ng c
halle
nges
an
d co
nstr
aint
s to
MTC
T ac
ross
the
cou
ntry
Ana
lysi
s of
effe
ctiv
enes
s of
the
var
ious
ap
proa
ches
nee
ded
to m
anag
e ri
sks
of M
TCT
prov
ides
val
uabl
e in
sigh
ts th
at n
eces
sishy
tate
the
ado
ptio
n of
mor
e ef
ficac
ious
car
e an
d tr
eatm
ent
regi
men
s T
hese
ins
ight
s ha
ve in
form
ed t
he d
evel
opm
ent
of n
ew G
uide
lines
The
Gui
delin
es in
corp
orat
e th
ese
chan
ges
and
are
reco
mm
ende
d fo
r us
e by
hea
lth p
rofe
ssio
nals
and
hea
lth in
stitu
tions
at a
ll le
vels
of c
are
The
Gui
delin
es w
ill e
nhan
ce th
e ca
paci
ty o
f hea
lth c
are
prov
ider
sto
giv
e m
ore
effic
ient
and
effe
ctiv
e se
rvic
es t
o H
IV p
ositi
ve e
xpec
tant
mot
hers
and
ne
wbo
rns
The
Gui
delin
es h
ave
ten
chap
ters
and
cov
er th
e fo
llow
ing
just
ifyin
g th
e ne
ed fo
r sp
eshyci
fic m
anag
emen
t of
HIV
pos
itive
wom
en c
are
befo
re d
urin
g an
d af
ter
preg
nanc
yus
e of
ant
iret
rovi
ral t
hera
py in
pre
gnan
cy p
ostn
atal
car
e fa
mily
pla
nnin
g e
arly
inshy
fant
dia
gnos
is
feed
ing
car
e an
d fo
llow
-up
of H
IV-in
fect
ed i
nfan
ts
and
mon
itori
ng
and
eval
uatio
n A
dditi
onal
inf
orm
atio
n on
WH
O s
tagi
ng
cont
race
ptiv
e op
tions
for
PLW
As
and
a su
mm
ary
of A
RV
use
in P
MTC
T is
giv
en in
the
appe
ndic
es
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
1
16
The
Gui
delin
es h
ave
also
inc
orpo
rate
d ba
sic
info
rmat
ion
that
pro
gram
man
ager
sne
ed in
ord
er to
mak
e th
eir
inst
itutio
ns P
MTC
T-fr
iend
ly T
his
info
rmat
ion
is fo
und
in
the
boxe
s an
d ap
pend
ices
Sum
mar
ies
of t
he i
nfor
mat
ion
cont
aine
d in
the
tex
t ar
e fo
und
in th
e ta
bles
The
Gui
delin
es p
rovi
de a
bac
kgro
und
to t
he P
MTC
T pr
oble
m in
the
wor
ld i
n A
fric
a an
d in
Ken
ya T
hey
also
giv
e de
tails
on
HIV
in p
regn
ancy
the
tran
smis
sion
pat
tern
sof
MTC
T an
d de
scri
be t
he b
enef
its o
f pr
even
ting
mot
her-
to-c
hild
tra
nsm
issi
on(P
MTC
T) T
hey
also
pro
vide
info
rmat
ion
on in
terv
entio
ns n
eces
sary
to
redu
ce M
TCT
that
incl
ude
coun
selli
ng a
nd te
stin
g la
bora
tory
inve
stig
atio
ns o
bste
tric
inte
rven
tions
and
trea
tmen
tpro
phyl
axis
The
ante
nata
l man
agem
ent
for
HIV
pos
itive
wom
en i
nclu
ding
pol
icy
guid
e jo
b ai
dsw
ith s
umm
aris
ed e
ssen
tial p
acka
ge o
f int
egra
ted
ante
nata
l car
e se
rvic
es a
re d
etai
led
in C
hapt
er 2
Cha
pter
3 p
rovi
des
info
rmat
ion
on i
ntra
part
um c
are
Thi
s is
the
man
agem
ent
ofw
omen
from
the
onse
t of l
abou
r to
del
iver
y A
t thi
s st
age
it is
impo
rtan
t to
esta
blis
hth
e H
IV s
tatu
s of
wom
en p
rior
to d
eliv
ery
or d
urin
g la
bour
Gui
delin
es s
houl
d be
folshy
low
ed fo
r al
l wom
en a
dmitt
ed to
labo
ur a
nd d
eliv
ery
To
cond
uct v
agin
al d
eliv
erie
s fo
r H
IV p
ositi
ve w
omen
m
odifi
ed r
outin
e ca
re i
s gi
ven
The
gui
delin
es p
rovi
de a
reshy
min
der
on th
e ac
tiviti
es e
ssen
tial t
o ca
rry
out f
or s
afe
vagi
nal d
eliv
ery
for
all w
omen
no
t ju
st fo
r th
ose
infe
cted
with
HIV
It
is r
ecom
men
ded
that
the
re s
houl
d be
no
disshy
crim
inat
ion
or is
olat
ion
of H
IV p
ositi
ve w
omen
dur
ing
labo
ur a
nd d
eliv
ery
Del
iver
y th
roug
h el
ectiv
e ca
esar
ean
sect
ion
redu
ces
the
risk
of
HIV
MTC
T as
com
pare
d to
vagi
nal d
eliv
ery
amon
g H
IV p
ositi
ve w
omen
Whe
re C
S is
per
form
ed a
s an
em
erge
ncy
or e
lect
ivel
y a
ntib
iotic
s sh
ould
be
give
n
Ant
iret
rovi
ral (
AR
V) t
hera
py is
dis
cuss
ed in
det
ail i
n C
hapt
er 4
Thi
s in
clud
es t
hershy
apy
for
the
mot
her
befo
re la
bour
dur
ing
labo
ur a
nd a
fter
del
iver
y a
nd fo
r th
e in
fant
afte
r de
liver
y C
urre
ntly
N
evir
apin
e is
the
rec
omm
ende
d re
gim
en H
owev
er
shor
tco
urse
effi
caci
ous
AR
V d
rug
regi
men
s ca
n be
im
plem
ente
d in
res
ourc
e lim
ited
setshy
tings
AR
Vs
are
used
bot
h fo
r tr
eatm
ent
and
for
PMTC
T in
HIV
inf
ecte
d pr
egna
ntw
omen
and
thei
r ne
onat
es
Gui
delin
es f
or t
he p
ostp
artu
m c
are
of t
he m
othe
r an
d ca
re f
or H
IV e
xpos
ed in
fant
s ar
e de
taile
d in
Cha
pter
5 I
n C
hapt
er 6
the
Gui
de p
rovi
des
deta
iled
info
rmat
ion
on
late
pos
tnat
al c
are
and
fam
ily p
lann
ing
HIV
pos
itive
wom
en c
an u
se a
ll ty
pes
of fa
mshy
ily p
lann
ing
base
d on
sta
ndar
d el
igib
ility
cri
teri
a as
exp
licitl
y ou
tline
d in
the
text
Gui
delin
es fo
r in
fant
dia
gnos
is c
are
and
trea
tmen
t ar
e di
scus
sed
in C
hapt
er 7
Cur
shyre
ntly
the
re is
no
test
to
diffe
rent
iate
bet
wee
n an
tibod
ies
from
the
mot
her
and
thos
e pr
oduc
ed b
y th
e ba
by T
o id
entif
y H
IV in
fect
ed in
fant
s le
ss t
han
18 m
onth
s D
NA
or
RN
A ndash
PC
R te
st is
cur
rent
ly r
ecom
men
ded
HIV
exp
osed
infa
nts
at 6
wee
ks a
nd s
ick
infa
nts
at 1
2 m
onth
s sh
ould
hav
e ac
cess
to
DB
S fo
r D
NA
PC
R H
IV e
xpos
ed in
fant
ssh
ould
be
star
ted
on c
otri
mox
azol
e fr
om 6
wee
ks A
ll m
othe
rs w
ith 6
wee
k ol
d in
fant
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
E
Upt
ake
of c
ouns
ellin
g an
d te
stin
g in
Mat
erni
ty c
linic
Rat
io o
f m
ater
nity
clie
nts
with
unk
now
n H
IV s
tatu
s w
ho a
re c
ouns
elle
d an
d te
sted
for H
IV in
mat
erni
ty
Num
erat
or
Num
ber o
f pre
gnan
t wom
en a
dmitt
ed in
to m
ater
nity
with
un
know
n H
IV s
tatu
s th
at a
re c
ouns
elle
d an
d te
sted
for H
IV
durin
g la
bour
or a
fter d
eliv
ery
Den
omin
ator
N
umbe
r of p
regn
ant w
omen
adm
itted
into
mat
erni
ty
with
unk
now
n H
IV s
tatu
s
F
Mat
erni
ty m
othe
r AR
V pr
ophy
laxi
s up
take
R
atio
of H
IV in
fect
ed m
othe
rs in
mat
erni
ty c
linic
rece
ivin
g pr
even
tive
A
RV
pro
phyl
axis
Num
erat
or
Num
ber o
f HIV
-infe
cted
mot
hers
adm
itted
in m
ater
nity
takshy
ing
or re
porte
d to
hav
e ta
ken
the
mot
her d
ose(
s) o
f pre
venshy
tive
AR
V p
roph
ylax
is
Den
omin
ator
N
umbe
r of p
regn
ant w
omen
adm
itted
into
mat
erni
ty w
ho
are
HIV
-infe
cted
G
Infa
nt A
RV
prop
hyla
xis
upta
ke
Rat
io o
f inf
ants
bor
n to
HIV
-infe
cted
mot
hers
in m
ater
nity
clin
ic
rece
ivin
g pr
even
tive
AR
V p
roph
ylax
is
Num
erat
or
Num
ber o
f inf
ants
bor
n to
HIV
-infe
cted
mot
hers
who
rece
ive
prev
entiv
e
Den
omin
ator
N
umbe
r of i
nfan
ts b
orn
to H
IV-in
fect
ed m
othe
rs
Num
ber o
f pre
gnan
t wom
en a
dmitt
ed in
to m
ater
nity
who
are
H
IV-in
fect
ed is
use
d to
app
roxi
mat
e th
is n
umbe
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
7
90
With
the
mea
sure
men
ts li
sted
abo
ve t
he fo
llow
ing
perf
orm
ance
indi
cato
rs
for m
onito
ring
PMTC
T ac
tiviti
es a
re c
alcu
late
d
A
Upt
ake
of c
ouns
ellin
g an
d te
stin
g in
Ant
enat
al c
linic
R
atio
of a
nten
atal
clie
nts
who
wer
e co
unse
lled
and
test
ed fo
r HIV
Num
erat
or
This
is n
umbe
r of p
regn
ant w
omen
atte
ndin
g th
eir f
irst
ante
nata
l clin
ic v
isit
who
are
test
ed fo
r HIV
Den
omin
ator
N
umbe
r of n
ew v
isits
to th
e an
tena
tal c
linic
B
Ant
enat
al H
IV s
erop
reva
lenc
e
Rat
io o
f Ant
enat
al p
regn
ant w
omen
test
ed fo
r HIV
that
are
HIV
infe
cted
Num
erat
or
Num
ber o
f clie
nts
who
test
HIV
pos
itive
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
test
ed fo
r HIV
in a
nten
ashyta
l clin
ic
C
Ant
enat
al m
othe
r AR
V pr
ophy
laxi
s up
take
R
atio
of k
now
n H
IV in
fect
ed p
regn
ant w
omen
in a
nten
atal
clin
ic
rece
ivin
g A
RV
pre
vent
ive
prop
hyla
xis
Num
erat
or
Tota
l num
ber o
f HIV
-infe
cted
pre
gnan
t wom
en in
ant
enat
al
clin
ic re
ceiv
ing
mot
her p
reve
ntiv
e A
RV
pro
phyl
axis
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
who
are
HIV
-infe
cted
in
the
ante
nata
l clin
ic
D
Ant
enat
al in
fant
AR
V pr
ophy
laxi
s up
take
R
atio
of k
now
n H
IV-in
fect
ed p
regn
ant w
omen
in a
nten
atal
clin
ic w
ho
rece
ive
infa
nt d
ose(
s) o
f pre
vent
ive
AR
V p
roph
ylax
is
Num
erat
or
Tota
l num
ber o
f HIV
infe
cted
pre
gnan
t wom
en in
an
tena
tal c
linic
rece
ivin
g in
fant
dos
e(s)
pre
vent
ive
A
RV
pro
phyl
axis
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
who
are
HIV
-infe
cted
in
the
ante
nata
l clin
ic
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
shou
ld h
ave
rout
ine
HIV
ant
ibod
y te
st
Gui
delin
es f
or f
eedi
ng in
fant
s an
d yo
ung
child
ren
born
to
HIV
infe
cted
mot
hers
are
di
scus
sed
in C
hapt
er 8
The
Min
istr
y of
Hea
lth r
ecom
men
ds p
rom
otio
n of
exc
lusi
vebr
east
feed
ing
for
the
first
6 m
onth
s of
life
Whe
re r
epla
cem
ent f
eedi
ng is
acc
epta
ble
feas
ible
af
ford
able
su
stai
nabl
e an
d sa
fe (
AFA
SS)
avoi
danc
e of
bre
astf
eedi
ng b
yH
IV-in
fect
ed w
omen
is
reco
mm
ende
d (W
HO
200
6) D
iscu
ssio
n on
diff
eren
t ty
pes
offe
edin
g al
tern
ativ
es t
o br
east
feed
ing
is c
aptu
red
in t
he t
ext
Thes
e op
tions
exi
st f
orth
e m
othe
r to
cho
ose
with
the
aid
of
coun
selli
ng I
deal
ly c
oupl
e de
cisi
on-m
akin
g is
enco
urag
ed f
or t
he H
IV p
ositi
ve m
othe
r F
or t
he H
IV n
egat
ive
mot
her
exc
lusi
ve
brea
stfe
edin
g is
rec
omm
ende
d fo
r 6
mon
ths
or le
ss fo
llow
ed b
y w
eani
ng
Car
e an
d fo
llow
-up
of c
hild
ren
of H
IV-in
fect
ed m
othe
rs is
dis
cuss
ed in
det
ail i
n C
hapshy
ter
9 A
ll ch
ildre
n bo
rn t
o H
IV i
nfec
ted
mot
hers
sho
uld
be f
ollo
wed
up
clos
ely
from
birt
h th
roug
h 2
year
s T
able
92
pro
vide
s th
e W
HO
rec
omm
ende
d fo
llow
up
deta
ils
Sim
ilarl
y t
he m
othe
rs s
houl
d be
sup
port
ed t
o pr
ovid
e op
timal
infa
nt fe
edin
g an
d to
av
oid
mix
ed fe
edin
g w
ithin
6 m
onth
s
In C
hapt
er 1
0 t
he G
uide
lines
exp
lain
the
ben
efits
of
mon
itori
ng a
nd e
valu
atio
n of
PMTC
T pr
ogra
ms
Mamp
E p
rovi
des
an o
ppor
tuni
ty t
o m
easu
re a
nd a
ppra
ise
perf
orm
shyan
ce w
ithin
def
ined
tim
e fr
ame
to e
nsur
e ac
com
plis
hmen
t of s
et g
oals
and
obj
ectiv
es
PMTC
T se
rvic
es m
ust
be g
uide
d by
tim
ely
and
accu
rate
dat
a re
port
ed f
rom
the
heal
th f
acili
ties
thr
ough
the
dis
tric
t an
d pr
ovin
cial
lev
els
to
the
natio
nal
leve
l at
NA
SCO
P
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
9
18
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
(xiii
) H
IV in
fect
ed in
mat
erni
ty w
ard
Num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to
mat
erni
ty c
linic
who
are
HIV
infe
cted
In
clud
es b
oth
thos
e w
ho w
ere
adm
itted
al
read
y kn
owin
g th
ey a
re H
IV-i
nfec
ted
and
thos
e w
ho w
ere
test
ed a
nd r
ecei
ved
thei
r re
sults
in m
ater
nity
clin
ic T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(xiv
) P
reve
ntiv
e A
RV
pro
phyl
axis
in m
ater
nity
war
d (m
othe
r do
se)
Num
ber
of
preg
nant
wom
en a
dmitt
ed in
mat
erni
ty t
akin
g or
rep
orte
d to
hav
e ta
ken
the
mot
her
dose
(s)
of p
reve
ntiv
e A
RV
pro
phyl
axis
T
his
is o
btai
ned
from
the
m
ater
nity
reg
iste
r
(xv)
Inf
ant
prev
entiv
e A
RV
pro
phyl
axis
in m
ater
nity
clin
ic
war
d N
umbe
r of
inshy
fant
s bo
rn in
mat
erni
ty r
ecei
ving
the
infa
nt p
reve
ntiv
e A
RV
pro
phyl
axis
in t
he
mat
erni
ty c
linic
T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(xvi
) D
eliv
erie
s T
otal
num
ber
of p
regn
ant
wom
en d
eliv
erin
g at
the
hea
lth fa
cilit
y
(xvi
i) C
ouns
ellin
g on
infa
nt f
eedi
ng o
ptio
ns
Num
ber
of m
othe
rs d
eliv
erin
g at
the
he
alth
fac
ility
cou
nsel
led
on in
fant
fee
ding
opt
ions
T
his
is o
btai
ned
from
the
m
ater
nity
reg
iste
r
(xvi
ii) I
nfan
t te
stin
g at
6 w
eeks
bull N
umbe
r of
infa
nts
test
ed f
or H
IV a
t 6
wee
ks o
ld
bull N
umbe
r of
infa
nts
test
ing
HIV
-pos
itive
T
his
is o
btai
ned
from
labo
rato
ry
regi
ster
(xix
) R
efer
red
for
care
and
tre
atm
ent
bull N
umbe
r of
HIV
infe
cted
wom
en a
ttend
ing
ante
nata
l clin
ic t
hat
is r
efer
red
for
HIV
car
e an
d tr
eatm
ent
bull N
umbe
r of
HIV
infe
cted
wom
en in
mat
erni
ty t
hat
is r
efer
red
for
HIV
car
e an
d tr
eatm
ent
bull N
umbe
r H
IV in
fect
ed in
fant
s re
ferr
ed f
or H
IV c
are
and
trea
tmen
t T
his
is
ob
tain
ed f
rom
ant
enat
al a
nd m
ater
nity
reg
iste
rs
(xx)
Ini
tiate
d on
Cot
rim
oxaz
ole
Num
ber
of H
IV in
fect
ed p
regn
ant
wom
en a
ttend
ing
ante
nata
l clin
ic th
at h
as
been
initi
ated
on
Cot
rimox
azol
e T
his
is o
btai
ned
from
the
ant
enat
al r
egis
ter
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
9
88
Th
e da
ta is
pre
sent
ed u
sing
def
ined
per
form
ance
indi
cato
rs th
at in
clud
e th
e fo
llow
ing
(i)
New
clie
nts
first
ant
enat
al c
linic
vis
its
Num
ber
of p
regn
ant
wom
en a
ttend
ing
thei
r fir
st a
nten
atal
vis
it fo
r th
e cu
rren
t pr
egna
ncy
at t
he h
ealth
fac
ility
T
his
is
obta
ined
fro
m t
he a
nten
atal
reg
iste
r
(ii)
Ret
urn
visi
tsr
evis
its
Num
ber
of r
etur
n an
tena
tal c
linic
vis
itsr
evis
its
atte
nded
by
the
preg
nant
wom
en a
t th
e fa
cilit
y T
his
is o
btai
ned
from
the
an
tena
tal r
egis
ter
(iii)
C
ouns
ellin
g an
d te
stin
g fo
r H
IV in
ant
enat
al c
linic
Tot
al n
umbe
r of
pre
gnan
t w
omen
cou
nsel
led
and
test
ed f
or H
IV a
t th
e an
tena
tal c
linic
w
heth
er t
his
is d
one
on th
e fir
st a
nten
atal
vis
it or
a la
ter
visi
t T
his
is o
btai
ned
from
the
an
tena
tal r
egis
ter
(iv)
H
IV c
ouns
ellin
g an
d te
stin
g at
fir
st a
nten
atal
clin
ic v
isit
Num
ber
of p
regn
ant
wom
en a
tten
ding
the
ir fir
st a
nten
atal
clin
ic v
isit
for
curr
ent
preg
nanc
y w
ho a
re
test
ed f
or H
IV
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(v)
Lear
ning
HIV
sta
tus
in a
nten
atal
clin
ic
Num
ber
of a
nten
atal
clin
ic p
regn
ant
wom
en t
este
d fo
r H
IV w
ho r
ecei
ve t
heir
HIV
res
ults
w
heth
er t
his
is d
one
on t
he
first
ant
enat
al c
linic
vis
it or
at
a la
ter
visi
t T
his
is o
btai
ned
from
the
ant
enat
al
regi
ster
(vi)
HIV
infe
cted
in a
nten
atal
clin
ic
Num
ber
of a
nten
atal
clin
ic p
regn
ant
wom
en
who
are
HIV
-inf
ecte
d on
the
late
st t
est
durin
g th
e pr
egna
ncy
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(vii)
Pre
vent
ive
AR
V p
roph
ylax
is in
ant
enat
al c
linic
(m
othe
r do
se)
Num
ber
of
preg
nant
wom
en in
the
ant
enat
al c
linic
rec
eivi
ng t
he m
othe
r do
se(s
) of
pre
venshy
tive
AR
V p
roph
ylax
is
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(viii
) P
reve
ntiv
e A
RV
pro
phyl
axis
in a
nten
atal
clin
ic (
infa
nt d
ose)
N
umbe
r of
pr
egna
nt w
omen
in t
he A
nten
atal
clin
ic is
sued
with
the
infa
nt d
ose(
s) o
f pr
even
shytiv
e A
RV
pro
phyl
axis
T
his
is o
btai
ned
from
the
ant
enat
al r
egis
ter
(ix)
New
clie
nts
in m
ater
nity
clin
ic
Num
ber
of p
regn
ant
wom
en a
tten
ding
the
Mashy
tern
ity c
linic
for
the
firs
t tim
e T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(x)
Unk
now
n H
IV s
tatu
s at
mat
erni
ty
Num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to
the
mat
erni
ty w
ith u
nkno
wn
HIV
sta
tus
Thi
s is
obt
aine
d fr
om t
he m
ater
nity
reg
isshy
ter
(xi)
Cou
nsel
ling
and
test
ing
for
HIV
in m
ater
nity
war
dT
otal
num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to m
ater
nity
with
unk
now
n st
atus
tha
t ar
e co
unse
lled
and
test
ed fo
r H
IV d
urin
g la
bour
or
afte
r de
liver
y T
his
is o
btai
ned
from
the
mat
erni
ty
regi
ster
(xii)
Lea
rnin
g H
IV s
tatu
s in
mat
erni
ty w
ard
Num
ber
of p
regn
ant
wom
en a
dmitt
ed
into
mat
erni
ty a
nd t
este
d fo
r H
IV w
ho r
ecei
ved
thei
r H
IV r
esul
ts
Thi
s is
obt
aine
d fr
om t
he m
ater
nity
reg
iste
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Cha
pter
1
Bac
kgro
und
11
THE
GLO
BA
L P A
ND
EMIC
Ove
r 38
mill
ion
peop
le a
re li
ving
with
HIV
AID
S w
orld
wid
e a
nd a
bout
two-
thir
ds o
r 25
m
illio
n of
PLW
HA
liv
e in
sub
-Sah
aran
Afr
ica1
H
IVA
IDS
mai
nly
affe
cts
peop
le o
fre
prod
uctiv
e ag
e an
d in
crea
sing
ly a
ffect
s w
omen
w
ho n
ow a
ccou
nt f
or 5
7 o
f ne
win
fect
ions
in s
ub-S
ahar
an A
fric
a w
here
wom
en a
re 3
0 m
ore
likel
y to
be
livin
g w
ith
HIV
AID
S th
an m
en a
nd y
oung
wom
en a
ged
15-2
4 ar
e ne
arly
four
tim
es m
ore
likel
y to
be
inf
ecte
d th
an t
heir
mal
e co
unte
rpar
ts2
Youn
g m
arri
ed w
omen
w
ho a
re o
ften
m
onog
amou
s h
ave
beco
me
one
of t
he g
roup
s m
ost
vuln
erab
le t
o H
IV i
n th
e re
gion
Th
is r
equi
res
new
and
rap
id r
espo
nses
that
bro
aden
the
focu
s be
yond
trad
ition
al ldquoh
igh
risk
rdquo gro
ups
like
com
mer
cial
sex
wor
kers
tru
ck d
rive
rs a
nd d
rug
user
s
To r
each
you
ng m
arri
ed w
omen
w
ho m
ay n
ot b
e aw
are
of t
heir
vul
nera
bilit
y H
IV
AID
S pr
even
tion
ca
re
and
supp
ort
activ
ities
m
ust
be
inte
grat
ed
into
al
read
yes
tabl
ishe
d he
alth
ser
vice
s th
at a
re u
sed
by t
he g
ener
al p
opul
atio
n A
n es
timat
ed
630
000
child
ren
wor
ld-w
ide
beca
me
infe
cted
with
HIV
in
2003
mdash m
ost
thro
ugh
MTC
T3
The
risk
of
an H
IV-in
fect
ed m
othe
r pa
ssin
g th
e vi
rus
to h
er i
nfan
t du
ring
pr
egna
ncy
labo
ur a
nd d
eliv
ery
or in
the
post
nata
l per
iod
is 1
in 3
if n
othi
ng is
don
e to
re
duce
this
ris
k I
n ot
her
wor
ds o
ut o
f 100
infa
nts
born
to w
omen
with
HIV
AID
S an
d w
ithou
t in
terv
entio
n 6
0-75
of t
hem
will
not
be
infe
cted
Of t
he o
ne-t
hird
who
bec
ome
infe
cted
abo
ut 5
-10
babi
es w
ill b
e in
fect
ed d
urin
g pr
egna
ncy
15
will
be
infe
cted
dur
ing
labo
ur a
nd d
eliv
ery
whi
le 5
-15
will
be
infe
cted
dur
ing
brea
stfe
edin
g l
arge
ly b
eing
de
pend
ent
on b
reas
tfee
ding
pra
ctic
es a
nd o
n th
e du
ratio
n of
bre
astfe
edin
g4 I
n 20
03
near
ly 5
000
00 c
hild
ren
died
of A
IDS-
rela
ted
caus
es M
ost
child
ren
born
with
HIV
die
befo
re th
ey r
each
thei
r fif
th b
irth
day
with
mos
t not
sur
vivi
ng b
eyon
d tw
o ye
ars5
The
high
rat
es o
f M
TCT
in d
evel
opin
g co
untr
ies
com
pare
d to
muc
h lo
wer
rat
es i
nri
cher
cou
ntri
es
illus
trat
e gr
owin
g in
equa
litie
s in
glo
bal
heal
th
In t
he w
ealth
y co
untr
ies
the
rat
e of
MTC
T is
les
s th
an 2
b
ecau
se o
f w
ides
prea
d ac
cess
to
antishy
retr
ovir
al th
erap
y (A
RT)
pla
nned
cae
sare
an s
ectio
ns (C
S) t
he m
eans
to s
afel
y fo
rmul
afe
ed a
nd a
cces
s to
qua
lity
med
ical
ser
vice
s I
n po
orer
cou
ntri
es li
ke K
enya
the
re is
a
30-4
0 c
hanc
e th
at a
n H
IV-p
ositi
ve b
reas
tfee
ding
mot
her
will
pas
s H
IV to
her
chi
ld in
th
e ab
senc
e of
the
se s
ervi
ces
In
such
set
tings
it
is c
ritic
al t
hat
prev
entio
n pr
oced
ures
be i
nteg
rate
d in
to e
xist
ing
sexu
al a
nd r
epro
duct
ive
heal
th (
SRH
) an
d m
ater
nal
and
child
hea
lth (
MC
H)
serv
ices
re
achi
ng a
s m
any
wom
en a
s po
ssib
le a
nd l
ower
ing
tran
smis
sion
rat
es A
lthou
gh p
harm
aceu
tical
com
pany
don
atio
ns d
onor
sup
port
and
othe
r go
vern
men
t in
itiat
ives
hav
e he
lped
exp
and
acce
ss t
o H
IV t
estin
g fo
r pr
egna
ntw
omen
and
use
of a
ntir
etro
vira
l dru
gs li
ke N
evir
apin
e w
hich
red
uce
the
chan
ce o
f HIV
tr
ansm
issi
on s
till o
nly
10
of p
regn
ant w
omen
glo
bally
hav
e ac
cess
to th
ese
drug
s6
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
7
20
HIV
AID
S tr
ansm
issi
on fr
om m
othe
r to
chi
ld in
Ken
ya is
one
of t
he b
igge
st h
ealth
and
de
velo
pmen
t cha
lleng
es in
Ken
ya A
ccor
ding
to th
e 20
03 D
emog
raph
ic a
nd H
ealth
Sur
shyve
y7 6
7
or
over
12
mill
ion
Ken
yan
adul
ts w
ere
livin
g w
ith H
IVA
IDS
in 2
003
The
re
has
been
a s
tead
y de
clin
e in
HIV
ser
opre
vale
nce
in K
enya
In
2005
the
pre
vale
nce
rate
w
as e
stim
ated
at 5
9
and
as
per
the
2006
sta
tistic
s th
e pr
eval
ence
rat
e am
ong
adul
tsha
d dr
oppe
d to
51
8
Acc
ordi
ng t
o 20
07 K
enya
AID
S In
dica
tor
Surv
ey (
KA
IS)8a
the
H
IV s
erop
reva
lenc
e in
Ken
ya is
cur
rent
ly 7
8
am
ong
adul
ts a
ged
15-4
9 ye
ars
bei
nghi
gher
in
wom
en (
87
) th
an i
n m
en (
56
) Y
oung
wom
en a
re m
ore
vuln
erab
le i
n K
enya
tha
n m
en a
s ev
iden
ced
by a
nea
rly
9 p
reva
lenc
e ra
te a
mon
g w
omen
and
unshy
der
5 a
mon
g m
en9
Ther
e ar
e w
ide
vari
atio
ns b
etw
een
urba
n an
d ru
ral
area
s b
etw
een
regi
ons
bet
wee
n ad
ults
and
you
ng p
eopl
e an
d be
twee
n m
en a
nd w
omen
The
re h
as b
een
a no
tabl
e dr
op
in t
he n
umbe
r of
new
inf
ectio
ns
with
an
estim
ated
60
000
new
inf
ectio
ns i
n 20
05
drop
ping
to 5
500
0 in
200
6 In
fant
s an
d yo
ung
child
ren
unde
r 15
yea
rs a
ccou
nt fo
r 16
of
all
new
HIV
infe
ctio
ns m
ainl
y as
a r
esul
t of M
TCT
Mos
t of t
he n
ew in
fect
ions
occ
ur
amon
g yo
ung
peop
le i
n w
hom
the
mai
n m
ode
of t
rans
mis
sion
is t
hrou
gh s
exua
l int
ershy
cour
se
Tabl
e 1
1 A
dult
HIV
-Pre
vale
nce
Estim
ate
by P
rovi
nce
in 2
006
Prov
ince
N
umbe
r of H
IV +
Pre
vale
nce
()
Nai
robi
Cen
tral
Coa
st
Eas
tern
N E
aste
rn
Nya
nza
Rift
Val
ley
Wes
tern
Tota
l
197
000
960
00
930
00
720
00
900
0 18
300
0
171
000
112
000
11
milli
on
Tota
l
101
41
59
28
14
78
38
53
51
Mal
e
80
17
50
11
09
61
26
42
35
Fem
ale
123
65
69
44
18
96
49
64
67
Mal
eFe
mal
e R
atio
15
38
14
40
20
16
19
15
19
all t
he d
ata
from
the
prov
ince
s (a
nd r
efer
ral h
ospi
tals
) Th
e ag
greg
ated
dat
a is
di
ssem
inat
ed t
o th
e H
ealth
Man
agem
ent
Info
rmat
ion
Syst
em N
atio
nal A
IDS
Con
trol
Cou
ncilrsquo
s (N
AC
C)
natio
nal
data
ban
k an
d re
sour
ce c
entr
e T
he f
ocal
pe
rson
s he
re a
re t
he d
irec
tor
NA
CC
and
the
Mamp
E m
anag
er D
ata
is d
isse
mishy
nate
d ba
ck to
the
prov
ince
s an
d re
ferr
al h
ospi
tals
for
use
in d
ecis
ion-
mak
ing
7
Dat
a flo
w f
rom
fac
ility
lev
el t
o na
tiona
l le
vel
At
the
heal
th f
acili
ty P
MTC
T in
divi
dual
le
vel d
ata
reco
rded
in t
he M
oH s
tand
ardi
sed
regi
ster
s (A
NC
Mashy
tern
ity a
nd P
ostn
atal
) is
sum
mar
ised
ag
greg
ated
on
a m
onth
ly b
asis
ont
o M
oH F
orm
726
F
orm
726
is
then
for
war
ded
upw
ards
to
the
dist
rict
Lev
el
(DA
SCO
rsquos O
ffice
) for
agg
rega
tion
of th
e D
istr
ict l
evel
dat
a on
to F
orm
727
Cop
shyie
s of
For
m 7
26 a
nd F
orm
727
are
forw
arde
d to
the
Nat
iona
l Offi
ce (N
ASC
OP)
w
ith a
noth
er c
opy
of F
orm
727
bei
ng s
ent t
o th
e Pr
ovin
cial
Offi
ce (P
ASC
O)
8
Dat
a di
ssem
inat
ion
Thi
s is
car
ried
out
at
all
leve
ls s
tart
ing
from
fac
ility
to
natio
nal l
evel
It i
s th
e re
spon
sibi
lity
of N
AC
C to
coo
rdin
ate
the
diss
emin
atio
n an
d us
e of
all
HIV
AID
S da
ta a
nd in
form
atio
n fo
r na
tiona
l res
pons
e J
APR
a
join
t pro
gram
me
of a
ll st
akeh
olde
rs in
HIV
AID
S re
ceiv
es a
nd u
ses
the
data
to
disc
uss
the
chal
leng
es a
chie
vem
ents
and
les
sons
lea
rnt
from
HIV
AID
S an
d gi
ves
feed
back
for n
atio
nal r
espo
nse
9
PMTC
T in
dica
tors
and
thei
r so
urce
s H
ealth
car
e fa
cilit
ies
colle
ct th
e fo
llow
ing
data
as
a m
inim
um t
o be
use
d in
the
mon
itori
ng o
f PM
TCT
prog
ram
s T
he
data
is
to b
e ag
greg
ated
on
a m
onth
ly b
asis
ont
o th
e M
inis
try
of H
ealth
In
tegr
ated
Mon
itori
ng a
nd E
valu
atio
n R
epor
t For
m M
oH 7
26 u
sing
dat
a fr
om
the
Min
istr
y of
Hea
lth
Ken
ya A
nten
atal
and
Mat
erni
ty R
egis
ters
(D
eliv
ery
Reg
iste
r) M
oH 4
05 a
nd M
oH 3
33 r
espe
ctiv
ely
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
1
86
102
O
PER
ATI
ON
AL
GU
IDEL
INES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed in
the
mon
itorin
g an
d ev
alua
-tio
n of
PM
TCT
serv
ices
1
W
ithin
PM
TCT
prog
ram
s d
ata
is c
olle
cted
and
rep
orte
d at
the
fol
low
ing
leve
ls I
ndiv
idua
l fa
cilit
y d
istr
ict
prov
inci
al a
nd n
atio
nal
2
Indi
vidu
al l
evel
The
com
bine
d m
othe
r an
d ch
ild h
ealth
boo
klet
pro
vide
s de
shyta
iled
info
rmat
ion
on t
he w
oman
and
chi
ld i
nclu
ding
the
HIV
sta
tus
oth
er
HIV
car
e se
rvic
es d
rugs
del
iver
y in
form
atio
n im
mun
isat
ion
gro
wth
mon
itorshy
ing
and
othe
r par
amet
ers
3
Faci
lity
leve
l da
ta c
aptu
re t
ools
The
MoH
has
sta
ndar
dise
d re
gist
ers
for
reshy
cord
ing
data
at
faci
litie
s T
hese
inc
lude
the
Rev
ised
AN
C R
egis
ter
Rev
ised
M
ater
nity
Reg
iste
r an
d Po
st N
atal
Reg
iste
r an
d W
orkl
oad
MO
H 7
17 O
ther
re
gist
ers
incl
ude
Chi
ld H
ealth
and
Nut
ritio
n In
form
atio
n Sy
stem
and
Inshy
patie
nt M
orbi
dity
and
Mor
talit
y F
orm
711
and
the
Rep
rodu
ctiv
e H
ealth
Ser
shyvi
ces
mon
thly
rep
orts
are
use
d fo
r m
akin
g fa
cilit
y le
vel s
umm
arie
s on
PM
TCT
and
repr
oduc
tive
heal
th s
ervi
ces
3 F
acili
ty le
vel d
ata
capt
ure
tool
s T
he M
oH
has
stan
dard
ized
reg
iste
rs f
or r
ecor
ding
dat
a at
fac
ilitie
s T
hese
inc
lude
the
R
evis
ed A
NC
Reg
iste
r R
evis
ed M
ater
nity
Reg
iste
r an
d Po
st N
atal
Reg
iste
r an
d w
orkl
oad
MO
H 7
17 O
ther
reg
iste
rs in
clud
e C
hild
Hea
lth a
nd N
utri
tion
Info
rmat
ion
Syst
em a
nd I
n-pa
tient
mor
bidi
ty a
nd m
orta
lity
Fo
rm 7
26 a
nd
the
Rep
rodu
ctiv
e he
alth
ser
vice
s m
onth
ly r
epor
ts a
re u
sed
for
mak
ing
faci
lity
leve
l sum
mar
ies
on P
MTC
T an
d re
prod
uctiv
e he
alth
ser
vice
s
4
Dis
tric
t le
vel
data
For
m 7
27 i
s us
ed t
o su
mm
aris
e an
d re
port
dis
tric
t le
vel
data
Oth
er s
umm
ary
repo
rtin
g to
ols
are
also
use
d to
rep
ort
dist
rict
leve
l inshy
form
atio
n A
t th
e di
stri
ct le
vel
the
DAS
CO
rsquos of
fice
aggr
egat
es d
ata
from
sev
shyer
al h
ealth
faci
lity
spec
ific
Form
726
ont
o Fo
rm 7
27 th
at is
use
d to
sum
mar
ise
and
repo
rt d
istr
ict l
evel
dat
a
5
Prov
inci
al l
evel
dat
a A
t th
e pr
ovin
cial
lev
el t
he P
ASC
O r
ecei
ves
Form
727
da
ta f
rom
the
res
pect
ive
DA
SCO
rsquos of
fices
in
the
prov
ince
for
the
ir o
wn
data
us
e an
d re
cord
s A
cop
y of
the
sam
e is
sen
t to
the
Nat
iona
l Offi
ce (N
ASC
OP)
by
the
DA
SCO
rsquos of
fice
At
the
prov
inci
al le
vel
the
dist
rict
leve
l dat
a is
agg
reshy
gate
d to
giv
e th
e pr
ovin
cial
leve
l dat
a
6 N
atio
nal
leve
l da
ta
At
the
natio
nal
leve
l th
e M
ampE
Man
ager
rec
eive
s da
ta
from
the
PASC
Os
for
each
of t
he p
rovi
nces
Dat
a is
als
o re
ceiv
ed fr
om th
e R
eshyfe
rral
hos
pita
ls a
nd o
ther
fac
ilitie
s at
the
ref
erra
l ho
spita
l or
ter
tiary
lev
el
The
data
rec
eive
d at
the
nat
iona
l lev
el is
als
o co
pied
to
the
Hea
d of
NA
SCO
P an
d PM
TCT
prog
ram
me
man
ager
The
Mamp
E m
anag
er a
t NA
SCO
P ag
greg
ates
85
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
12
MA
GN
ITU
DE
OF
HIV
IN P
REG
NA
NC
YIN
KEN
YA
Ken
ya N
atio
nal
AID
SST
I C
ontr
ol P
rogr
amm
e (N
ASC
OP)
est
imat
es t
hat
ther
e w
ere
12
mill
ion
babi
es b
orn
in 2
006
in K
enya
and
that
as
man
y as
9
of p
regn
ant w
omen
inK
enya
wer
e liv
ing
with
HIV
AID
S10
At
leas
t 50
000
to
600
00 i
nfan
ts i
n K
enya
wer
e th
ough
t to
hav
e be
en i
nfec
ted
with
H
IV a
s a
resu
lt of
MTC
T th
at y
ear
With
an
estim
ated
pop
ulat
ion
of 3
72
mill
ion
in th
eye
ar 2
007
the
num
ber
of b
irth
s in
200
7 w
as 1
73
mill
ion
With
an
HIV
pre
vale
nce
of 6
7
the
num
ber
of H
IV -
expo
sed
babi
es is
114
101
and
at
leas
t 45
640
HIV
-pos
itive
bab
ies
are
born
ass
umin
g a
40
tran
smis
sion
(Tab
le 1
2)
Tabl
e 1
2 E
stim
ated
mag
nitu
de o
f MTC
T in
Ken
ya 2
007
Popu
latio
n (E
stim
ates
200
7)
372
mill
ion
Birt
hs p
er a
nnum
1
73 m
illio
n
HIV
pre
vale
nce
in m
othe
rs
67
Tota
l num
ber o
f birt
hs to
HIV
-infe
cted
mot
hers
exp
osed
14
110
1 to
MTC
T as
sum
ing
no m
ultip
le p
regn
ancy
Num
ber o
f HIV
pos
itive
infa
nts
per a
nnum
in K
enya
45
640
as
sum
ing
40
tran
smis
sion
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
22
13
RIS
KS
OF
T RA
NSM
ISSI
ON
OF
MTC
T A
T D
IFFE
REN
T
T
IME
P ER
IOD
S
In K
enya
an
estim
ated
40
000
to 5
000
0 in
fant
s ar
e in
fect
ed w
ith H
IV a
nnua
lly d
ue to
m
othe
r-to
-chi
ld t
rans
mis
sion
Th
is c
an o
ccur
in u
tero
dur
ing
labo
ur a
nd d
eliv
ery
and
thro
ugh
brea
stfe
edin
g D
urin
g pr
egna
ncy
abo
ut 5
to
8 pe
rcen
t of
HIV
-exp
osed
bab
ies
beco
me
infe
cted
thr
ough
tra
nsm
issi
on a
cros
s th
e pl
acen
ta L
abou
r an
d de
liver
y po
ses
the
grea
test
ris
k fo
r tr
ansm
issi
on w
ith 1
0 to
20
perc
ent
of e
xpos
ed i
nfan
ts b
ecom
ing
infe
cted
at t
his
time
Bre
astf
eedi
ng a
lso
expo
ses
infa
nts
to H
IV
Whe
n m
othe
rs b
reas
tfee
d fo
r 18
to
24m
onth
s an
othe
r 10
to 1
5 pe
rcen
t of i
nfan
ts b
ecom
e in
fect
ed T
hus
in n
on-b
reas
tfee
ding
po
pula
tions
with
out
antir
etro
vira
l tre
atm
ent
appr
oxim
atel
y 15
to
30 p
erce
nt in
fant
s w
ill b
ecom
e in
fect
ed
with
pro
long
ed b
reas
tfee
ding
25
to
45 p
erce
nt i
nfan
ts w
ill
beco
me
infe
cted
Tabl
e 1
3 T
rans
mis
sion
pat
tern
s in
bre
astfe
edin
g an
d no
n br
east
feed
ing
popu
latio
ns
Tran
smis
sion
rate
in
Tim
ing
No
Bre
astfe
edin
g B
reas
tfeed
ing
Bre
astfe
edin
g th
roug
h
thro
ugh
6
mon
ths
18 to
24
mon
ths
Dur
ing
preg
nanc
y 05
to 1
0 05
to 1
0 05
to 1
0
Dur
ing
labo
ur
10 to
20
10 to
20
10 to
20
Thro
ugh
brea
stfe
edin
g 10
to 2
0 05
to 1
0 05
to 1
0
Ear
ly (f
irst 2
mon
ths)
10
to 2
0 05
to 1
0 05
to 1
0
Late
(afte
r 2 m
onth
s)
10 to
20
01 to
05
05 to
10
Ove
rall
15 to
30
25 to
35
30 to
45
Sou
rce
De
Coc
k K
M (2
002)
Form
MoH
711
has
bee
n re
com
men
ded
to r
epla
ce F
orm
MoH
726
HIV
Mamp
E d
ata
flow
pip
elin
e fr
om t
he i
ndiv
idua
l he
alth
fac
ilitie
s t
o th
e di
stri
ct a
ndpr
ovin
cial
leve
ls u
p to
the
cent
ral o
r na
tiona
l lev
els
at N
ASC
OP
and
NA
CC
is s
umm
ashyri
sed
in F
igur
e 1
01
Figu
re 1
01
HIV
Mon
itorin
g an
d Ev
alua
tion
data
flow
pip
elin
e in
Ken
ya
HM
IS
NA
SC
OP
N
ACC
H
ead
Nat
iona
l Dat
a B
ank
amp
Res
ourc
e C
entre
M
E M
anag
er
The
Dire
ctor
P
rogr
amm
e M
anag
er
ME
Man
ager
Ref
erra
l Hos
pita
ls
CE
Os
Spe
cial
ists
The
Prov
ince
P
MO
P
AS
CO
P
AR
TO
PH
RIO
P
CO
The
Dis
trict
D
MO
D
AS
CO
Dat
a en
try
cler
k D
AR
TO
DH
RIO
Hea
lth F
acilit
y P
ublic
Sec
tor
FBO
etc
23
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
84
Cha
pter
10
Mon
itorin
g an
d Ev
alua
tion
of P
MTC
T Se
rvic
es
101
IN
TRO
DU
CTI
ON
PMTC
T pr
ogra
m m
onito
ring
and
eva
luat
ion
activ
ities
pro
vide
the
oppo
rtun
ity to
mea
sshyur
e an
d ap
prai
se p
erfo
rman
ce w
ithin
def
ined
par
amet
ers
that
ens
ure
acco
mpl
ishm
ent
of g
oals
and
obj
ectiv
es
Ken
ya is
com
mitt
ed to
the
ldquoThr
ee-o
nesrdquo
pri
ncip
les
whi
ch a
re
bull O
ne a
gree
d A
IDS
Act
ion
Fra
mew
ork
that
pro
vide
s th
e ba
sis
for
coor
dina
ting
the
wor
k pl
an o
f al
l par
tner
s
bull O
ne N
atio
nal A
IDS
Coo
rdin
atin
g A
utho
rity
with
a b
road
-bas
ed
mul
tisec
tora
l man
date
bull O
ne a
gree
d co
untr
y-le
vel M
onito
ring
and
Eva
luat
ion
(M
ampE
) sy
stem
In l
ine
with
thi
s t
he c
ount
ry h
as d
evel
oped
the
Nat
iona
l H
IVA
IDS
Mon
itori
ng a
ndE
valu
atio
n Fr
amew
ork
that
pro
vide
s st
akeh
olde
rs w
ith a
too
l fo
r w
ell
coor
dina
ted
in
terl
inke
d an
d fu
nctio
nal H
IVA
IDS
Mamp
E s
yste
m t
hat
allo
ws
for
effic
ient
mon
itori
ngof
int
erve
ntio
ns i
n ac
hiev
ing
the
natio
nal
prog
ram
mat
ic g
oals
usi
ng d
efin
ed t
arge
ts
This
pro
vide
s th
e fr
amew
ork
for M
ampE
act
iviti
es w
ithin
PM
TCT
prog
ram
s
Nat
iona
l PM
TCT
data
is
repo
rted
usi
ng M
oH I
nteg
rate
d M
onito
ring
and
Eva
luat
ion
Rep
ortin
g Fo
rms
For
m M
oH 7
11 o
r Fo
rm M
oH 7
27
Indi
vidu
al P
MTC
T da
ta is
col
shyle
cted
at
the
heal
th f
acili
ties
offe
ring
PM
TCT
serv
ices
usi
ng s
tand
ard
MoH
reg
iste
rs(A
NC
Mat
erni
ty a
nd P
ostn
atal
Reg
iste
rs)
On
mon
thly
bas
is t
he h
ealth
faci
litie
s w
ill a
ggre
gate
the
dat
a fr
om t
he r
egis
ters
on
to
Form
MoH
711
or
MO
H 7
26 w
hich
is th
en fo
rwar
ded
upw
ards
to th
e D
ASC
Orsquos
offic
e A
copy
is
left
at
the
heal
th f
acili
ty f
or t
heir
ow
n da
ta u
se
At
the
dist
rict
lev
el
the
DA
SCO
rsquos of
fice
aggr
egat
es d
ata
from
sev
eral
hea
lth f
acili
ty s
peci
fic F
orm
726
ont
o Fo
rm M
oH 7
27 (o
r Fo
rm 7
11) t
hat
is u
sed
to s
umm
aris
e an
d re
port
dis
tric
t le
vel d
ata
B
oth
Form
726
and
For
m M
oH 7
27 a
re th
en s
ent t
o N
ASC
OP
A c
opy
of th
e Fo
rm 7
27
or F
orm
711
is s
ent t
o th
e PA
SCO
and
ano
ther
to th
e he
alth
faci
litie
s in
the
dist
rict
for
thei
r ow
n da
ta u
se
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
14
RIS
K F
AC
TOR
SFO
R M
TCT
OF
HIV
M
any
fact
ors
are
know
n or
sus
pect
ed t
o in
crea
se t
he r
isk
of a
n H
IV in
fect
ed m
othe
r tr
ansm
ittin
g th
e vi
rus
to h
er i
nfan
t Th
ese
fact
ors
incl
ude
the
HIV
vir
al l
oad
in t
he
mot
her
as
wel
l as
othe
r m
ater
nal
obst
etri
cal
vira
l and
infa
nt fa
ctor
s (T
able
14
)
The
mos
t sig
nific
ant r
isk
fact
or a
ppea
rs to
be
the
HIV
vir
al lo
ad in
the
mot
her
thou
gh
the
othe
r fa
ctor
s m
ay a
lso
cont
ribu
te t
o in
crea
sing
an
infa
ntrsquos
expo
sure
or
susc
eptib
ilshyity
to
acqu
irin
g H
IV S
ome
fact
ors
may
cau
se a
bre
akdo
wn
in t
he p
rote
ctio
n of
fere
d to
the
foet
us b
y th
e pl
acen
ta w
hich
in n
orm
al c
ircu
mst
ance
s w
ould
not
allo
w H
IV to
cro
ssth
e pl
acen
ta fr
om m
othe
r to
foet
us
Tran
smis
sion
dur
ing
labo
ur a
nd d
eliv
ery
occu
rs w
hen
the
infa
nt s
ucks
im
bibe
s or
asshy
pira
tes
mat
erna
l bl
ood
or c
ervi
cal
secr
etio
ns t
hat
cont
ain
HIV
or
whe
n it
has
othe
r m
ucou
s m
embr
ane
expo
sure
Tab
le 1
4
Ris
k fa
ctor
s fo
r M
TCT
of H
IV
Stro
ng e
vide
nce
Lim
ited
evid
ence
VIR
AL
MA
TER
NA
L
OB
STE
TRIC
AL
FETA
LIN
FAN
T
BR
EA
ST-
FEE
DIN
G
Hig
h vi
ral l
oad
Imm
une
defic
ienc
y (lo
w
CD
4 co
unt)
HIV
infe
ctio
n ac
quire
d du
ring
preg
nanc
y o
r br
east
feed
ing
perio
d
Vagi
nal d
eliv
ery
(com
pare
d to
ele
ctiv
e ca
esar
ean
sect
ion)
ru
ptur
e of
the
mem
bran
es
for m
ore
than
4 h
ours
Prem
atur
ity
Dur
atio
n of
bre
astfe
edin
g
mix
ed fe
edin
g b
reas
t di
seas
e (m
astit
isc
rack
ed
nipp
les)
Vira
l res
ista
nce
(theo
retic
al p
ossi
bilit
y)
Vira
l gen
otyp
e an
d ph
enot
ype
Vita
min
A d
efic
ienc
y a
naem
ia s
exua
lly
trans
mitt
ed d
isea
ses
ch
orio
amni
oniti
s fr
eque
nt u
npro
tect
ed
sexu
al in
terc
ours
e m
ultip
le s
exua
l pa
rtner
s s
mok
ing
inje
ctin
g dr
ug a
buse
Inva
sive
or t
raum
atic
pro
cedu
res
in
stru
men
tal d
eliv
erie
s a
mni
ocen
tesi
s
epis
ioto
my
ext
erna
l cep
halic
ver
sion
(E
CV
) et
c i
ntra
partu
m h
aem
orrh
age
Lesi
ons
of s
kin
and
or m
ucou
s m
embr
anes
Ora
l thr
ush
(bab
y)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
3
24
15
BEN
EFIT
SO
F P R
EVEN
TIN
G M
OTH
ER-T
O-C
HIL
D
T
RA
NSM
ISSI
ON
OF
HIV
A
IDS
rela
ted
deat
hs a
re r
ever
sing
gai
ns m
ade
in c
hild
hea
lth a
nd s
urvi
val i
n K
enya
C
arin
g fo
r H
IV-in
fect
ed c
hild
ren
has
maj
or e
cono
mic
and
soc
ial
impa
cts
on f
amili
es
and
heal
th s
yste
ms
Thu
s at
the
nat
iona
l lev
el p
reve
ntin
g M
TCT
has
the
pote
ntia
l to
incr
ease
the
unde
rsta
ndin
g an
d ac
cept
ance
of t
he H
IVA
IDS
epid
emic
and
thos
e liv
ing
with
HIV
AID
S C
ouns
ellin
g t
estin
g an
d co
mm
unity
sen
sitis
atio
n ca
n co
ntri
bute
to
redu
cing
stig
ma
Red
uctio
n of
MTC
T of
HIV
bull
Dec
reas
es n
umbe
rs o
f H
IV in
fect
ed c
hild
ren
bull
Incr
ease
s ch
ild h
ealth
and
sur
viva
l
bull
Dec
reas
es t
he lo
ad o
n th
e he
alth
sys
tem
bull
Giv
es a
n op
port
unity
to im
prov
e an
d ex
pand
hea
lth s
ervi
ces
as w
ell a
s to
str
engt
hen
the
exis
ting
heal
th in
fras
truc
ture
16
BEN
EFIT
SO
F H
IV C
OU
NSE
LLIN
GA
ND T
ESTI
NG
(CT)
(a) I
t pro
mot
es b
ehav
iour
cha
nge
by
bull R
educ
ing
high
ris
k be
havi
our
for
HIV
bull Id
entif
ying
HIV
dis
cord
ant
coup
les
bull In
crea
sing
the
use
of
dual
met
hods
of f
amily
pla
nnin
g an
d S
TI
prev
entio
n
bull Im
prov
ing
ante
nata
l car
e
bull G
uidi
ng in
fant
fee
ding
(b) I
t ena
bles
pre
vent
ive
ther
apy
for
bull
Mal
aria
bull O
ppor
tuni
stic
infe
ctio
ns (
eg
Pne
umoc
ystis
jiro
veci
i pn
eum
onia
)
bull T
B
25
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
82
Foo
tnot
es
9
Use
oth
er o
ptions
for
child
ren o
ver
9 k
ilogra
ms
10
Use
reg
ula
r or
double
-str
ength
tab
lets
for
child
ren o
ver
16 k
ilogra
ms
NO
T A
PP
LIC
AB
LE
bullPsp
sm
ear
The
fram
ewor
k be
low
illu
stra
tes
poin
ts o
f int
egra
tion
of c
ompr
ehen
sive
HIV
ca
re p
acka
ge in
to e
xist
ing
child
hea
lth s
ervi
ces
Fram
ewor
k for
integ
ratio
n F
rom
Ped
iatr
ic H
IV P
reve
nti
on
to C
are
A
Co
nce
ptu
al F
ram
ewo
rk N
ewb
orn
In
fan
t W
om
an
H
IV e
duca
tion
Pre
gn
an
cy
prev
entio
n C
T
bull F
ocus
ed A
NC
incl
udin
g
AR
V p
roph
ylax
is s
tagi
ng
STI
syph
ilis
CT
Z p
roph
ylax
isA
RT
M
alar
ia tr
eatm
ent amp
pre
vent
ion
CD
4 w
here
ava
ilabl
e in
clud
ing
IPT
amp I
TNs
Infa
nt f
eedi
ng c
ouns
elin
g (I
FC)
Lab
ou
r an
d D
eliv
ery
U
nive
rsal
pre
caut
ions
CT
for
unt
este
d m
othe
rs in
clud
ing
bull D
eliv
ery
care
bull E
OC
-Em
erge
ncy
obst
etri
c ca
re
part
ner
bull R
efer
ral s
yste
m
AR
V p
roph
ylax
is
(mot
her
and
infa
nt)
AR
T C
TZ
pro
phyl
axis
Exc
lusi
ve b
reas
t fe
edin
g or
rep
lace
men
t fe
edin
g
Post
Na
tal
Ca
re
Infa
nt fe
edin
g co
unse
ling
bull B
reas
t hea
lth
Dia
gnos
is (
antib
ody)
if
bull Se
xual
hea
lth
expo
sure
unk
now
n bull
Fam
ily
plan
ning
D
NA
PC
R if
exp
osed
CT
Z p
roph
ylax
is I
FC-
infa
nt f
eedi
ng c
ouns
elin
g
CT
for
unt
este
d m
othe
rs
CT
for
par
tner
D
BS
resu
lt I
FC
IFC
Wea
ning
Bf
eedi
ng
cess
atio
n s
uppo
rt
bullBre
ast e
xam
D
iagn
osis
(an
tibod
y
bullPap
sm
ear
test
) C
T f
or n
egat
ive
wom
en a
nd p
artn
ers
Dia
gnos
is (
antib
ody
test
)
New
born
Ca
re
bull B
CG
bull P
olio
0
bull Is
sue
child
hea
th c
ard
bullEnt
er b
irth
wei
ght
HIV
an
d A
RV
Exp
osur
e st
atus
on
chi
ld h
ealth
car
d Tw
o w
eeks
Infa
nt fe
edin
g co
unse
ling
Six
wee
ks
Imm
uniz
atio
ngr
owth
mon
itori
ng
Ten
wee
ks
im
mun
izat
ion
GM
Fou
rtee
n w
eeks
Im
mun
izat
ion
grow
th m
onito
ring
Si
x m
onth
s
Com
plem
enta
ry fe
eds
Vita
min
A S
uppl
emen
tatio
n
9 m
onth
s
imm
uniz
atio
nG
M
12 amp
18
mon
ths
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
17
(c) I
t pro
mot
es a
cces
s to
ear
ly m
edic
al c
are
bull
Obs
tetr
ical
car
e
bull T
B th
erap
y
bull M
alar
ia t
reat
men
t
bull S
TI t
reat
men
t
bull A
RV
the
rapy
for
mot
her
and
fam
ily
(d) I
t hel
ps to
pla
n fo
r the
futu
re
bull In
fant
fee
ding
sup
port
sys
tem
s
bull F
amily
pla
nnin
g
bull P
erso
nal a
nd f
inan
cial
dec
isio
ns
(e) I
t ena
bles
pre
vent
ive
ther
apy
of m
alar
ia a
nd
othe
r opp
ortu
nist
ic in
fect
ions
suc
h a
PCP
(f) It
giv
es ti
me
to p
lan
for t
he fu
ture
eg
inf
ant
feed
ing
supp
ort s
yste
ms
TH
E F O
UR-P
RO
NG
ED A
PPR
OA
CH
TO P
MTC
T Th
e In
ter
Age
ncy
Task
Tea
m o
n Pr
even
tion
of H
IV T
rans
mis
sion
in p
regn
ant
wom
en
mot
hers
and
the
ir c
hild
ren
(IA
TT)
has
prop
osed
a f
our-
pron
ged
appr
oach
for
the
pre
shyve
ntio
n of
HIV
tra
nsm
issi
on t
hat
targ
ets
non-
preg
nant
and
pre
gnan
t w
omen
mot
hers
and
thei
r ch
ildre
n
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
1
26
The
four
pro
ngs
are
1 P
rimar
y pr
even
tion
of H
IV in
fect
ion
in w
omen
2 P
reve
ntio
n of
uni
nten
ded
preg
nanc
y am
ong
HIV
-inf
ecte
d w
omen
3 I
nter
vent
ions
to
redu
ce t
rans
mis
sion
fro
m H
IV-i
nfec
ted
preg
nant
and
la
ctat
ing
wom
en t
o th
eir
child
ren
4 C
are
and
supp
ort
of w
omen
ch
ildre
n an
d fa
mili
es in
fect
ed a
nd
affe
cted
by
HIV
and
AID
S (
The
PM
TC
T-p
lus)
Ove
rall
the
cov
erag
e of
PM
TCT
prog
ram
mes
and
the
upt
ake
of s
ervi
ces
prov
ided
thro
ugh
thes
e pr
ogra
mm
es
incl
udin
g H
IV
test
ing
and
coun
selli
ng
and
AR
V
prop
hyla
xis
are
still
ver
y lo
w I
n 20
06 w
orld
wid
e le
ss t
han
10
of
preg
nant
wom
ente
stin
g H
IV-p
ositi
ve r
ecei
ved
AR
V d
rugs
for
PMTC
T11
In K
enya
acc
ordi
ng to
the
2007
Ken
ya A
IDS
Indi
cato
r Su
rvey
(KA
IS) 7
the
re h
as b
een
a sm
all i
ncre
ase
in H
IV te
stin
g am
ong
wom
en a
nd m
en c
ompa
red
to th
e 20
03 K
DH
S
KA
IS s
how
s th
at t
houg
h a
vast
maj
ority
(83
)
of H
IV-in
fect
ed w
omen
and
men
in
Ken
ya d
o no
t kn
ow t
heir
HIV
sta
tus
the
re h
as b
een
a cl
ear
and
dram
atic
incr
ease
inco
vera
ge o
f HIV
-tes
ting
amon
g A
NC
clin
ic a
tten
dees
PMTC
T se
rvic
es a
re t
here
fore
im
port
ant
entr
y po
ints
for
HIV
pre
vent
ion
and
trea
tshym
ent
Ove
rall
AR
V c
over
age
for
HIV
infe
cted
peo
ple
who
nee
d tr
eatm
ent
in K
enya
ison
ly 3
5
bull 9
0
of K
enya
n w
omen
who
del
iver
ed in
the
last
4 y
ears
att
end
AN
C
bull 5
7 o
f th
ose
atte
ndin
g A
NC
tes
ted
for
HIV
bull A
mon
g H
IV in
fect
ed w
omen
with
rec
ent
birt
hs
47
wer
e te
sted
in
AN
C
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
(8)
HIV
dis
ease
sta
ging
in H
IV-in
fect
ed c
hild
ren
Dis
ease
sta
ging
with
or
with
out
labo
rato
ry s
uppo
rt f
ollo
ws
HIV
dia
gshyno
sis
Sta
ging
HIV
dis
ease
pro
vide
s a
guid
e to
the
prog
nosi
s an
d in
tershy
vent
ions
nee
ded
at th
e di
ffere
nt s
tage
s (R
efer
to C
hapt
er 5
and
8)
(9)
AR
V th
erap
y
Chi
ldre
n w
ho a
re e
ligib
le fo
r A
RT
shou
ld b
e lin
ked
with
the
AR
T pr
oshygr
am a
nd p
rovi
ded
with
trea
tmen
t acc
ordi
ng to
Nat
iona
l Gui
delin
es a
sso
on a
s an
HIV
dia
gnos
is i
s m
ade
Ear
ly t
reat
men
t si
gnifi
cant
ly r
eshydu
ces
mor
talit
y in
HIV
infe
cted
chi
ldre
n
(10)
C
omm
unic
atio
n
Com
mun
icat
ing
with
car
e-pr
ovid
ers
and
prov
idin
g ps
ycho
soci
al s
upshy
port
for
the
child
mot
her
care
give
r an
d fa
mily
are
a c
ruci
al c
ompo
nent
of
car
e
Pare
nts
care
give
rs a
ndo
r th
e ch
ild n
eed
to p
artic
ipat
e in
mak
ing
deci
shysi
ons
and
plan
ning
app
ropr
iate
car
e fo
r th
e ch
ild i
nclu
ding
dec
isio
nsab
out t
hera
py a
nd w
here
the
child
sho
uld
rece
ive
care
In
this
res
pect
he
alth
wor
kers
mus
t en
sure
tha
t th
e fa
mily
con
side
rs t
he s
ocia
l nee
ds
of H
IV in
fect
ed a
nd a
ffect
ed c
hild
ren
Hea
lth c
are
wor
kers
sho
uld
ensu
re th
at th
ey p
rovi
de a
dequ
ate
time
for
care
give
rs to
ask
que
stio
ns s
o th
at th
ey c
an fu
lly u
nder
stan
d th
e im
plishy
catio
ns o
f HIV
and
HIV
tes
ting
for
them
selv
es a
nd fo
r th
eir
child
ren
H
ealth
car
e w
orke
rs s
houl
d co
unse
l car
egiv
ers
on d
iscl
osur
e in
clud
ing
disc
losu
re to
the
child
(11)
R
efer
rals
Ref
erra
ls a
re a
n im
port
ant p
art o
f man
agin
g an
HIV
exp
osed
or
infe
cted
chi
ld
Thes
e in
clud
e re
ferr
als
to
bull H
ighe
r le
vels
of s
peci
alis
ed c
are
for
furt
her
inve
stig
atio
ns a
nd
trea
tmen
t
bull S
ocia
l sup
port
pro
gram
mes
bull C
omm
unity
-bas
ed c
are
prog
ram
mes
bull P
ITC
site
s fo
r pa
rent
s an
d si
blin
gs
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
7
80
Tabl
e 9
2 W
HO
Rec
omm
enda
tions
for
Follo
w-u
p of
an
HIV
-Exp
osed
Chi
ld
bull A
t birt
h (f
or in
fant
s de
liver
ed a
t ho
me)
bull A
t age
1 t
o 2
wee
ks (
mai
nly
for
infa
nt f
eedi
ng c
ouns
elin
g)
bull A
t ag
e 6
10
and
14
wee
ks (
for
imm
uniz
atio
n an
d in
fant
fee
ding
co
unse
ling)
bull A
fter
age
14
wee
ks
mon
thly
thr
ough
age
12
mon
ths
bull A
fter
age
12 m
onth
s e
very
3 m
onth
s th
roug
h 24
mon
ths
bull A
t 18
mon
ths
do
conf
irm
ator
y H
IV la
bora
tory
test
(if
ther
e ar
e no
re
sour
ces
for
an e
arlie
r an
tigen
-bas
ed t
est)
bull A
fter
2 ye
ars
a m
inim
um o
f ye
arly
vis
its
For t
he H
IV-in
fect
ed f
ollo
w th
ese
guid
elin
es
From
M
onito
r
6 w
eeks
ndash12
mon
ths
Mon
thly
12 ndash
24 m
onth
s Ev
ery
3 m
onth
s
24 m
onth
s an
d on
war
ds
Yea
rly i
f not
sym
ptom
atic
If sy
mpt
omat
ic f
ollo
w u
p as
nee
ded
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
18
OV
ERV
IEW
OF
THE
NEW
PM
TCT
GU
IDEL
INES
Ken
yarsquos
Min
istr
y of
Hea
lth (
MO
H)
thro
ugh
NA
SCO
P h
as t
aken
sev
eral
act
ions
to
expa
nd a
nd s
tren
gthe
n PM
TCT
inte
rven
tions
in
the
coun
try
In
2000
a
Nat
iona
lTe
chni
cal
Wor
king
Gro
up (
TWG
) on
PM
TCT
was
for
med
Th
e TW
G
co-c
hair
ed b
yN
ASC
OP
and
the
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
co
ordi
nate
s im
plem
enta
tion
and
prov
ides
tec
hnic
al s
uppo
rt t
o th
e N
atio
nal
PMTC
T Pr
ogra
m
The
TWG
ser
ves
as a
foru
m t
o up
date
sta
keho
lder
s an
d di
scus
s ch
alle
nges
and
upc
omin
g ac
tiviti
es
The
TWG
is
also
res
pons
ible
for
upd
atin
g na
tiona
l gu
idel
ines
for
PM
TCT
The
nat
iona
l PM
TCT
prog
ram
was
offi
cial
ly l
aunc
hed
in 2
002
NA
SCO
P al
so e
stab
lishe
d se
vera
lpi
lot P
MTC
T si
tes
thro
ugho
ut th
e co
untr
y an
d pr
epar
ed n
atio
nal P
MTC
T gu
idel
ines
The
goal
of t
he n
atio
nal P
MTC
T pr
ogra
m is
in li
ne w
ith th
e go
al s
et o
ut a
t the
Uni
ted
Nat
ions
Gen
eral
Ass
embl
y Sp
ecia
l Ses
sion
on
HIV
AID
S (U
NG
ASS
) in
2001
to
redu
ceth
e pr
opor
tion
of in
fant
s in
fect
ed w
ith H
IV b
y 20
b
y th
e ye
ar 2
005
and
50
by
2010
In
Ken
ya t
he n
atio
nal P
MTC
T pr
ogra
m p
lann
ed t
o ex
tend
its
serv
ices
to
at le
ast
80
of
all
heal
th f
acili
ties
by 2
0071
2 A
ccor
ding
to
the
2003
PM
TCT
serv
ice
stat
istic
sap
prox
imat
ely
9 o
f al
l pr
egna
nt w
omen
rec
eive
d PM
TCT
serv
ices
in
that
yea
rC
urre
ntly
mor
e th
an 5
0 o
f al
l pr
egna
nt w
omen
in
Ken
ya r
ecei
ve P
MTC
T se
rvic
es
Thes
e gu
idel
ines
are
bas
ed o
n a
publ
ic h
ealth
app
roac
h to
car
e t
akin
g in
to c
onsi
dera
shytio
n is
sues
of
feas
ibili
ty a
nd a
ccep
tabi
lity
in
addi
tion
to e
ffica
cy a
nd c
ost-
bene
fit i
ndi
ffere
nt s
ettin
gs
The
guid
elin
es a
re e
xpec
ted
to i
mpr
ove
the
upta
ke
qual
ity a
nd
effe
ctiv
enes
s of
PM
TCT
serv
ices
in th
e co
untr
y
19
OB
JEC
TIV
ESA
ND O
RG
AN
ISA
TIO
NO
FTH
E G
UID
ELIN
ES
The
PMTC
T gu
idel
ines
are
par
t of
the
impl
emen
tatio
n in
stru
men
ts t
owar
ds u
nive
rsal
ac
cess
to
PMTC
T se
rvic
es a
nd a
res
pons
e to
the
cal
l to
actio
n to
war
ds H
IV-fr
ee a
ndA
IDS-
free
gen
erat
ion
Tog
ethe
r w
ith tw
o ot
her
guid
elin
es (A
RV
Ther
apy
in A
dults
and
Ad
oles
cent
s an
d AR
V Th
erap
y in
Inf
ants
and
You
ng C
hild
ren)
th
ey f
orm
a t
rilo
gy
aim
ed a
t co
ntex
tual
isin
g an
d m
ains
trea
min
g th
e W
HO
tri
logy
of
guid
elin
es o
n H
IVA
IDS
prev
entio
n an
d tr
eatm
ent
The
cont
ext
reso
urce
s an
d de
man
ds o
f PM
TCT
prog
ram
mes
diff
er g
reat
ly a
cros
s co
unshy
trie
s an
d ev
en a
cros
s pr
ogra
mm
es w
ithin
the
sam
e co
untr
y C
onsi
deri
ng t
his
vari
abilshy
ity t
hese
gui
delin
es in
clud
e th
e cu
rren
t con
sens
us o
n be
st p
ract
ices
as
wel
l as
alte
rnashy
tives
whi
ch m
ight
be
mor
e ap
prop
riat
e in
par
ticul
ar s
ettin
gs E
xper
ts a
gree
tha
t th
e ldquos
tate
of
the
artrdquo
in
PMTC
T is
cha
ngin
g ra
pidl
y an
d th
at r
ecom
men
datio
ns w
ill c
ershy
tain
ly a
lter
with
adv
ance
s in
med
ical
sci
ence
and
as
mor
e pr
ogra
mm
e ex
peri
ence
is
docu
men
ted
and
diss
emin
ated
The
are
as o
f A
RV
pro
phyl
axis
and
inf
ant
feed
ing
are
part
icul
arly
sub
ject
to r
apid
cha
nge
In 2
005
the
WH
O is
sued
pro
pose
d re
visi
ons
to it
s re
com
men
datio
ns o
n th
e us
e of
ant
ishyre
trov
iral
dru
gs f
or P
MTC
T T
he r
ecom
men
datio
ns w
ere
the
prod
uct
of e
xper
ts w
ho
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
9
28
conv
ened
to
disc
uss
impo
rtan
t ne
w i
nfor
mat
ion
conc
erni
ng t
he d
evel
opm
ent
of r
esis
shyta
nce
in w
omen
and
chi
ldre
n us
ing
sing
le d
ose
nevi
rapi
ne (S
dNV
P) fo
r PM
TCT
as w
ell
as n
ew c
linic
al fi
ndin
gs o
n st
rate
gies
that
mig
ht r
educ
e th
e de
velo
pmen
t of r
esis
tanc
e
Bas
ed o
n th
e ne
w W
HO
gui
delin
es K
enya
rsquos TW
G h
as d
evel
oped
sim
ple
pra
ctic
al a
nd
evid
ence
-bas
ed r
ecom
men
datio
ns o
n PM
TCT
that
wou
ld w
ork
in a
var
iety
of r
esou
rce-
limite
d en
viro
nmen
ts a
nd c
linic
al s
ituat
ions
that
con
fron
t hea
lthca
re w
orke
rs n
ot o
nly
in K
enya
but
als
o in
oth
er d
evel
opin
g co
untr
ies
110
U
SIN
GTH
E G
UID
ELIN
ES
Thes
e gu
idel
ines
are
inte
nded
prim
arily
for u
se b
y PM
TCT
prov
ider
s Th
ese
inclu
de n
urse
sm
idw
ives
clin
ical o
ffice
rs d
octo
rs c
ouns
ello
rs n
utrit
ioni
sts
and
othe
r he
alth
care
pro
fesshy
sion
als
They
will
als
o be
use
ful a
s a re
fere
nce
for p
rogr
amm
e m
anag
ers a
t fac
ility
dis
trict
pr
ovin
cial
and
nat
iona
l lev
els
thro
ugho
ut th
e he
alth
sec
tor
The
guid
elin
es a
re d
ivid
ed in
tote
n ch
apte
rs a
s out
lined
in T
able
15
The
spec
ific
obje
ctiv
es o
f the
new
PM
TCT
guid
elin
es a
re to
bull O
utlin
e th
e po
licy
issu
es in
pro
vidi
ng P
MT
CT
serv
ices
bull R
ecom
men
d op
erat
iona
l gui
delin
es to
be
follo
wed
by
heal
th c
are
prov
ider
s of
PM
TC
T se
rvic
es
bull E
nabl
e pr
ovid
ers
of P
MT
CT
to s
elec
t an
d pr
escr
ibe
AR
Vs
for
prop
hyla
xis
agai
nst
MT
CT
and
for
trea
tmen
t of
pre
gnan
t w
omen
in
fant
s an
d yo
ung
child
ren
bull S
tand
ardi
se t
he c
are
and
coun
selli
ng g
iven
by
PM
TC
T s
ervi
ce
prov
ider
s re
gard
ing
risk
of
MT
CT
and
on
PM
TC
T
bull I
mpr
ove
PM
TC
T se
rvic
es u
sing
eas
y-to
-use
job
aids
and
a
stan
dard
ised
Mamp
E s
yste
m
Prev
entin
g TB
Fo
r chi
ldre
n ex
pose
d to
sm
ear p
ositi
ve tu
berc
ulos
is
bull E
xclu
de a
ctiv
e T
B th
roug
h ca
refu
l his
tory
ph
ysic
al e
xam
and
in
vest
igat
ions
bull
If
ther
e is
no
evid
ence
of
activ
e T
B
star
t on
IN
H f
or p
roph
ylax
is f
or 6
m
onth
s (I
PT
) bull
If
TB
is p
rese
nt
star
t on
TB
tre
atm
ent
as p
er N
atio
nal T
B g
uide
lines
If
a ch
ild is
bor
n to
a m
othe
r with
act
ive
TB
bull S
tart
on
INH
pro
phyl
axis
(IP
T)
and
give
for
3 m
onth
s bull
Afte
r 3
mon
ths
do a
man
toux
bull
If
man
toux
is n
egat
ive
sto
p IN
H a
nd g
ive
BC
G
bull I
f man
toux
is p
ositi
ve a
t 3
mon
ths
con
tinue
for
a f
urth
er 3
mon
ths
bull A
t the
end
of
prop
hyla
xis
re-v
alua
te f
or a
ctiv
e T
B
|
If no
evi
denc
e of
act
ive
TB d
o no
t tre
at fo
r TB
|
If th
ere
is e
vide
nce
of a
ctiv
e TB
tre
at fo
r TB
as
per N
atio
nal
TB g
uide
lines
(6)
Trea
tmen
t of a
cute
infe
ctio
ns a
nd o
ther
HIV
-rel
ated
con
ditio
ns
HIV
-exp
osed
chi
ldre
n ar
e su
scep
tible
to c
omm
on in
fect
ions
as
wel
l as
OIs
for
the
HIV
infe
cted
and
HIV
may
alte
r th
e in
cide
nce
pre
senshy
tatio
n an
d re
spon
se t
o co
nven
tiona
l th
erap
y I
n so
me
case
s m
ore
aggr
essi
ve a
nd lo
nger
tre
atm
ent
cour
ses
may
be
nece
ssar
y a
s tr
eatshy
men
t fai
lure
s ar
e m
ore
freq
uent
(7)
Reg
ular
follo
w-u
p ca
re amp
refe
rral
s
Reg
ular
follo
w-u
p is
the
back
bone
to c
arin
g fo
r th
e H
IV e
xpos
ed c
hilshy
dren
and
ens
ures
opt
imal
hea
lthca
re a
nd p
sych
osoc
ial s
uppo
rt to
the
fam
ily W
HO
has
mad
e re
com
men
datio
ns o
n fr
eque
ncy
of fo
llow
-up
as s
how
n in
Tab
le 9
2 T
his
is t
he m
inim
um a
nd m
ore
freq
uent
con
shyta
ct w
ith t
he h
ealth
car
e sy
stem
may
be
indi
cate
d fo
r H
IV in
fect
ed
child
ren
and
espe
cial
ly if
they
are
on
anti-
retr
ovir
al tr
eatm
ent
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
9
78
Pro
phyl
axis
aga
inst
Pne
umoc
ysti
s ji
rove
cii
Pne
umon
ia (
PC
P)
in c
hild
ren
whe
re C
otri
mox
azol
e is
con
trai
ndic
ated
Ta
ble
15
The
Fou
r-Pr
onge
d A
ppro
ach
App
lied
to th
e PM
TCT
Gui
delin
e
Alte
rnat
ive
drug
s to
use
if C
TX is
con
train
dica
ted
are
give
n be
low
A s
econ
d ch
oice
wou
ld b
e ei
ther
dap
sone
or
atov
aqui
ne
Dap
sone
bull C
hild
ren
gt 1
mon
th
2 m
gkg
24
hour
s or
ally
onc
e da
ily
bull I
f bot
h C
TX
and
Dap
sone
are
con
trai
ndic
ated
(e
g
in c
hilshy
dren
with
G6P
D d
efic
ienc
y w
ho g
et h
aem
olys
is w
ith C
TX
and
D
apso
ne)
the
n us
e ei
ther
Ato
vaqu
one
bull
30m
gkg
day
for
age
1-3
mon
ths
bull H
ighe
r do
se 4
5mg
kgd
ay f
or a
ge 4
-24
mon
ths
OR
Aer
osol
ized
Pen
tam
idin
e
bull 3
00 m
g in
6 m
l wat
er v
ia in
hala
tion
nebu
lizer
onc
e m
onth
ly
bull c
hild
ren
gt 5
year
s
Cha
pter
CH
AP
TER
1
Bac
kgro
und
CH
AP
TER
2
Ant
enat
al C
are
and
Pre
vent
ion
of M
TCT
of H
IV
CH
AP
TER
3
Intra
partu
m C
are
Pron
g 1
Prim
ary
prev
entio
n of
HIV
in
fect
ion
in w
omen
Pron
g 2
Prev
entio
n of
un
inte
nded
pr
egna
ncy
amon
g H
IV in
fect
ed w
omen
Pron
g 3
Inte
rven
tions
to
redu
ce
tran
smis
sion
from
H
IV in
fect
ed
preg
nant
and
la
ctat
ing
wom
en to
th
eir c
hild
ren
Pron
g 4
Car
e an
d su
ppor
t of
wom
en c
hild
ren
and
fam
ilies
in
fect
ed a
nd
affe
cted
by
HIV
A
IDS
C
HA
PTE
R 4
U
se o
f Ant
iretro
vira
l D
rugs
in P
regn
ancy
fo
r Tre
atm
ent a
nd
Pre
vent
ion
of M
othe
r to
Chi
ld
Tran
smis
sion
of H
IV
Infe
ctio
n
CH
AP
TER
5
Imm
edia
te P
ostn
atal
an
d N
eona
tal C
are
CH
AP
TER
6
Late
Pos
tnat
al C
are
and
Fam
ily P
lann
ing
CH
AP
TER
7
HIV
Dia
gnos
is in
C
hild
ren
CH
AP
TER
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
born
to
HIV
infe
cted
m
othe
rs
CH
AP
TER
9
Car
e an
d Fo
llow
-up
of C
hild
ren
of H
IV
infe
cted
mot
hers
C
HA
PTE
R 1
0
Mon
itorin
g an
d E
valu
atio
n of
PM
TCT
se
rvic
es
77
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
30
For
each
of t
hese
cha
pter
s (e
xcep
t ch
apte
r on
e on
bac
kgro
und)
the
gui
delin
es g
ive
anin
trod
uctio
n fo
llow
ed b
y po
licy
stat
emen
ts t
hen
oper
atio
nal g
uide
lines
of w
hat p
rovi
dshyer
s sh
ould
do
to r
educ
e m
othe
r-to
-chi
ld t
rans
mis
sion
of
HIV
and
or
to i
mpr
ove
thei
r pe
rfor
man
ce a
nd th
e ef
fect
iven
ess
of th
eir s
ervi
ces
A li
st o
f job
aid
s fo
r us
e by
the
hea
lthca
re p
rovi
der
follo
ws
the
oper
atio
nal g
uide
lines
and
whe
re n
eces
sary
a li
st o
f ap
pend
ices
and
add
ition
al d
ocum
ents
tha
t m
ay b
e re
shyfe
rred
to
but
are
cons
ider
ed t
oo b
ig o
r de
taile
d to
be
incl
uded
with
in t
he m
ain
body
of
the
guid
elin
es
Foo
tnot
es
1
UN
AID
S (
2004)
Rep
ort
on t
he
Glo
bal AID
S E
pid
emic
Ava
ilable
at
ww
wu
nai
ds
org
2
Ibid
2004
3
It
is
import
ant
to r
ecognis
e th
at t
he
use
of
the
phra
se M
TC
T in n
o w
ay is
inte
nded
to
pla
ce b
lam
e on t
he
moth
er
who m
ay o
r m
ay n
ot
know
her
HIV
sta
tus
who t
ransm
its
the
viru
s to
her
child
Pa
thfinder
ack
now
ledges
that
man
y tim
es p
regnant
wom
en
may
hav
e bee
n infe
cted
by
thei
r m
ale
par
tner
and d
o n
ot
hav
e th
e ab
ility
to n
egoti-
ate
safe
r se
x o
r to
see
k M
TC
T s
ervi
ces
for
fear
of
viole
nce
st
igm
a o
r ab
andonm
ent
if t
hei
r st
atu
s is
rev
eale
d
Path
finder
uphold
s th
e re
pro
duct
ive
rights
of
all w
om
en t
o
choose
if
and w
hen
to h
ave
child
ren
regar
dle
ss o
f H
IV-s
tatu
s
4
W
HO
CD
C
Dep
artm
ent
of
Hea
lth a
nd H
um
an S
ervi
ces
(2004)
Pre
vention o
f M
oth
er-t
o-C
hild
Tra
nsm
issi
on o
f H
IV
Gen
eric
Tra
inin
g P
acka
ge
Gen
eva
Sw
itze
r-la
nd
WH
O
5
U
NAID
S (
2004)
Rep
ort
on t
he
Glo
bal AID
S E
pid
emic
Ava
ilable
at
ww
wu
nai
ds
org
6
Polic
y Pro
ject
(2004)
Cove
rage
of
sele
cted
ser
vice
s fo
r H
IVA
IDS p
reve
ntion a
nd
care
in low
and m
iddle
-inco
me
countr
ies
in 2
003
Ava
ilable
at
ww
wp
olia
pro
ject
com
7
Cen
tral Bure
au o
f Sta
tist
ics
(CBS)
[Ken
ya]
Min
istr
y of
Hea
lth (
MO
H)
[Ken
ya]
and
ORC M
acro
(2004)
Ken
ya D
emogra
phic
and H
ealth S
urv
ey 2
003
Cal
vert
on
Mar
y-la
nd
CBSM
OH
an
d O
RC M
acr
o
8
Nat
ional AID
S C
ontr
ol Counci
l 2
007
8a
Ken
ya A
IDS I
ndic
ato
r Surv
ey 2
007
9
Ibid
2004
10
NASCO
P (
2002)
Surv
eilla
nce
data
as
cite
d in N
ASCO
PM
OH
(2
003)
Nat
ional
PM
CT
Str
ate
gic
Managem
ent
Pla
n 2
003-2
007
111
2 A
IDS in K
enya
Tre
nds
Inte
rven
tions
and I
mpact
7th
editio
n
(2005)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Who
Nee
ds P
CP
Prop
hyla
xis
bull A
ll in
fant
s bo
rn t
o H
IV-i
nfec
ted
mot
hers
irr
espe
ctiv
e of
any
ant
iret
rovi
ral
ther
apy
duri
ng p
regn
ancy
and
labo
ur
Pro
phyl
axis
con
tinue
s un
til th
e in
fant
is 1
2 m
onth
s or
is P
CR
neg
ativ
e or
ant
ibod
y ne
gativ
e w
hich
ever
co
mes
ear
lier
bull A
ll in
fant
s id
entif
ied
as H
IV-i
nfec
ted
duri
ng th
e fir
st y
ear
of li
fe b
y a
PC
R
test
or
by a
clin
ical
dia
gnos
is o
f H
IV in
fect
ion
and
a po
sitiv
e an
tibod
y te
st
bull C
hild
ren
olde
r th
an 1
2 m
onth
s w
ith s
ympt
omat
ic H
IV d
isea
se o
r an
A
IDS
-def
inin
g ill
ness
(W
HO
sta
ge I
I an
d III
se
e ch
apte
r 5)
or
with
CD
4 lt
15
or
TLC
150
0m
m3
bull A
ny c
hild
with
a h
isto
ry o
f P
CP
sho
uld
cont
inue
with
sec
onda
ry
prop
hyla
xis
(dai
ly C
T)
for
life
Clin
icia
ns s
houl
d cl
earl
y in
form
HIV
inf
ecte
d m
othe
rs a
t de
liver
y th
at t
heir
chi
ldre
n ne
ed p
roph
ylax
is a
gain
st P
CP
star
ting
at 6
wee
ks o
f age
unt
il it
is e
stab
lishe
d th
at th
e ch
ild i
s no
t H
IV i
nfec
ted
A p
ract
ical
way
to
ensu
re t
hat
mot
hers
and
oth
er h
ealth
wor
kers
are
inf
orm
ed i
s to
mak
e a
note
on
the
child
rsquos im
mun
izat
ion
card
at
birt
h st
atin
g ldquoP
leas
e gi
ve c
o-tr
imox
azol
e (5
mg
kgd
ay o
rally
dai
ly) f
rom
6 w
eeks
of a
gerdquo
Tabl
e 9
1 D
ose
of C
otrim
oxaz
ole
for P
CP
Prop
hyla
xis
Wei
ght o
f C
hild
(kg)
1ndash4
5ndash8
9ndash16
17ndash5
0
gt 50
CT
tabl
ets
20 m
g TM
P1
00
mg
SM
X p
edia
tric
stre
ngth
(120
mg)
1 ta
b
2 ta
bs
Cot
rimox
azol
e su
spen
sion
40
mg
TMP
200
mg
SM
X
5ml (
240
mg)
25
ml
5 m
l
10 m
l
CT
tabl
ets
80 m
g TM
P4
00 m
g S
MX
re
gula
r stre
ngth
(4
80 m
g)
frac14 ta
b
frac12 ta
b
1 ta
b
2 ta
bs
2 ta
bs
CT
Tabl
ets
160
mg
TMP
800
mg
SM
X
Dou
ble
stre
ngth
(9
60 m
g) -
frac14 ta
b
frac12 ta
b
1 ta
b
1 ta
b
In r
are
case
s a
s in
chi
ldre
n w
ith G
6PD
def
icie
ncy
CTX
may
be
cont
rain
dica
ted
G
uid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
1
76
(3)
Mon
itor
the
child
rsquos g
row
th a
nd d
evel
opm
ent
as a
mea
ns o
f id
entif
ying
the
ch
ild w
ho is
faili
ng to
thriv
e an
d al
so a
s a
tool
for m
onito
ring
the
effe
ct o
f int
ershy
vent
ions
(4)
Ens
ure
that
im
mun
isat
ions
are
sta
rted
and
com
plet
ed
acco
rdin
g to
the
re
com
men
datio
ns o
f the
nat
iona
l im
mun
isat
ion
sche
dule
|
Add
ition
al c
onsi
dera
tions
are
as
follo
ws
bull
Whe
n co
nsid
erin
g BC
G v
acci
natio
n at
a la
ter a
ge
(re-
vacc
inat
ion
for n
o sc
ar o
r mis
sed
earli
er v
acci
natio
n)
excl
ude
sym
ptom
atic
HIV
infe
ctio
n
bull
Do
not g
ive
yello
w fe
ver v
acci
ne to
sym
ptom
atic
HIV
-infe
cted
chi
lshydr
en H
owev
er a
sym
ptom
atic
chi
ldre
n in
end
emic
are
as s
houl
d re
shyce
ive
the
yello
w fe
ver v
acci
ne a
t 9 m
onth
s of
age
bull
Mea
sles
vac
cine
sho
uld
be g
iven
to H
IV in
fect
ed c
hild
ren
at 6
and
9
mon
ths
sinc
e H
IV in
fect
ed c
hild
ren
expe
rienc
e m
uch
mor
e se
vere
di
seas
e w
ith w
ild m
easl
es v
irus
whi
ch o
utw
eigh
s th
e ris
k of
a m
ilder
illn
ess
from
the
vacc
ine
(5)
Pro
vide
pro
phyl
axis
for o
ppor
tuni
stic
infe
ctio
ns
|
Pro
phyl
axis
aga
inst
Pne
umoc
ystis
jiro
veci
i Pne
umon
ia
bull
Pne
umoc
ystis
jiro
veci
i (fo
rmer
ly P
neum
ocys
tis c
arin
ii) p
neum
onia
(PC
P)
is a
sig
nific
ant c
ause
of m
orbi
dity
and
mor
talit
y am
ong
youn
g in
fant
s in
A
frica
Co-
trim
oxaz
ole
(CTX
) pro
phyl
axis
sig
nific
antly
redu
ces
the
inci
shyde
nce
and
seve
rity
of P
CP
Add
ition
al b
enef
its o
f co-
trim
oxaz
ole
incl
ude
prot
ectio
n ag
ains
t com
mon
bac
teria
l inf
ectio
ns t
oxop
lasm
osis
and
mashy
laria
All
child
ren
born
to H
IV in
fect
ed m
othe
rs s
houl
d re
ceiv
e pr
ophy
shyla
xis
agai
nst P
CP
at l
east
dur
ing
the
first
yea
r of l
ife o
r unt
il th
ey a
re
prov
en to
be
unin
fect
ed (s
ee b
ox b
elow
)
bull
CTX
is c
lear
ly th
e dr
ug o
f cho
ice
for p
roph
ylax
is b
ecau
se o
f its
hig
h
effic
acy
rela
tive
safe
ty l
ow c
ost a
nd b
road
ant
imic
robi
al s
pect
rum
In
cas
e of
CTX
hyp
erse
nsiti
vity
des
ensi
tizat
ion
is re
com
men
ded
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
CH
AP
TE
R 2
Ant
enat
al C
are
and
Prev
entio
n of
MTC
T of
HIV
21
INTR
OD
UC
TIO
N
HIV
inf
ectio
n ha
s em
erge
d in
Ken
ya a
s th
e m
ost
impo
rtan
t he
alth
ris
k fa
ctor
for
m
othe
rs a
nd t
heir
chi
ldre
n an
d ha
s a
grea
t im
pact
on
the
long
ter
m o
utco
me
ofpr
egna
ncy
and
child
sur
viva
l A
ll pr
egna
nt w
omen
sho
uld
be e
ncou
rage
d to
lear
n th
eir
HIV
infe
ctio
n st
atus
as
wel
l as
that
of t
heir
sex
ual p
artn
ers
O
nly
by k
now
ing
onersquos
H
IV s
tatu
s ca
n th
e he
alth
wor
kers
mak
e ap
prop
riat
e he
alth
car
e m
anag
emen
t re
com
men
datio
ns a
nd t
he c
oupl
e m
ake
appr
opri
ate
deci
sion
s ab
out
mai
ntai
ning
the
ir
heal
th a
nd t
hat
of t
heir
unb
orn
baby
Pr
e-co
ncep
tion
care
is
enco
urag
ed w
here
an
oppo
rtun
ity a
rise
s an
d a
birt
h pl
an is
dis
cuss
ed w
ith th
e pr
egna
nt w
oman
In m
ost
case
s t
he p
regn
ant
wom
an w
ill n
ot h
ave
HIV
infe
ctio
n P
regn
ancy
offe
rs a
n op
port
une
time
to d
iscu
ss p
reve
ntio
n of
HIV
inf
ectio
n as
man
y w
omen
com
e in
toco
ntac
t w
ith h
ealth
ser
vice
s fo
r th
e fir
st (
and
in s
ome
case
s th
e on
ly)
time
duri
ng
preg
nanc
y
In K
enya
50
o
f m
arri
ed H
IV p
ositi
ve p
erso
ns h
ave
an H
IV n
egat
ive
spou
se1
Ther
efor
e k
now
ing
the
HIV
inf
ectio
n st
atus
of
onersquos
par
tner
is
criti
cal
Add
ition
ally
th
is f
orm
s an
im
port
ant
entr
y po
int
for
esta
blis
hing
pre
vent
ion
with
po
sitiv
e (P
WP)
pro
gram
s am
ong
coup
les
as w
ell a
s pr
ovid
ing
acce
ss to
HIV
pre
vent
ion
ca
re a
nd tr
eatm
ent s
ervi
ces
for
the
who
le fa
mily
PMTC
T pr
ovid
es a
n op
port
unity
for
prev
entin
g ne
w p
aedi
atri
c H
IV in
fect
ions
as
wel
l as
for
reac
hing
the
10 to
20
of H
IV p
ositi
ve p
regn
ant w
omen
who
mee
t WH
O e
ligib
ilshyity
cri
teri
a fo
r in
itiat
ing
AR
T fo
r th
eir
own
heal
th N
ew in
fect
ions
and
hig
h vi
ral l
oads
duri
ng p
regn
ancy
pos
e th
e gr
eate
st r
isk
of M
TCT
to t
he u
nbor
n ba
by t
hus
prim
ary
prev
entio
n A
RV
pro
phyl
axis
as
wel
l as
trea
tmen
t at t
his
time
is c
ritic
al G
iven
that
25
perc
ent o
f wom
en in
Ken
ya h
ave
an u
nwan
ted
preg
nanc
y s
tren
gthe
ning
the
link
to F
P se
rvic
es a
nd c
ondo
m a
cces
s fo
r du
al p
rote
ctio
n of
fers
a c
hanc
e to
fur
ther
pre
vent
MTC
T2
22
OPE
RA
TIO
NA
L G
UID
ELIN
ES
Ant
enat
al c
are
and
prev
entio
n of
MTC
T du
ring
thi
s pe
riod
can
be
sum
mar
ised
usi
ngan
ess
entia
l pa
ckag
e of
int
egra
ted
ante
nata
l ca
re s
ervi
ces
as s
how
n in
Tab
le 2
1
This
ou
tline
s th
e pa
ckag
e of
ca
re
to
be
prov
ided
to
ev
ery
wom
an
atte
ndin
g A
NC
ser
vice
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
5
32
Tabl
e 2
1 Es
sent
ial P
acka
ge o
f Int
egra
ted
Ant
enat
al C
are
Serv
ices
Gro
up e
duca
tion
Incl
ude
info
rmat
ion
on fo
ur A
NC
vis
its b
reas
tfeed
ing
mat
erna
l and
infa
nt n
utrit
ion
per
sona
l hyg
iene
birt
h pr
epar
edne
ss d
ange
r sig
ns p
reve
ntio
n of
com
plic
atio
ns s
kille
d bi
rth a
ttend
ance
fam
ily p
lann
ing
imm
uniz
atio
n sc
hedu
le
post
-nat
al c
are
and
HIV
and
AID
S m
anag
emen
t
Clie
nt h
isto
ry O
btai
n ro
utin
e da
ta in
clud
ing
med
ical
obs
tetri
c a
nd p
sych
osoc
ial h
isto
ry D
eter
min
e dr
ug h
isto
ry k
now
n al
lerg
ies
and
use
of a
ltern
ativ
e m
edic
ines
suc
h as
her
bal p
rodu
cts
Phy
sica
l exa
min
atio
n In
clud
e vi
tal s
igns
ins
pect
ion
aus
culta
tion
and
palp
atio
n
Abd
omin
al a
nd g
enita
l exa
min
atio
n In
clud
e in
spec
tion
pal
patio
n fo
etal
aus
culta
tion
spe
culu
m a
nd b
iman
ual e
xam
inat
ions
w
here
indi
cate
d
AN
C P
rofil
e R
outin
e te
sts
for s
yphi
lis H
b b
lood
gro
up a
nd R
hesu
s fa
ctor
urin
alys
is a
nd p
rovi
de ra
pid
HIV
test
ing
to th
e pr
egna
nt w
oman
and
her
par
tner
if a
ccom
pany
ing
her
If in
dica
ted
chec
k sp
utum
for A
AFB
and
CD
4 co
unt
Cou
nsel
ing
on b
irth
prep
ared
ness
Sup
port
the
preg
nant
wom
an a
nd h
er p
artn
er to
dev
elop
an
indi
vidu
al b
irth
plan
that
in
clud
es p
lace
of d
eliv
ery
with
ski
lled
birth
atte
ndan
ce e
mer
genc
y tra
nspo
rt b
irth
com
pani
onsh
ip a
nd re
adin
ess
for i
nfan
t ca
re
Cou
nsel
ing
on p
regn
ancy
dan
ger s
igns
Pro
vide
wom
en w
ith in
form
atio
n an
d in
stru
ctio
ns o
n se
ekin
g ea
rly c
are
for p
regshy
nanc
y co
mpl
icat
ions
suc
h as
ble
edin
g fe
ver
seve
re h
eada
che
sw
olle
n fe
et f
its o
r con
vuls
ions
Cou
nsel
ing
on in
fant
feed
ing
All
wom
en re
quire
infa
nt-fe
edin
g co
unse
ling
and
supp
ort
Exc
lusi
ve b
reas
tfeed
ing
for s
ix
mon
ths
shou
ld b
e pr
omot
ed a
s th
e no
rm fo
r all
wom
en re
gard
less
of H
IV s
tatu
s W
omen
infe
cted
with
HIV
nee
d to
be
gu
ided
in th
e se
lect
ion
of s
afer
infa
nt-fe
edin
g op
tions
(ref
er to
WH
O g
uide
lines
and
MO
H c
ircul
ar o
n in
fant
and
you
ng c
hild
fe
edin
g)
Nut
ritio
nal a
sses
smen
t co
unse
ling
and
educ
atio
n In
clud
e iro
n m
ultiv
itam
in a
nd fo
late
sup
plem
enta
tion
mon
itor f
or a
naeshy
mia
ade
quat
e ca
loric
and
nut
rient
inta
ke a
nd re
com
men
d re
alis
tic d
iet a
djus
tmen
ts b
ased
on
loca
l res
ourc
es a
nd n
eeds
of
HIV
+ pr
egna
nt w
omen
(at l
east
10
mor
e of
the
RD
A)
Cou
nsel
ing
on H
IV a
nd A
IDS
Pro
vide
wom
en w
ith in
form
atio
n an
d in
stru
ctio
ns o
n se
ekin
g he
alth
car
e fo
r
sym
ptom
s of
HIV
dis
ease
pro
gres
sion
suc
h as
freq
uent
and
recu
rrent
illn
esse
s c
hron
ic p
ersi
sten
t dia
rrho
ea c
andi
dias
is
feve
r w
astin
g or
sig
ns o
f any
opp
ortu
nist
ic in
fect
ion
Lin
k w
omen
to A
IDS
trea
tmen
t and
oth
er s
uppo
rt pr
ogra
mm
es w
here
av
aila
ble
Cou
nsel
ing
the
HIV
neg
ativ
e w
oman
and
her
par
tner
Pro
vide
info
rmat
ion
on re
peat
test
ing
risk
redu
ctio
n an
d pa
rtner
test
ing
RTI
scr
eeni
ng A
ll w
omen
with
hig
h ris
k se
xual
his
tory
or p
rese
ntin
g w
ith s
igns
of R
TI s
uch
as a
bnor
mal
gen
ital d
isch
arge
ge
nita
l ulc
ers
and
pelv
ic in
flam
mat
ory
dise
ase
shou
ld b
e sc
reen
ed a
nd m
anag
ed a
ccor
ding
to K
enya
pro
toco
ls
Tube
rcul
osis
(TB
) A
ll w
omen
pre
sent
ing
for A
NC
ser
vice
s w
ith a
cou
gh o
f mor
e th
an 2
wee
ksrsquo d
urat
ion
shou
ld b
e sc
reen
ed
for T
B re
gard
less
of H
IV s
tatu
s F
ollo
w K
enya
pro
toco
ls fo
r scr
eeni
ng p
roph
ylax
is a
nd tr
eatm
ent
Teta
nus
toxo
id im
mun
isat
ions
Adm
inis
ter a
ccor
ding
to c
urre
nt K
EP
I TT
Imm
uniz
atio
n S
ched
ule
Dew
orm
ing
All
preg
nant
wom
en s
houl
d re
ceiv
e an
ti-he
lmin
thes
afte
r firs
t trim
este
r as
per t
he g
uide
lines
on
m
ater
nal n
utrit
ion
Ant
imal
aria
ls I
TNs
All
preg
nant
wom
en in
mal
aria
end
emic
are
as s
houl
d sl
eep
unde
r an
ITN
and
rece
ive
SP
inte
rmitt
ent
pres
umpt
ive
treat
men
t acc
ordi
ng to
the
Nat
iona
l Mal
aria
gui
delin
es
AR
V a
nd O
ppor
tuni
stic
Infe
ctio
ns p
roph
ylax
is (d
urin
g pr
egna
ncy)
Pro
vide
AR
V C
TX a
nd o
ther
pro
phyl
actic
m
edic
atio
ns a
ccor
ding
to th
e K
enya
AR
T pr
otoc
ol o
n O
I pro
phyl
axis
and
use
of A
RV
s in
pre
gnan
cy
AR
V tr
eatm
ent d
urin
g pr
egna
ncy
Pro
vide
HA
AR
T w
ithin
the
MC
H s
ettin
g ac
cord
ing
to th
e K
enya
pro
toco
l on
use
of A
RV
s
Est
ablis
h cl
ear r
efer
ral n
etw
orks
with
sen
ior c
linic
ians
Pre
vent
ion
with
Pos
itive
s E
ncou
rage
pos
itive
livi
ng d
iscl
osur
e c
orre
ct a
nd c
onsi
sten
t con
dom
use
and
pro
vide
psy
chos
oshyci
al s
uppo
rt to
the
affe
cted
fam
ilies
For
the
HIV
-infe
cted
and
affe
cted
fam
ilies
est
ablis
h an
dor
stre
ngth
en li
nkag
es to
car
e
treat
men
t and
sup
port
serv
ices
incl
udin
g po
st-p
artu
m fo
llow
up
Effe
ctiv
e co
ntra
cept
ion
plan
Cou
nsel
abo
ut o
ther
fam
ily p
lann
ing
met
hods
em
phas
izin
g on
par
tner
invo
lvem
ent
and
dual
pro
tect
ion
met
hods
to a
void
unw
ante
d pr
egna
ncy
new
infe
ctio
n re
-infe
ctio
n an
d fu
rther
tran
smis
sion
Sourc
e K
enya
Nat
ional PM
TC
T T
rain
ing C
urr
iculu
m
2005
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
92
OPE
RA
TIO
NA
L G
UID
ELIN
ES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed in
the
care
and
fo
llow
-up
of c
hild
ren
of H
IV-in
fect
ed m
othe
rs
bull A
ll ch
ildre
n bo
rn t
o H
IV in
fect
ed m
othe
rs s
houl
d be
see
n in
the
he
alth
car
e fa
cilit
y w
ithin
tw
o w
eeks
of
deliv
ery
bull F
or a
ll H
IV e
xpos
ed in
fant
s m
onth
ly f
ollo
w u
p vi
sits
are
re
com
men
ded
begi
nnin
g at
six
wee
ks t
hrou
gh 2
yea
rs
bull W
here
pos
sibl
e v
isits
sho
uld
be li
nked
to
the
imm
unis
atio
n an
d
grow
th m
onito
ring
vis
its
bull A
ll H
IV e
xpos
ed in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e
prop
hyla
xis
from
6 w
eeks
of
age
bull F
or in
fant
s w
ho te
st H
IV p
ositi
ve b
y D
NA
PC
R b
efor
e 18
mon
ths
or
by a
ntib
ody
test
aft
er 1
8 m
onth
s of
age
co
-trim
oxaz
ole
shou
ld b
e gi
ven
daily
for
life
bull F
or in
fant
s w
ho te
st H
IV n
egat
ive
|
If th
ey h
ave
stop
ped
brea
stfe
edin
g fo
r 2 m
onth
s or
mor
e s
top
C
otrim
oxaz
ole
|
If st
ill br
east
feed
ing
con
tinue
Cot
rimox
azol
e un
til tw
o m
onth
s af
ter
com
plet
e ce
ssat
ion
of b
reas
tfeed
ing
bull C
ompr
ehen
sive
car
e fo
r th
e H
IV e
xpos
ed o
r in
fect
ed in
fant
s sh
ould
be
pro
vide
d in
the
bro
ader
con
text
of
othe
r ch
ild h
ealth
car
e st
rate
gies
Hea
lth w
orke
rs s
houl
d pr
ovid
e th
e fo
llow
ing
pack
age
of c
are
as a
min
imum
to
thes
e ch
ildre
n
(1)
Con
firm
HIV
sta
tus
as e
arly
as
poss
ible
(R
efer
to C
hapt
er 7
)
(2)
M
othe
rs s
houl
d be
sup
porte
d to
pro
vide
opt
imal
infa
nt fe
edin
g an
d pa
rticu
larly
to
avoi
d m
ixed
feed
ing
in th
e fir
st 6
mon
ths
of li
fe I
t is
impo
rtant
that
infa
nt fe
edin
g ch
oice
s at
initi
atio
n of
feed
ing
follo
win
g ea
rly in
fant
dia
gnos
is a
t wea
ning
and
at
the
time
of in
trodu
ctio
n of
com
plem
enta
ry fe
eds
are
guid
ed b
y th
e A
FAS
S c
riter
ia
(Ref
er to
Cha
pter
8)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
3
74
Cha
pter
9
Car
e an
d Fo
llow
-up
of C
hild
ren
of H
IV-in
fect
ed M
othe
rs
91
INTR
OD
UC
TIO
N
PMTC
T in
terv
entio
ns re
duce
but
do
not e
limin
ate
the
risk
of H
IV tr
ansm
issi
on fr
om m
othshy
ers t
o th
eir i
nfan
ts a
nd y
oung
child
ren
Bot
h H
IV-in
fect
ed a
nd u
ninf
ecte
d ex
pose
d ch
ildre
n ha
ve in
crea
sed
risk
s of
infe
ctio
n an
d de
ath
from
com
mon
chi
ldho
od in
fect
ions
The
sur
shyvi
val o
f H
IV-e
xpos
ed c
hild
ren
whe
ther
or
not
they
are
inf
ecte
d i
s cl
osel
y lin
ked
to t
he
heal
th a
nd s
urvi
val o
f the
ir m
othe
rs T
here
fore
lon
g-te
rm b
enef
its o
f PM
TCT
prog
ram
s w
ill o
nly
be s
usta
ined
if t
here
is o
ngoi
ng c
ompr
ehen
sive
car
e fo
r th
e ch
ildre
n an
d th
eir
mot
hers
and
or c
are
give
rs
HIV
exp
osed
chi
ldre
n ar
e vu
lner
able
to
the
com
mon
illn
esse
s af
fect
ing
othe
r ch
ildre
n
Thes
e in
fect
ions
incl
ude
neon
atal
infe
ctio
ns m
alar
ia p
neum
onia
dia
rrho
ea m
easl
es a
nd
othe
r vac
cine
pre
vent
able
dis
ease
s H
IV in
fect
ed ch
ildre
n ar
e lik
ely
to s
uffe
r mor
e se
vere
ly
and
have
a h
ighe
r lik
elih
ood
of d
ying
from
com
mon
chi
ldho
od il
lnes
ses
than
non
-infe
cted
ch
ildre
n W
here
as m
alnu
triti
on c
ause
s 53
o
f all
child
hood
dea
ths
HIV
exp
osed
chi
ldre
n ar
e m
ore
vuln
erab
le to
it th
an n
on-in
fect
ed c
hild
ren
Thi
s is
bec
ause
HIV
exp
osed
child
ren
have
hig
her
calo
ric
requ
irem
ents
as
a re
sult
of th
eir
HIV
infe
ctio
n th
e pr
esen
ce o
f opp
orshy
tuni
stic
infe
ctio
ns a
nd o
ther
com
plic
atio
ns re
late
d to
AID
S
Regu
lar
follo
w u
p ca
re is
cri
tical
for
an in
fant
bor
n to
a m
othe
r w
ith H
IVA
IDS
The
com
shypr
ehen
sive
car
e of
HIV
exp
osed
chi
ldre
n in
clud
ing
nutr
ition
im
mun
isat
ion
mon
itori
ng o
f gr
owth
and
dev
elop
men
t pr
even
tion
and
trea
tmen
t of
opp
ortu
nist
ic in
fect
ions
and
ear
ly
infa
nt d
iagn
osis
of
HIV
is f
easi
ble
in r
esou
rce-
cons
trai
ned
sett
ings
and
sig
nific
antly
imshy
prov
es th
e su
rviv
al o
f the
se ch
ildre
n
23
JOB A
IDS
Prov
ider
s ar
e en
cour
aged
to re
fer t
o th
e ap
prop
riate
job
aid(
s) w
hen
deal
ing
with
spe
cific
issu
es
bull P
MT
CT
test
ing
and
coun
selli
ng t
ools
bull C
oupl
e co
unse
lling
tool
s
bull A
NC
alg
orith
ms
for
AR
V p
roph
ylax
is a
nd in
fant
fee
ding
gui
delin
es
as a
dapt
ed f
rom
WH
O g
uide
lines
bull P
reve
ntio
n w
ith p
ositi
ves
tool
kit
on d
iscl
osur
e
bull F
ocus
ed a
nte-
nata
l car
e
bull M
alar
ia in
pre
gnan
cy
bull T
B in
pre
gnan
cy
bull K
EP
I S
ched
ule
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
3
34
A ra
pid
HIV
test
ing
algo
rithm
for s
eria
l tes
ting
is il
lust
rate
d be
low
35
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Pre-Test Education and or Counselling
First HIV Rapid Test ndashDETERMINE
Negative TestResult
Counsel for Negative Result
Positive TestResult
Second HIV Rapid Test ndashBIOLINE
Positive Test ResultCounsel for
Positive Result
NegativeTestResult
Third HIV Rapid Test ndashUNIGOLD
Positive Test ResultCounsel for
Positive Result
Negative Test ResultCounsel for
Negative Result
Figure 32 Rapid HIV testing algorithm Serial testing
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
72
M
othe
r and
Chi
ld H
ealth
Boo
klet
71
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
36
Cha
pter
ref
eren
ces
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
National G
uid
e-lin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
atal Car
e (
2004)
WH
O
UN
FPA
UN
ICEF
World B
ank
Manag
ing C
om
plic
atio
ns
in P
regnan
cy a
nd C
hild
birth
A g
uid
e fo
r m
idw
ives
and d
oct
ors
(2003)
WH
O
Sta
ndar
ds
for
Mat
ernal
and N
eonat
al C
are
(2006)
WH
O
Antire
trovi
ral dru
gs
for
trea
ting p
regnan
t w
om
en a
nd p
reve
nting H
IV infe
ctio
ns
in
infa
nts
in r
esourc
e lim
ited
set
tings
Tow
ard
s U
niv
ersa
l Acc
ess
Rec
om
men
dations
for
a public
hea
lth a
ppro
ach (
2006)
Min
istr
y of
Hea
lth
Nat
ional AID
S amp
STD
Contr
ol Pro
gra
mm
e (N
ASCO
P)
Guid
elin
es f
or
Antire
trovi
ral dru
g t
her
apy
in K
enya
(2005)
Min
istr
y of
Hea
lth
Ken
ya N
atio
nal
Rep
roduct
ive
Hea
lth I
nst
ruct
ional M
anual
for
Ser
vice
Pro
vider
s (M
arch
2005)
Nat
ional AID
S amp
STD
Contr
ol Pro
gra
mm
e K
enya
AID
S I
ndic
ator
Syr
vey
Foo
tnot
es
1
2Ken
ya D
emogra
phic
and H
ealth S
urv
ey (
KD
HS)
2003
37
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
70
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
CH
AP
TE
R 3
Intr
apar
tum
Car
e 3
1 IN
TRO
DU
CTI
ON
Intr
apar
tum
car
e is
the
man
agem
ent
of w
omen
fro
m t
he o
nset
of
labo
ur t
o de
liver
y T
his
peri
od p
oses
the
grea
test
ris
k fo
r tr
ansm
issi
on o
f HIV
from
the
mot
her
to th
e ch
ild (M
TCT)
w
ith 1
0 to
20
perc
ent o
f exp
osed
infa
nts
beco
min
g in
fect
ed a
t thi
s tim
e in
the
abse
nce
of a
ny
inte
rven
tion
1 In
the
con
text
of
HIV
AID
S it
is t
here
fore
im
port
ant
to e
stab
lish
the
HIV
stat
us o
f wom
en p
rior
to o
r du
ring
labo
ur a
nd d
eliv
ery
and
prov
ide
inte
rven
tions
aim
ed a
t re
duci
ng th
e ri
sk o
f tra
nsm
issi
on W
ith a
ppro
pria
te in
terv
entio
ns t
he r
isk
of M
TCT
can
bere
duce
d si
gnifi
cant
ly
32
OPE
RA
TIO
NA
L G
UID
ELIN
ES
a) O
ptim
al In
trap
artu
m C
are
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed fo
r all
wom
en a
dmitt
ed
to la
bour
and
del
iver
y un
its 2
3
1 M
inim
ise
vagi
nal e
xam
inat
ions
2 U
se a
sept
ic t
echn
ique
s in
con
duct
ing
deliv
ery
3 A
void
rou
tine
artif
icia
l rup
ture
of m
embr
anes
(A
RM
)
4 A
void
pro
long
ed la
bour
5 A
void
unn
eces
sary
trau
ma
duri
ng d
eliv
ery
6 M
inim
ise
the
risk
of p
ostp
artu
m h
aem
orrh
age
7 U
se s
afe
bloo
d tr
ansf
usio
n pr
actic
es
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
9
38
b) S
peci
fic M
anag
emen
t of H
IV P
ositi
ve P
regn
ant W
omen
Pro
phyl
acti
c A
ntir
etro
vira
l the
rapi
es4
The
AR
V p
roph
ylac
tic r
egim
en d
epen
ds o
n w
heth
er th
e m
othe
r ha
d A
RV
s du
ring
pre
gshyna
ncy
or n
ot T
hus
the
heal
th c
are
wor
ker s
houl
d es
tabl
ish
the
regi
men
use
d du
ring
th
e A
NC
whe
ther
the
wom
an h
ad ta
ken
the
SdN
VP
and
AZT
at t
he o
nset
of l
abou
r an
d de
term
ine
the
appr
opri
ate
intr
a-pa
rtum
AR
V c
are
as p
er th
e al
gori
thm
s on
pag
e80
(App
endi
x II
I) p
age
81 (A
ppen
dix
IV) a
nd a
s su
mm
aris
ed b
elow
No
AR
Vs t
aken
in p
regn
ancy
Mot
her i
n ea
rly la
bour
(up
to 4
cm c
ervi
cal d
ilata
tion)
bull
Int
rapa
rtum
per
iod
Giv
e m
othe
r S
dNV
P 2
00m
g A
ZT
600
mg
and
3T
C 1
50m
g st
at
bull P
ostp
artu
m m
othe
r G
ive
mot
her
AZ
T 3
00m
g an
d 3T
C 1
50m
g B
D
for
7 da
ys
bull P
ostp
artu
m p
erio
d G
ive
infa
nt S
d N
evir
apin
e 2
mg
kg w
ithin
72
hour
s of
birt
h P
LUS
3T
C 4
mg
kg B
D fo
r 1
wee
k an
d A
ZT
syr
up 4
mg
kg
BD
for
6 w
eeks
Mot
her r
ecei
ved
AZT
300
mg
BD
in P
regn
ancy
bull P
ostp
artu
m
Giv
e in
fant
Sd
Nev
irap
ine
2mg
kg w
ithin
72
hour
s of
birt
h
PLU
S 3
TC
4m
gkg
BD
for
1 w
eek
and
AZ
T sy
rup
4 m
gkg
BD
for
6 w
eeks
Mot
her r
ecei
ved
HA
AR
T in
Pre
gnan
cy
Reg
ardl
ess
of d
urat
ion
rece
ived
HA
AR
T bull
Giv
e m
othe
r A
RV
dos
e as
per
reg
imen
bull P
ostp
artu
m
Giv
e In
fant
Sd
Nev
irap
ine
2mg
kg w
ithin
72
hour
s of
bir
th
PLU
S 3
TC
4m
gkg
BD
for
1 w
eek
and
AZ
T sy
rup
4 m
gkg
BD
for
6 w
eeks
Mod
e of
del
iver
y E
lect
ive
caes
area
n se
ctio
n (C
S) r
educ
es t
he r
isk
of H
IV M
TCT
as c
ompa
red
to v
agin
al
deliv
ery
but
will
not
be
avai
labl
e in
man
y se
ttin
gs in
our
cou
ntry
Whe
re C
S is
per
shyfo
rmed
(ele
ctiv
e or
em
erge
ncy)
in H
IV p
ositi
ve w
omen
the
y sh
ould
rec
eive
pro
phyl
actic
an
tibio
tics
If
the
CS
is p
erfo
rmed
aft
er p
rolo
nged
lab
our
or r
uptu
re o
f m
embr
anes
lo
nger
cour
ses
of a
ntib
iotic
s sh
ould
be
cons
ider
ed
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
9
68
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Supp
ort d
urin
g la
bour
E
mot
iona
l su
ppor
t du
ring
lab
our
is i
mpo
rtan
t fo
r al
l w
omen
and
may
be
even
mor
ene
cess
ary
for
an H
IV p
ositi
ve w
oman
who
is c
once
rned
abo
ut h
er c
ondi
tion
and
risk
of
HIV
tran
smis
sion
to c
hild
Whe
neve
r po
ssib
le d
urin
g la
bour
war
d st
aff m
ust b
e se
nsishy
tive
to t
he fe
ars
and
conc
erns
of t
he H
IV p
ositi
ve m
othe
r ab
out
her
infe
ctio
n a
nd h
owm
uch
she
had
told
her
par
tner
Indu
ctio
n of
labo
ur
Indu
ctio
n of
labo
ur m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f H
IV M
TCT
Car
eful
asshy
sess
men
t of
the
nee
d fo
r an
d de
sira
bilit
y of
ind
uctio
n ra
ther
tha
n C
S is
nec
essa
ry
Whe
n in
duct
ion
of la
bour
is c
hose
n m
embr
anes
sho
uld
be le
ft in
tact
for
as lo
ng a
s po
sshysi
ble
Syn
toci
non
shou
ld n
ot b
e us
ed w
ith in
tact
mem
bran
es
Indi
catio
ns fo
r ele
ctiv
e C
S A
lthou
gh e
lect
ive
CS
will
not
be
avai
labl
e in
mos
t hea
lth fa
cilit
ies
as a
rou
tine
for
HIV
posi
tive
wom
en t
here
may
be
som
e ca
ses
that
mer
it co
nsid
erat
ion
for
CS
The
se i
nshycl
ude
preg
nanc
ies
whe
re l
abou
r is
exp
ecte
d to
be
prol
onge
d or
whe
re o
ther
obs
tetr
ic
com
plic
atio
ns m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f tra
nsm
issi
on (e
g a
brup
tio p
lashy
cent
ae
plac
enta
pra
evia
pr
e-te
rm r
uptu
re o
f m
embr
anes
pr
evio
us C
S an
d br
eech
pr
esen
tatio
n)
Man
agem
ent o
f lab
our a
nd d
eliv
ery
Labo
ur a
nd d
eliv
ery
man
agem
ent
shou
ld fo
llow
opt
imal
obs
tetr
ic m
anag
emen
t gu
ideshy
lines
(R
efer
to
Opt
imal
Int
rapa
rtum
car
e ab
ove
and
Nat
iona
l G
uide
lines
for
Qua
lity
Obs
tetr
ics
and
IMPA
C C
are
Man
ual)
RO
LEO
FTH
E C
OM
MU
NIT
Y
A la
rge
prop
ortio
n (6
0) o
f wom
en in
Ken
ya is
del
iver
ed o
utsid
e th
e he
alth
sys
tem
s by
fam
ilym
embe
rs n
eigh
bour
s and
TBA
s
bull T
here
is n
eed
to e
duca
te th
e co
mm
unity
on
the
risk
of M
TC
T an
d w
ays
of
prev
entio
n
bull T
hose
ass
istin
g th
e de
liver
ies
need
to u
nder
stan
d th
eir
own
risk
of in
fect
ion
and
how
to p
rote
ct th
emse
lves
bull T
he c
omm
unity
sho
uld
be e
ncou
rage
d to
faci
litat
e m
othe
rs to
del
iver
in
heal
th fa
cilit
ies
bull T
he c
omm
unity
sho
uld
be e
ncou
rage
d to
ref
er to
hea
lth fa
cilit
ies
all c
hild
ren
born
at h
ome
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
7
40
Fi
gure
81
Gui
delin
es fo
r Cou
nsel
ling
on H
IV a
nd In
fant
feed
ingJ
ob A
ids
Cha
pter
ref
eren
ces
an
d IE
C M
ater
ials
on
Infa
nt a
nd Y
oung
Chi
ld F
eedi
ng
1R
epublic
of
Ken
ya
Min
istr
y of
Hea
lth
Ess
ential
Obst
etric
Car
e M
anual
for
Hea
lth
Ser
vice
Pro
vider
s in
Ken
ya (
3rd
Editio
n J
an 2
006)
Foo
tnot
es
1 D
e Cock
KM
2002
2 K
enya
National
Rep
roduct
ive
Hea
lth I
nst
ruct
ion M
anual
for
Ser
vice
Pro
vider
s (2
006)
3 D
ivis
ion o
f Rep
roduct
ive
Hea
lth
Guid
elin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
ata
l Car
e
(2004)
4 W
HO
Antire
tovi
ral dru
gs
for
trea
ting p
regnan
t w
om
en a
nd p
reve
nting H
IV infe
ctio
n in
infa
nts
to
ward
s univ
ersa
l acc
ess
(2006)
41
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
66
85
EXTR
AC
TSFR
OM
RES
EAR
CH
ON
I NFA
NT
F EED
ING
A
ND H
IVA
IDS
Evid
ence
ava
ilabl
e fr
om c
urre
nt re
sear
ch d
ata
show
s th
at
bull I
ncre
ased
ris
k of
mor
talit
y w
ith r
epla
cem
ent
feed
ing
is s
igni
fican
t
bull H
IV f
ree
surv
ival
rat
e at
18
mon
ths
of a
ge d
oes
not
sign
ifica
ntly
var
y be
twee
n a
brea
stfe
d an
d re
plac
emen
t fed
chi
ld
bull M
odifi
ed a
nim
alrsquos
milk
doe
s no
t pr
ovid
e ad
equa
te n
utrit
ion
for
ch
ildre
n le
ss t
han
6 m
onth
s he
nce
mic
ronu
trie
nts
shou
ld b
e gi
ven
un
der
thes
e ci
rcum
stan
ces
bull A
brup
t ce
ssat
ion
of b
reas
tfee
ding
is n
o lo
nger
rec
omm
ende
d
bull E
xclu
sive
bre
astf
eedi
ng u
p to
6 m
onth
s is
rec
omm
ende
d un
less
re
plac
emen
t fee
ding
can
mee
t AF
AS
S c
rite
ria
Cha
pter
4
Use
of A
ntire
trov
iral D
rugs
in P
regn
ancy
for T
reat
men
t and
for
Prev
entio
n of
Mot
her-
to-C
hild
Tra
nsm
issi
on o
f HIV
Infe
ctio
n
41
INTR
OD
UC
TIO
N
With
out
any
inte
rven
tion
up
to 4
0 pe
rcen
t of
HIV
pos
itive
wom
en w
ill t
rans
mit
the
infe
ctio
n to
the
ir c
hild
ren
duri
ng p
regn
ancy
lab
our
and
brea
stfe
edin
g U
se o
f ant
iret
shyro
vira
l dru
gs (A
RV
s) o
bste
tric
inte
rven
tions
and
avo
idan
ce o
f all
brea
stfe
edin
g fo
r pr
eshyve
ntio
n of
mot
her
to c
hild
tran
smis
sion
of H
IV in
fect
ion
(PM
TCT)
has
red
uced
the
risk
of m
othe
r to
chi
ld tr
ansm
issi
on o
f HIV
infe
ctio
n (M
TCT)
to le
ss th
an 2
per
cent
in d
evel
shyop
ed c
ount
ries
Shor
t cou
rse
effic
acio
us A
RV
dru
g re
gim
ens
can
redu
ce th
e ri
sk o
f MTC
T to
2-4
per
cent
and
can
be i
mpl
emen
ted
in r
esou
rce-
limite
d se
ttin
gs o
n a
popu
latio
n-ba
sed
publ
ic
heal
th s
cale
AR
Vs
are
used
bot
h fo
r th
e tr
eatm
ent
of H
IV d
isea
se a
nd fo
r PM
TCT
in
HIV
-infe
cted
pre
gnan
t w
omen
and
the
ir n
eona
tes
Ant
iret
rovi
ral t
reat
men
t (A
RT)
for
wom
en w
ho q
ualif
y fo
r it
pro
long
s an
d im
prov
es t
he q
ualit
y of
the
ir l
ives
The
sur
shyvi
val
of t
he c
hild
is
clos
ely
inte
rlin
ked
with
the
hea
lth a
nd s
urvi
val
of t
he m
othe
r
Wom
en e
ligib
le fo
r A
RT
shou
ld b
e st
arte
d on
trea
tmen
t as
soon
as
poss
ible
Pre
gnan
cy
is n
ot a
rea
son
to d
elay
AR
T W
omen
who
are
alr
eady
on
AR
T be
fore
bec
omin
g pr
egshy
nant
sho
uld
cont
inue
with
thei
r tr
eatm
ent
In c
erta
in s
ituat
ions
mod
ifica
tions
may
be
need
ed to
mak
e tr
eatm
ent s
afer
for
the
mot
her
and
the
unbo
rn b
aby
The
bene
fits
of u
sing
AR
Vs
to t
reat
HIV
-infe
cted
pre
gnan
t w
omen
and
or
PMTC
T ou
tshyw
eigh
the
ris
ks H
owev
er w
hen
AR
T or
oth
er s
hort
cou
rse
AR
V r
egim
ens
are
used
ba
selin
e ev
alua
tion
and
mon
itori
ng is
enc
oura
ged
to e
nsur
e th
e sa
fety
of t
he m
othe
rsan
d th
eir
new
born
s L
inka
ges
of H
IV-in
fect
ed p
regn
ant
wom
en a
nd t
heir
chi
ldre
n to
ot
her
care
and
sup
port
pro
gram
s at
hea
lth f
acili
ty a
nd c
omm
unity
lev
els
shou
ld b
e en
sure
d
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
5
42
42
OPE
RA
TIO
NA
L G
UID
ELIN
ES
All
HIV
-infe
cted
pre
gnan
t w
omen
sho
uld
be c
ouns
elle
d on
com
preh
ensi
ve H
IV c
are
incl
udin
g us
e of
AR
Vs
for
thei
r ow
n he
alth
and
for
PMTC
T
All
HIV
-infe
cted
pre
gnan
t wom
en s
houl
d ha
ve th
eir H
IV d
isea
se
stag
ed u
sing
bull W
HO
clin
ical
sta
ging
(se
e A
ppen
dix
1) a
nd
bull I
mm
unol
ogic
al s
tagi
ng (
CD
4 co
unt)
(se
e ta
ble
1)
The
wom
en s
houl
d al
so b
e sc
reen
ed a
nd tr
eate
d fo
r op
port
unis
tic in
fect
ions
(OIs
) inc
ludi
ngTu
berc
ulos
is (T
B)
All
HIV
-infe
cted
pre
gnan
t wom
en s
houl
d ha
ve b
asel
ine
labo
rato
ry a
nd o
ther
nec
essa
rydi
agno
stic
eva
luat
ions
Thes
e di
agno
stic
s sh
ould
incl
ude
bull R
outin
e an
tena
tal c
are
labo
rato
ry in
vest
igat
ions
that
are
nor
mal
ly
done
for
all
preg
nant
wom
en
haem
oglo
bin
(Hb)
rh
esus
blo
od
grou
p an
d A
BO
typ
ing
VD
RL
uri
ne a
naly
sis
and
scre
enin
g fo
r S
TI
bull A
LT a
nd c
reat
inin
e le
vels
for
wom
en e
ligib
le f
or H
AA
RT
Prop
hyla
xis
amp m
icro
nutr
ient
sup
plem
enta
tion
bull
Cot
rimox
azol
e (C
TX) o
ne d
oubl
e st
reng
th o
r tw
o si
ngle
stre
ngth
tabl
ets
once
dai
ly
bull
Mul
tivita
min
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
83
OPE
RA
TIO
NA
L G
UID
ELIN
ESO
N F
EED
ING
CH
ILD
REN
6 M
ON
THS
AN
DO
LDER
The
follo
win
g sh
ould
gui
de fe
edin
g fo
r chi
ldre
n 6
mon
ths
and
olde
r
bull A
t 6
mon
ths
oth
er f
orm
s of
milk
alo
ne a
re n
ot a
dequ
ate
to m
eet
the
baby
rsquos n
utrit
iona
l req
uire
men
ts
bull C
ompl
emen
tary
foo
ds s
houl
d be
intr
oduc
ed w
ith c
ontin
ued
br
east
feed
ing
or w
ith r
epla
cem
ent
feed
ing
until
a n
utrit
iona
lly
adeq
uate
die
t ca
n be
sus
tain
ed w
ithou
t m
ilk
bull A
brup
t ces
satio
n of
bre
astf
eedi
ng s
houl
d be
dis
cour
aged
to
avoi
d
trau
ma
for
both
the
mot
her
and
the
baby
bull M
ilk s
houl
d co
ntin
ue a
s an
impo
rtan
t co
mpo
nent
of
the
diet
bull C
ompl
emen
tary
foo
ds s
houl
d be
enr
iche
d fr
om lo
cally
ava
ilabl
e
fam
ily f
oods
84
NU
TRIT
ION
AL
CA
RE
AN
D S
UPP
OR
TO
F H
IV
INFE
CTE
DC
HIL
DR
EN
bull E
nerg
y ne
eds
for
asym
ptom
atic
HIV
infe
cted
chi
ldre
n in
crea
se b
y 10
pe
rcen
t to
mai
ntai
n gr
owth
as
com
pare
d to
the
non-
infe
cted
chi
ldre
n
bull T
here
is n
o ev
iden
ce o
f in
crea
sed
prot
ein
requ
irem
ents
The
re
quir
emen
ts s
houl
d be
bas
ed o
n in
divi
dual
sym
ptom
s an
d ne
eds
bull M
icro
nutr
ient
req
uire
men
ts d
o no
t ch
ange
W
HO
rec
omm
ends
not
m
ore
than
one
RD
A
(For
fur
ther
det
ails
re
fer
to K
enya
n G
uide
lines
on
nutr
ition
and
HIV
A
IDS
)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
3
64
82
OPE
RA
TIO
NA
L G
UID
ELIN
ESO
N I N
FAN
TFE
EDIN
G (0
-6 M
ON
THS)
The
follo
win
g sh
ould
gui
de in
fant
feed
ing
for t
he fi
rst 6
mon
ths
bull A
ll w
omen
and
men
irre
spec
tive
of th
eir
HIV
sta
tus
shou
ld r
ecei
ve
coun
selin
g an
d de
mon
stra
tions
on
how
to s
afel
y fe
ed t
heir
babi
es
duri
ng t
he a
nten
atal
and
pos
tnat
al f
ollo
w u
p
bull T
he m
ost
appr
opria
te in
fant
fee
ding
opt
ion
for
an H
IV in
fect
ed
mot
her
shou
ld c
ontin
ue t
o de
pend
on
indi
vidu
al c
ircu
mst
ance
s an
d
the
av
aila
ble
supp
ort
bull E
very
HIV
infe
cted
wom
an s
houl
d be
eva
luat
ed a
t ev
ery
visi
t to
ch
eck
whe
ther
her
soc
ial
econ
omic
and
hea
lth s
tatu
s ha
s ch
ange
d
suff
icie
ntly
eno
ugh
to a
ffec
t he
r in
fant
fee
ding
opt
ion
bull E
xclu
sive
bre
astf
eedi
ng fo
r H
IV in
fect
ed w
omen
for
the
firs
t 6
mon
ths
of t
he in
fant
rsquos li
fe is
adv
isab
le
unle
ss r
epla
cem
ent f
eedi
ng is
ac
cept
able
fea
sibl
e a
ffor
dabl
e s
usta
inab
le a
nd s
afe
for
them
and
th
eir
infa
nts
befo
re t
hat t
ime
bull W
hen
repl
acem
ent
feed
ing
is a
ccep
tabl
e f
easi
ble
aff
orda
ble
su
stai
nabl
e an
d sa
fe
avoi
danc
e of
exc
lusi
ve b
reas
tfee
ding
by
HIV
in
fect
ed w
omen
is r
ecom
men
ded
bull I
f th
e co
nditi
ons
for
repl
acem
ent
feed
ing
are
still
not
met
for
6
mon
ths
then
co
ntin
uatio
n of
bre
astf
eedi
ng w
ith a
dditi
onal
co
mpl
emen
tary
fee
ding
is r
ecom
men
ded
giv
ing
prio
rity
to t
he lo
cally
av
aila
ble
food
s
bull I
nfan
t fe
edin
g de
cisi
ons
for
all H
IV e
xpos
ed in
fant
s sh
ould
be
base
d on
the
AF
AS
S c
riter
ia e
ven
whe
re e
arly
infa
nt d
iagn
osis
(E
ID)
is
avai
labl
e
bull B
reas
tfeed
ing
mot
hers
of
infa
nts
and
youn
g ch
ildre
n w
ho a
re k
now
n to
be
HIV
infe
cted
sho
uld
be s
tron
gly
enco
urag
ed to
con
tinue
bre
ast
feed
ing
How
ever
br
east
feed
ing
HIV
infe
cted
mot
hers
sho
uld
be
give
n nu
triti
on s
uppo
rt (
nutr
ition
al c
ouns
elin
g e
duca
tion
foo
d an
d nu
triti
onal
sup
plem
ents
)
63
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
44
Sulp
hur-
base
d in
term
itten
t pr
esum
ptiv
e m
alar
ia t
reat
men
t (I
PT) s
houl
d no
t be
giv
en
to w
omen
who
are
on
CTX
pro
phyl
axis
AR
V us
e
bull A
RV
s ar
e us
ed fo
r tr
eatin
g H
IV-i
nfec
ted
elig
ible
wom
en a
ndo
r fo
r pr
even
tion
of m
othe
r-to
-chi
ld tr
ansm
issi
on
bull H
IV-i
nfec
ted
preg
nant
wom
en e
ligib
le f
or A
RT
sho
uld
initi
ate
AR
T
as s
oon
as p
ossi
ble
as s
how
n in
Tab
le 4
1
bull H
IV-i
nfec
ted
preg
nant
wom
en a
lread
y on
AR
T b
efor
e be
com
ing
preg
nant
sho
uld
cont
inue
AR
T
The
bab
y sh
ould
be
give
n A
RV
pr
ophy
laxi
s so
on a
fter
birt
h as
sho
wn
in T
able
42
Tabl
e 4
1 R
ecom
men
datio
ns fo
r ini
tiatin
g A
RV
trea
tmen
t in
preg
nant
w
omen
bas
ed o
n cl
inic
al s
tage
and
ava
ilabi
lity
of C
D4
Cou
nt
WH
O
CD
4 te
stin
g
CD
4 te
stin
g
Clin
ical
Sta
ge
not a
vaila
ble
avai
labl
e
1 D
o no
t Tre
at
Trea
t if C
D4le
350
cells
mm
3
2 D
o no
t Tre
at
Trea
t if C
D4 le
350
cells
mm
3
3 Tr
eat
Trea
t irre
spec
tive
of C
D4
coun
t (c
onsi
der C
D4
valu
es fo
r bet
ter
man
agem
ent)
4 Tr
eat
Trea
t irre
spec
tive
of C
D4
cell
coun
t
Sourc
e A
dopte
d f
rom
WH
O
Anti-r
etro
vira
l dru
gs
for
trea
ting p
regnant
wom
en a
nd p
re-
venting H
IV infe
ctio
ns
Tabl
e 4
2 R
ecom
men
ded
first
-line
AR
T re
gim
en fo
r tre
atin
g pr
egna
nt w
omen
and
pro
phyl
actic
regi
men
for i
nfan
ts
Mot
her
Ant
epar
tum
AZ
T +
3TC
+ N
VP D
aily
Intra
partu
m
AZT
+ 3T
C +
NVP
Dai
ly
Pos
tpar
tum
AZ
T +
3TC
+ N
VP D
aily
Infa
nt p
roph
ylax
is
Sd
NV
P 2
mg
kg s
tat w
ithin
72
hour
s 3T
C X
1 w
eek
(4
mg
kg B
ID)
AZT
X 6
wee
ks (4
mg
kg B
ID)
Mat
erna
l dos
ages
AZT
300
mg
BID
3TC
150
mg
BID
NV
P 2
00 m
g O
D fo
r tw
o w
eeks
the
reaf
ter 2
00 m
g B
ID
Infa
nt D
osag
es
NV
P
2mg
kg s
tat w
ithin
72
hour
s
AZT
4mg
kg B
ID X
6 w
eeks
3TC
4m
gkg
BID
X 1
wee
k
Cha
pter
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
Bor
n to
HIV
Infe
cted
Mot
hers
81
INTR
OD
UC
TIO
N T
RA
NSM
ISSI
ON
OF
HIV
THR
OU
GH
B
REA
STFE
EDIN
G
In A
fric
a 3
to 4
out
of e
very
10
infa
nts
born
to H
IV in
fect
ed w
omen
acq
uire
HIV
infe
cshytio
n T
here
is t
here
fore
a 5
ndash 2
0 pe
rcen
t ri
sk o
f inf
ants
bor
n to
HIV
pos
itive
mot
hers
ac
quir
ing
infe
ctio
n th
roug
h br
east
-fe
edin
g if
ther
e ar
e no
inte
rven
tions
in
pla
ce
For
wom
en w
ho a
re i
nshyfe
cted
with
HIV
for
the
first
tim
e or
w
ho a
re r
e-in
fect
ed w
ith a
diff
eren
t st
rain
of H
IV d
urin
g th
e br
east
feed
shyin
g ph
ase
the
ris
k in
crea
ses
up t
o29
per
cen
t H
alf (
12)
of H
IV b
reas
t m
ilk t
rans
mis
sion
tak
es p
lace
by
6 w
eeks
and
thre
e qu
arte
rs (3
4) b
y 6
mon
ths
Mix
ed fe
edin
g in
crea
ses
the
risk
of
brea
st m
ilk t
rans
mis
sion
of
HIV
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
5
62
For
prop
hyla
xis
the
reco
mm
enda
tions
are
ran
ked
and
will
dep
end
on t
ime
of fi
rst
conshy
tact
with
the
wom
an H
IV-in
fect
ed p
regn
ant w
omen
who
are
not
elig
ible
for
AR
T or
in
72
3 C
OM
PREH
ENSI
VE
CA
RE
FOR H
IV-E
XPO
SED
CH
ILD
REN
w
hom
it is
not
pos
sibl
e to
sta
rt A
RT
imm
edia
tely
and
the
mot
her
is b
eing
see
n be
twee
n28
and
38
wee
ks o
f pr
egna
ncy
sho
uld
be s
tart
ed o
n re
com
men
ded
mor
e ef
ficac
ious
shor
t co
urse
pro
phyl
actic
AR
V r
egim
ens
as s
how
n in
Tab
le 4
3a
The
bab
y sh
ould
als
obe
giv
en A
RV
pro
phyl
axis
soo
n af
ter
birt
h as
sho
wn
in th
e sa
me
tabl
e T
he r
egim
ens
asou
tline
d be
low
are
for
prop
hyla
xis
and
not f
or tr
eatm
ent
MINI
STRY
OF H
EAL
TH
Tabl
e 4
3a R
ecom
men
ded
Firs
t Lin
e A
RV
prop
hyla
xis
ALGO
RITH
M FO
R EA
RLY
INFA
NTDI
AGNO
SISFO
R HI
VEX
POSE
DCH
ILDRE
N
to p
reve
nt H
IV in
fect
ion
in in
fant
s A
mon
g Pr
egna
nt W
omen
Pr
esen
ting
Bef
ore
38 W
eeks
Ran
king
Ti
me
of A
dmin
istr
atio
n
WEL
L CHI
LD
SICK
CHI
LD
(Man
age
pres
entin
g ill
ness
and
stab
ilize
)
STAR
T CO
TRIM
OXAZ
OLE
PROP
HYLA
XIS
FOR M
OR E
INFOR
MATIO
N C ON
TACT
THE N
ATI O
NAL A
IDS S
TD CO
NTRO
L PRO
GRAM
ME ( N
ASCO
P) PO
BOX
19 36
1-00
20 2 N
AIRO
BI TE
L 02
02 72
95 02
FAX 0
2 0 2 7
1 05 1
8
Exp
osur
e sta
tus s
houl
d be
det
erm
ined
for a
ll in
fants
of u
nkno
wn s
tatu
s at t
he
6 we
ek v
isit o
r firs
t con
t act
Coun
sel o
n inf
ant f
eedi
ng a
s per
nat
iona
l gui
delin
es
Conf
irma
tory
ABt
est
at 1
8 M
onth
s
Eval
uate
for
ART
star
t on
ARV
if el
igibl
e
If HI
V+ a
t 12
Mont
hs
Evalu
ate f
or A
RT
Start
on
ARV
if eli
gible
6 Wee
ks D
BS (P
CR)
HIV
+
If HI
V-sto
p CT
X if
not
BF
for a
t lea
st 2
Mont
hs
HI
V-
Antib
ody
test
ing
12 M
onth
s
Conf
irmat
ory
ABte
st at
18 M
onth
s
Conf
irmat
ory A
B te
st at
18 M
onth
s
Eval
uate
for A
RT
star
t on
ARV
if el
igible
If HIV
+ at
12
Mon
ths
Eval
uate
for A
RT
Star
t on
ARV
if el
igibl
e
If lt1
2 Mon
ths D
BS (P
CR)
If gt
12m
o An
tibod
y te
st
HIV
+
If HIV-
stop
CTX
if n
ot
BF
for a
t lea
st 2
Mont
hs
HI
V-
Antib
ody
testi
ng
12 M
onth
s
Conf
irma
tory
AB
test
at 1
8 Mo
nths
Exp
osur
e sta
tus s
hould
be de
term
ined
for a
ll in
fant
s of u
nkno
wn st
atus
at th
e 6w
eek
visit
or fi
rst c
onta
ct
Co
unse
l on
infa
nt fe
edin
g as
per n
atio
nal g
uideli
nes
Pre
gnan
cy
Labo
ur
Pos
tpar
tum
Mat
erna
l In
fant
Rec
omm
ende
d
AZT(
28-3
8 w
eeks
ge
stat
ion)
sd
NV
P
+ AZ
T+3T
C
AZT+
3TC
X
7 da
ys
sdN
VP
PL
US
3TC
X1
wee
k +
AZT
X
6 w
eeks
Tabl
e 4
3b b
elow
sho
ws
alte
rnat
ive
prop
hyla
ctic
regi
men
s fo
r w
omen
pre
sent
ing
befo
re 3
8 w
eeks
of p
regn
ancy
Ran
king
Ti
me
of A
dmin
istr
atio
n
Alte
rnat
ive
Min
imum
Pre
gnan
cy
AZT(
28-3
8 w
eeks
)
Labo
ur
sd N
VP
+
AZT(
600m
gs
stat
)
sdN
VP
+ A
ZT+3
TC
Pos
tpar
tum
AZT+
3TC
X
7 da
ys
Infa
nt
sdN
VP
+
3TC
X 7
da
ys +
AZT
X
6 w
eeks
sdN
VP
+
3TC
day
s +
AZT
X 6
wee
ks
HIV
-infe
cted
pre
gnan
t w
omen
who
are
see
n fo
r th
e fir
st t
ime
afte
r 38
wee
ks o
f pr
egshy
nanc
y or
in la
bour
sho
uld
be g
iven
AR
V p
roph
ylac
tic r
egim
ens
as s
how
n in
Tab
le 4
4
The
baby
sho
uld
also
be
give
n A
RV
pro
phyl
axis
soo
n af
ter
birt
h as
sho
wn
in t
he s
ame
Bot
h H
IV-in
fect
ed a
nd u
ninf
ecte
d ch
ildre
n re
quir
e co
mpr
ehen
sive
car
e (R
efer
to C
hap-
tabl
ete
r 8
and
9)
61
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
46
Tabl
e 4
4 A
RV
prop
hyla
xis
for P
MTC
T am
ong
preg
nant
wom
en w
ho
have
not
rece
ived
ant
enat
al A
RT
or p
roph
ylax
is
Ran
king
Ti
me
of A
dmin
istr
atio
n
La
bour
P
ostp
artu
m
Mat
erna
l In
fant
Rec
omm
ende
d
sdN
VP
AZ
T+3T
C
SdN
VP
+
X 7
days
P
LUS
3TC
X 1
wee
k +
AZT+
3TC
AZ
T X
6 w
eeks
Min
imum
sd
NV
P
-S
dNV
P
PLU
S 3
TC X
1 w
eek
+
AZT
X 6
wee
ks
Dos
ages
Mot
her
Bab
y
NV
P
200
mg
stat
2m
gkg
sta
t with
in 7
2 ho
urs
AZT
300
mg
BID
4m
gkg
BID
X 6
wee
ks
3TC
15
0 m
g BI
D
4mg
kg B
ID X
1 w
eek
Tabl
e 4
5 R
ecom
men
ded
HA
AR
T fo
r Pre
gnan
t Wom
en
base
d on
CD
4 C
ount
and
Sta
ge o
f Pre
gnan
cy
CD
4 C
ount
H
AA
RT
Trim
este
r C
ells
mm
3
72
2 H
IV P
OSI
TIV
EIN
FAN
TB
Y D
NA
PC
R
bull A
ll H
IV p
ositi
ve in
fant
s sh
ould
be
eval
uate
d fo
r el
igib
ility
for
antishy
retr
ovir
al tr
eatm
ent
and
linke
d to
car
e an
d tr
eatm
ent
as a
ppro
pria
te
bull W
HO
clin
ical
sta
ging
sho
uld
be d
one
for
all H
IV p
ositi
ve in
fant
s
Chi
ldre
n w
ho a
re a
t W
HO
Clin
ical
sta
ge 3
or
4 ar
e el
igib
le f
or
antir
etro
vira
l tre
atm
ent
bull A
ll H
IV p
ositi
ve in
fant
s sh
ould
be
asse
ssed
for
CD
4 co
unt
whe
re
poss
ible
and
ava
ilabl
e R
efer
to
AR
T g
uide
lines
for
CD
4 co
unts
tha
t de
term
ine
elig
ibili
ty f
or A
RT
for
chi
ldre
n of
diff
eren
t ag
e br
acke
ts
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
hav
e a
visi
ble
guar
dian
or
care
-tak
er
befo
re t
hey
can
be s
tart
ed o
n A
RT
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e fr
om 6
w
eeks
or
on f
irst
cont
act t
here
afte
r
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
be
star
ted
on A
RT
if el
igib
le
bull B
reas
tfeed
ing
shou
ld b
e en
cour
aged
for
all
HIV
-pos
itive
infa
nts
for
a
min
imum
of t
wo
year
s (
Ref
er t
o C
hapt
er 8
)
bull F
or a
ll H
IV-p
ositi
ve in
fant
s p
erfo
rm a
ntib
ody
test
ing
at 9
mon
ths
12
mon
ths
and
conf
irm
at
18 m
onth
s
1st T
rimes
ter
2nd T
rimes
ter
3rd T
rimes
ter
lt250
A
ZT+
3TC
+NV
P
AZ
T+3T
C+N
VP
AZT+
3TC
+NVP
250-
350
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
gt 35
0
A
ZT+3
TC+L
PVr
OR
A
BC
+3TC
+LPV
r
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
47
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
60
72
OPE
RA
TIO
NA
L G
UID
ELIN
ES
72
0 G
UID
ELIN
ESFO
R H
IV D
IAG
NO
SIS
INC
HIL
DR
EN
bull P
erfo
rm r
outin
e ra
pid
HIV
ant
ibod
y te
sts
for
all m
othe
rs o
f 6
wee
k ol
d in
fant
s pr
esen
ting
with
unk
now
n st
atus
bull P
erfo
rm r
outin
e dr
y bl
ood
spot
s (D
BS
) fo
r D
NA
PC
R f
or a
ll in
fant
s kn
own
to b
e H
IV-e
xpos
ed a
t 6
wee
ks
bull P
erfo
rm r
outin
e an
tibod
y te
stin
g fo
r al
l sic
k in
fant
s in
out
patie
nt a
nd
paed
iatr
ic w
ards
to
esta
blis
h H
IV e
xpos
ure
infe
ctio
n st
atus
bull P
erfo
rm D
BS
for
all
HIV
-exp
osed
sic
k in
fant
s un
der
12 m
onth
s
bull A
ll H
IV-e
xpos
ed in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e fr
om 6
w
eeks
of
age
or o
n fir
st c
onta
ct th
erea
fter
bull R
efer
to
chap
ter
on c
are
and
follo
w u
p of
the
HIV
-exp
osed
infe
cted
in
fant
72
1 H
IV N
EGA
TIV
EIN
FAN
TA
TA
GE
6 W
EEK
SO
RFI
RST
CO
NTA
CT
Perf
orm
ant
ibod
y te
stin
g at
9 m
onth
s an
d 12
mon
ths
of a
ge
bull I
f H
IV n
egat
ive
at 1
2 m
onth
s an
d st
ill b
reas
tfee
ding
co
ntin
ue
Cot
rim
oxaz
ole
bull I
f not
bre
astf
eedi
ng f
or a
t le
ast
2 m
onth
s s
top
Cot
rim
oxaz
ole
bull P
erfo
rm c
onfir
mat
ory
antib
ody
test
ing
at 1
8 m
onth
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Mat
erna
l dos
ages
AZT
30
0 m
g B
ID
3TC
15
0 m
g BI
D
NVP
200
mg
OD
for t
wo
wee
ks t
here
afte
r 200
mg
BID
AB
C
300m
g B
ID
LPV
r (4
001
00)
2 ta
blet
s B
ID
EFV
60
0mg
QID
Not
es I
mpo
rtan
t con
side
ratio
ns th
at m
odify
cho
ice
of A
RV
s du
ring
pre
gnan
cy in
clud
e C
D4
coun
t m
ater
nal a
naem
ia a
nd
stag
e of
pre
gnan
cy
bull 2
NR
TIs
(A
ZT
and
3TC
) ac
ting
as a
ldquotr
eatm
ent
back
bone
rdquo w
ith a
dditi
on o
f an
N
NR
TI (
NV
P)
rem
ains
the
pre
ferr
ed fi
rst-
line
AR
V t
hera
py in
res
ourc
e-po
or
sett
ings
bull P
rote
ase
inhi
bito
rs b
ased
reg
imen
s ar
e pr
efer
able
whe
n C
D4
coun
t is
high
er
than
250
bull R
epla
ce A
ZT
with
d4T
if H
blt 8
gm
dL
bull
EF
V m
ay b
e us
ed in
stea
d of
NV
P a
fter
first
trim
este
r
bull
Usu
ally
AR
V s
houl
d be
with
held
if C
D4
coun
t is
not
ava
ilabl
e or
not
don
e
AR
V is
how
ever
use
d fo
r P
MT
CT
and
or in
adv
ance
d H
IV d
isea
se (
WH
O
Sta
ge 3
or
4) ir
resp
ectiv
e of
CD
4 co
unt
Bab
ies
who
se
mot
hers
di
d no
t re
ceiv
e an
tepa
rtum
or
in
trap
artu
m
AR
Vpr
ophy
laxi
s sh
ould
be
give
n A
RV
pro
phyl
axis
as
show
n in
Tab
le 4
6
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
9
48
Tabl
e 4
6 A
RV
prop
hyla
ctic
regi
men
s fo
r inf
ants
bor
n to
H
IV-p
ositi
ve w
omen
who
hav
e no
t rec
eive
d an
tepa
rtum
or
intr
apar
tum
AR
T or
AR
V pr
ophy
laxi
s
Ran
king
T
ime
of a
dmin
istr
atio
n an
d In
fant
dos
age
sdN
VP (2
mg
kg s
tat)
PLU
S 3T
C (4
mg
kg B
ID) X
1 w
eek
+ AZ
T (4
mg
kg
BID
) X 6
wee
ks
Rec
omm
ende
d
sdN
VP (2
mg
kg s
tat)
Min
imum
sdN
VP
is g
iven
to th
e in
fant
with
in 7
2 ho
urs
of b
irth
Plea
se n
ote
A
t fir
st c
onta
ct a
ll H
IV i
nfec
ted
preg
nant
wom
en s
houl
d be
giv
en s
dNV
P ta
blet
s to
take
hom
e w
ith t
hem
The
y sh
ould
be
inst
ruct
ed t
o ta
ke t
he t
able
ts a
t th
e on
set
of la
shybo
ur i
f lab
our
occu
rs o
utsi
de h
ealth
faci
lity
sett
ings
The
y sh
ould
als
o be
giv
en N
VP
3T
C a
nd A
ZT s
yrup
for
thei
r ba
bies
to b
e ad
min
iste
red
soon
aft
er b
irth
Som
e w
omen
with
a C
D4
coun
t gr
eate
r th
an 2
50 c
ells
microl
on
Nev
irap
ine
(NV
P)-b
ased
AR
T m
ay d
evel
op N
VP
hype
rsen
sitiv
e re
actio
ns t
hat
can
be li
fe t
hrea
teni
ng I
n th
ese
guid
elin
es it
is r
ecom
men
ded
that
for
preg
nant
wom
en w
ith C
D4
mor
e th
an 2
50 N
VP-
base
d re
gim
en m
ay s
till
be u
sed
but
with
clo
se m
onito
ring
O
ther
wis
e th
e re
com
shym
ende
d re
gim
en to
use
with
CD
4 co
unt a
bove
250
is a
PI-
base
d H
AA
RT
regi
men
Whe
n si
ngle
dos
e N
VP
(sdN
VP)
is u
sed
in P
MTC
T s
ome
wom
en a
nd c
hild
ren
may
deshy
velo
p re
sist
ance
to
NV
P th
at m
ay l
imit
futu
re u
se o
f N
on-N
ucle
osid
e R
ever
se T
ranshy
scri
ptas
e In
hibi
tors
(NN
RTI
s) t
o tr
eat
them
Th
e ri
sk o
f NN
RTI
res
ista
nce
is p
artic
ushyla
rly
high
if
two
dose
s of
sdN
VP
are
give
n T
here
fore
SdN
VP
shou
ld n
ever
be
used
mor
e th
an o
nce
in a
ny o
ne p
regn
ancy
Whe
re p
ossi
ble
AZT
3TC
sho
uld
be g
iven
for
7 da
ys t
o co
ver
the
NV
P ta
il bo
th in
the
mot
her
and
the
baby
Th
e ba
by is
the
n co
ntin
shyue
d on
AZT
for
a to
tal o
f 6 w
eeks
for
prop
hyla
xis
agai
nst M
TCT
HIV
-infe
cted
pre
gnan
t w
omen
sta
rtin
g zi
dovu
dine
(A
ZT)
cont
aini
ng r
egim
ens
shou
ld
have
hae
mog
lobi
n (H
b) le
vels
abo
ve 8
gm
dl
The
Hb
leve
l sho
uld
be c
heck
ed m
onth
ly
for
the
first
thr
ee m
onth
s W
here
pos
sibl
e A
ZT s
houl
d be
use
d in
stea
d of
sta
vudi
ne(d
4T)
Clin
ical
judg
emen
t can
be
used
to e
stim
ate
Hb
leve
ls a
nd in
itiat
e AR
V pr
ophy
laxi
s if l
aboshy
rato
ry te
sts a
re u
nava
ilabl
e
Efa
vire
nz (
EFV
) m
ay b
e te
rato
geni
c if
used
in t
he f
irst
tri
mes
ter
If t
he p
atie
nt is
on
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Cha
pter
7
HIV
Dia
gnos
is in
Chi
ldre
n 7
1 IN
TRO
DU
CTI
ON
In g
ener
al
a ch
ild m
ay b
e te
sted
und
er a
num
ber
of c
ircu
mst
ance
s T
hese
inc
lude
sh
ortly
aft
er b
irth
for
earl
y di
agno
sis
of H
IV f
or th
e pu
rpos
es o
f ind
ivid
ual d
iagn
osis
in
a ch
ild w
ho is
ill (
eg
tho
se p
rese
ntin
g w
ith a
n H
IV r
elat
ed il
lnes
s) i
n ca
ses
whe
re a
child
has
eith
er b
een
expo
sed
or is
pot
entia
lly e
xpos
ed t
o H
IV e
g t
hrou
gh m
othe
r-to
shych
ild t
rans
mis
sion
se
xual
abu
se
sexu
al a
ctiv
ity
with
in a
hea
lthca
re s
ettin
g (e
g
thro
ugh
cont
amin
ated
nee
dles
or
rece
ipt
of p
oten
tially
infe
ctio
us b
lood
) th
roug
h ot
her
mea
ns a
nd in
orp
hans
Ear
ly i
nfan
t di
agno
sis
(EID
) re
fers
to
the
mak
ing
of H
IV d
iagn
osis
in
infa
nts
and
youn
g ch
ildre
n be
fore
18
mon
ths
of a
ge E
ID g
ives
an
oppo
rtun
ity fo
r ea
rly
iden
tific
ashytio
n of
HIV
infe
cted
infa
nts
(des
pite
PM
TCT)
and
ear
ly li
nkag
e to
car
e an
d tr
eatm
ent
Dis
ease
pro
gres
sion
in H
IV in
fect
ed in
fant
s is
fast
with
a h
igh
mor
talit
y ra
te (gt
50
)by
2 y
ears
of a
ge T
he m
edia
n ag
e of
dea
th in
the
first
two
year
s is
6 m
onth
s H
IV a
ntishy
body
tes
ting
amon
g ch
ildre
n ag
ed 1
8 m
onth
s or
mor
e is
abl
e to
det
erm
ine
whe
ther
a
child
is in
fect
ed o
r no
t
Dur
ing
preg
nanc
y m
othe
rs g
ive
thei
r ba
bies
ant
ibod
ies
to in
fect
ions
the
y ha
ve e
xper
ishyen
ced
and
thes
e an
tibod
ies
wan
e w
ith ti
me
Ant
ibod
y te
stin
g in
chi
ldre
n ag
ed le
ss th
an
18 m
onth
s id
entif
ies
child
ren
who
hav
e be
en e
xpos
ed to
thei
r m
othe
rsrsquo H
IV in
fect
ion
or
who
may
be
trul
y in
fect
ed a
nd a
re m
akin
g H
IV a
ntib
odie
s C
urre
ntly
the
re is
no
test
to
diff
eren
tiate
the
mot
herrsquos
ant
ibod
ies
from
tho
se p
rodu
ced
by t
he b
aby
In
orde
r to
id
entif
y th
e H
IV-in
fect
ed c
hild
age
d le
ss t
han
18 m
onth
s a
sec
ond
test
is r
equi
red
for
all b
abie
s te
stin
g po
sitiv
e on
ant
ibod
y te
stin
g or
kno
wn
to b
e H
IV-e
xpos
ed (m
othe
r is
H
IV-p
ositi
ve)
Infa
nt D
NA
(or
RN
A) P
CR
tes
ting
is t
he c
urre
nt r
ecom
men
ded
met
hod
for
EID
Sinc
e m
ost b
abie
s lo
se m
ater
nal a
ntib
odie
s (A
b) b
y 12
mon
ths
a n
egat
ive
antib
ody
test
will
ide
ntify
uni
nfec
ted
babi
es a
s lo
ng a
s th
ey a
re n
ot s
till
brea
stfe
edin
g A
pos
itive
antib
ody
test
at
12 m
onth
s a
lthou
gh h
ighl
y lik
ely
to b
e di
agno
stic
may
stil
l be
due
topa
ssiv
ely
carr
ied
mat
erna
l ant
ibod
ies
Suc
h te
sts
need
to
be c
onfir
med
by
PCR
tes
ting
or r
epea
t ant
ibod
y te
st a
t 18
mon
ths
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
9
58
CARE
SU
PPO
RTAN
DTR
EATM
ENT
FOR
HIV
PO
SITI
VEM
OTH
ERAN
DCH
ILD
HIV
-pos
itive
mot
hers
requ
ire c
are
and
supp
ort w
hich
incl
udes
bull
Cou
nsel
ing
bull P
roph
ylax
is a
nd tr
eatm
ent
bull L
ink
to s
uppo
rt g
roup
s an
d as
sess
men
t of
the
nee
d fo
r A
RT
bull E
arly
infa
nt d
iagn
osis
sho
uld
be p
rovi
ded
at s
ix w
eeks
usi
ng D
NA
shyP
CR
tes
ting
Cha
pter
ref
eren
ces
1
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
Pla
nnin
g
Guid
elin
es f
or
serv
ice
pro
vider
s
Rev
ised
in M
arch
2006
Foo
tnot
es
1
Pre
ble
and P
iwoz
2001
2
WH
O
Contr
ace
ptive
Elig
ibili
ty C
rite
ria
Guid
e
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
EFV
bef
ore
beco
min
g pr
egna
nt i
t sho
uld
be s
ubsi
tute
d w
ith N
VP
in th
e 1s
t tri
mes
ter
In c
ase
of s
ever
e hy
pere
mes
is g
ravi
daru
m A
RT
may
nee
d to
be
brie
fly in
terr
upte
d
On
aver
age
mot
her-
to-c
hild
tra
nsm
issi
on r
ates
are
15
for
sdN
VP
65
fo
r m
ore
effishy
caci
ous
dual
reg
imen
s an
d 2
4 fo
r 3-
drug
AR
V c
ombi
natio
n
Futu
re P
ersp
ectiv
es
Ext
ende
d pr
ophy
laxi
s w
ith 3
AR
V d
rug
com
bina
tions
sta
rtin
g du
ring
pre
gnan
cy a
nd
cont
inui
ng a
fter
del
iver
y fo
r a
peri
od o
f up
to
6 m
onth
s a
mon
g H
IV-in
fect
ed b
reas
t-fe
edin
g m
othe
rs h
as b
een
show
n in
a f
ew r
ecen
t an
d is
olat
ed s
tudi
es a
nd p
ilot
proshy
gram
me
to le
ad to
low
er b
reas
tfee
ding
-rel
ated
pos
tnat
al M
TCT
Thi
s ap
proa
ch m
ay b
e co
nsid
ered
whe
re th
is is
feas
ible
acc
epta
ble
saf
e an
d w
here
adh
eren
ce c
an b
e as
sure
d
Mor
e st
udie
s on
this
issu
e ar
e ex
pect
ed
Thre
e A
RV
dru
g co
mbi
natio
ns g
iven
to
HIV
pos
itive
pre
gnan
t w
omen
who
are
not
yet
el
igib
le fo
r in
itiat
ion
of A
RTs
for
thei
r ow
n he
alth
als
o le
ad to
low
er M
TCT
and
may
be
cons
ider
ed in
pro
gram
mes
with
the
capa
city
to in
itiat
e th
e re
gim
en a
nd fo
llow
up
such
wom
en S
uch
inte
rven
tion
is in
itiat
ed a
t ar
ound
28
wee
ks o
r so
on a
fter
and
sto
pped
af
ter
birt
h if
CD
4 co
unt i
s st
ill a
bove
350
cel
lsm
m3
App
endi
ces
Appen
dix
I
Appen
dix
II
Appen
dix
III
Appen
dix
IV
WH
O C
linic
al S
tagin
g o
f H
IVA
IDS f
or
Adults
and A
dole
scen
ts
w
ith c
onfirm
ed H
IV infe
ctio
n
Contr
acep
tive
Options
for
Peo
ple
Liv
ing w
ith H
IV
Sum
mar
y of
ARV D
rug U
se f
or
PMTCT o
f H
IV
In
tegra
ted M
onitori
ng a
nd E
valu
ation R
eport
Form
MO
H 7
26
Cha
pter
ref
eren
ces
1
Sum
mar
y of
ARV D
rugs
Adve
rse
Effec
ts a
nd M
anag
emen
t T
able
6-1
0
pages
101-1
12 o
f G
uid
elin
es f
or
Antire
trovi
ral D
rug T
her
apy
in K
enya
3rd
Editio
n
De-
cem
ber
2005
2
Dru
g I
nte
ract
ions
Tab
le 7
-10
pag
es 1
12-1
22 o
f G
uid
elin
es f
or
Antire
trovi
ral
Dru
g T
her
apy
in K
enya
3rd
editio
n
Dec
2005
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
7
50
Cha
pter
5
Imm
edia
te P
ostn
atal
and
Neo
nata
l Car
e 5
1 IN
TRO
DU
CTI
ON
Imm
edia
te p
ostn
atal
and
neo
nata
l car
e re
fers
to th
e pa
ckag
e of
ser
vice
s pr
ovid
ed to
the
mot
her
and
infa
nt b
efor
e th
ey le
ave
the
heal
th fa
cilit
y (u
p to
48
hour
s) a
fter
del
iver
yTh
e pe
riod
pro
vide
s an
opp
ortu
nity
to e
duca
te a
ll m
othe
rs a
bout
HIV
to
prov
ide
coun
shyse
lling
and
tes
ting
if it
was
not
don
e pr
evio
usly
and
to
rein
forc
e th
e ed
ucat
ion
proshy
vide
d du
ring
the
ant
enat
al p
erio
d B
oth
HIV
inf
ecte
d an
d H
IV u
ninf
ecte
d m
othe
rs
shou
ld r
ecei
ve th
is e
duca
tion
and
coun
selli
ng b
efor
e di
scha
rge
52
OPE
RA
TIO
NA
L G
UID
ELIN
ES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed fo
r all
wom
en a
nd
infa
nts
in th
e im
med
iate
pos
t par
tum
per
iod
a)
Opt
imal
pos
tpar
tum
car
e
bull R
outin
e ca
re in
clud
ing
brea
st e
xam
inat
ion
exa
min
atio
n of
the
ute
rus
ex
amin
atio
n of
the
per
ineu
m a
nd lo
chia
pa
ssag
e of
uri
ne r
egul
arly
pr
oper
hyg
iene
to
prev
ent
infe
ctio
n c
heck
ing
for
sign
s of
ana
emia
fe
ver
and
tach
ycar
dia
bull D
iscu
ss m
ater
nal n
utri
tion
bull E
stab
lish
the
HIV
sta
tus
of t
he m
othe
rs in
clud
ing
thos
e gi
ving
birt
h ou
tsid
e th
e he
alth
inst
itutio
n se
tting
bull P
rovi
de H
IV C
T f
or m
othe
rs w
ith u
nkno
wn
HIV
sta
tus
bull E
ncou
rage
HIV
res
ults
dis
clos
ure
and
part
ner
test
ing
bull F
ollo
w t
he s
tand
ard
guid
elin
es o
n th
e ca
re o
f a n
ewbo
rn (
IMP
AC
C
are
Man
ual)
bull A
ll ba
bies
sho
uld
rece
ive
thei
r ro
utin
e im
mun
izat
ion
(OP
V a
nd B
CG
) in
th
eir
first
hou
rs o
f lif
e1
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Con
trac
eptio
n A
ll m
othe
rs r
egar
dles
s of
the
ir H
IV s
tatu
s h
ave
a ri
ght
to r
ecei
ve a
dequ
ate
info
rmashy
tion
on a
vaila
ble
met
hods
of f
amily
pla
nnin
g an
d to
mak
e an
info
rmed
cho
ice
on w
hat
is b
est
for
them
H
IV-in
fect
ed w
omen
who
are
not
bre
astf
eedi
ng s
houl
d in
itiat
e a
relia
ble
cont
race
ptiv
e m
etho
d by
2-4
wee
ks p
ostp
artu
m
This
is
in a
dditi
on t
o th
epr
oper
and
con
sist
ent
use
of t
he c
ondo
m a
s a
form
of
dual
pro
tect
ion
All
met
hods
of
cont
race
ptio
n ca
n be
use
d by
HIV
pos
itive
wom
en b
ased
on
stan
dard
med
ical
elig
ibili
tycr
iteri
a in
clud
ing
taki
ng c
are
of d
rug
inte
ract
ions
as
outli
ned
belo
w2
bull L
acta
tiona
l Am
enor
rhoe
a M
etho
d (L
AM
) S
uita
ble
for
excl
usiv
ely
brea
stfe
edin
g H
IV in
fect
ed w
omen
who
hav
e no
t re
sum
ed m
ense
s
bull H
orm
onal
con
trac
eptio
n A
ll ho
rmon
al c
ontr
acep
tives
can
be
used
in
HIV
pos
itive
wom
en in
clud
ing
thos
e on
HA
AR
T
Com
bine
d or
al
cont
race
ptiv
es a
re c
ontr
aind
icat
ed f
or u
se w
ith d
rugs
that
indu
ce
hepa
tic m
icro
-enz
yme
that
may
red
uce
the
effe
ctiv
enes
s of
hor
mon
al
cont
race
ptiv
es
Som
e an
ti-T
Bs
ant
iret
rovi
rals
an
tifun
gals
and
ant
i-ep
ilept
ics
and
in c
ondi
tions
tha
t ca
use
mal
abso
rptio
n8
bull I
ntra
-ute
rine
con
trac
eptiv
e de
vice
s (I
UC
Ds)
IU
CD
s ar
e no
t co
ntra
indi
cate
d in
HIV
pos
itive
wom
en
In s
ever
ely
imm
uno
supp
rese
d w
omen
use
sho
uld
not
be d
isco
ntin
ued
but
new
inse
rtio
n is
dis
cour
aged
as
it m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f in
fect
ion
duri
ng t
he in
sert
ion
proc
ess
bull S
urgi
cal m
etho
ds S
urgi
cal c
ontr
acep
tion
shou
ld b
e of
fere
d to
HIV
po
sitiv
e w
omen
and
the
ir pa
rtne
rs
bull B
arri
er m
etho
ds
Fem
ale
and
mal
e co
ndom
s pr
ovid
e pr
otec
tion
agai
nst
ST
Ds
and
redu
ce t
he r
isk
of H
IV t
rans
mis
sion
and
sho
uld
be
enco
urag
ed a
lone
or
toge
ther
with
oth
er c
ontr
acep
tive
met
hods
bull S
perm
icid
es
Use
d in
con
junc
tion
with
bar
rier
met
hods
spe
rmic
ides
w
ill p
rovi
de a
dditi
onal
con
trac
eptiv
e pr
otec
tion
How
ever
sp
erm
icid
es s
houl
d no
t be
use
d al
one
as t
hey
can
incr
ease
the
ris
k of
HIV
acq
uisi
tion
bull E
mer
genc
y co
ntra
cept
ion
HIV
pos
itive
wom
en s
houl
d be
info
rmed
ab
out
emer
genc
y co
ntra
cept
ion
whe
re it
is a
vaila
ble
and
how
to
obta
in a
nd u
se it
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
1
56
Bre
ast c
are
in b
reas
tfeed
ing
mot
hers
bull E
ncou
rage
dai
ly c
lean
ing
of t
he b
reas
ts a
nd a
void
ing
the
appl
icat
ion
of lo
tions
bull T
reat
mat
erna
l vag
inal
can
didi
asis
and
infa
nt o
ral c
andi
dias
is
bull E
duca
te m
othe
r on
opt
imal
bre
astf
eedi
ng te
chni
que
incl
udin
g la
tchi
ng
on t
echn
ique
ex
lusi
ve b
reas
tfee
ding
and
rem
ovin
g ba
by f
rom
bre
ast
bull E
duca
te th
e m
othe
r on
bre
ast c
are
to p
reve
nt c
ompl
icat
ions
(cr
acki
ng
and
engo
rgem
ent)
bull E
xpre
ss a
nd h
eat
trea
t th
e m
ilk if
bre
ast
has
mas
titis
or
absc
ess
Opt
imal
pos
tpar
tum
car
e fo
r HIV
pos
itive
wom
en
Loch
ia
bull P
ut e
mph
asis
on
good
per
inea
l hyg
iene
and
pro
per
hand
ling
of b
ody
fluid
s
bull A
void
con
tam
inat
ing
the
baby
with
bod
y flu
ids
or w
ith b
eddi
ng s
oile
d w
ith lo
chia
bull S
hari
ng o
f be
ds b
y m
othe
rs in
the
hos
pita
l sho
uld
be d
isco
urag
ed
Cae
sare
an S
ectio
n
Bro
ad s
pect
rum
ant
ibio
tics
shou
ld b
e us
ed r
outin
ely
afte
r C
S
Esse
ntia
l mat
erna
l edu
catio
n an
d fo
llow
-up
bull M
onito
r fo
r br
east
and
pel
vic
infe
ctio
n at
all
post
nat
al c
linic
vis
its
bull E
duca
te o
n pr
ompt
hea
lth s
eeki
ng b
ehav
iour
bull H
ealth
edu
catio
n on
hyg
iene
lo
chia
and
bre
ast
care
bull A
void
sex
ual i
nter
cour
se f
or a
t lea
st 2
wee
ks a
fter
birt
h or
unt
il th
ere
is
no lo
nger
any
loch
ia r
ubra
or
sero
sa
bull D
o pa
p sm
ear
or V
IA a
t 4-
6 w
eeks
bull F
or e
very
sex
ual a
ctiv
ity
the
coup
le s
houl
d us
e co
ndom
s
bull D
iscu
ss f
amily
pla
nnin
g at
eve
ry o
ppor
tuni
ty a
nd p
rovi
de t
he
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Supp
ort
infa
nt fe
edin
g op
tions
For
all
HIV
neg
ativ
e w
omen
wom
en o
f unk
now
n H
IV
stat
us a
nd H
IV p
ositi
ve m
othe
rs o
ptin
g fo
r ex
clus
ive
brea
stfe
edin
g in
itiat
e br
east
feed
shyin
g w
ithin
hal
f hou
r of
bir
th a
nd fo
llow
oth
er g
uide
lines
as
per
Bab
y Fr
iend
ly H
ospi
tal
Initi
ativ
e2 (B
FHI)
bull G
ive
info
rmat
ion
on fa
mily
pla
nnin
g an
d du
al p
rote
ctio
n
bull C
ouns
el o
n H
IV r
isk
redu
ctio
n
bull S
ched
ule
post
nata
l clin
ic v
isits
at
2 w
eeks
and
at
4-6
wee
ks a
nd
com
plet
e m
othe
r-ch
ild b
ookl
et (
refe
r to
DR
H m
anua
l)
(b) S
peci
fic p
ostp
artu
m c
are
for H
IV p
ositi
ve w
omen
bull S
uppo
rt e
xclu
sive
bre
astf
eedi
ng u
nles
s m
othe
r ha
s ap
prop
riat
ely
opte
d fo
r an
d be
en c
ouns
elle
d on
rep
lace
men
t fe
edin
g an
tena
tally
bull I
nitia
te o
r co
ntin
ue c
o-tr
imox
azol
e pr
ophy
laxi
s -1
dou
ble
stre
ngth
tab
shyle
t da
ily
bull F
or H
IV p
ositi
ve m
othe
rs t
hat
rece
ived
sd
nevi
rapi
ne in
trap
artu
m
initi
shyat
e A
ZT
300m
g an
d 3T
C 1
50 m
g B
D f
or 1
wee
k
bull F
or n
ewly
dia
gnos
ed m
othe
rs
do H
IV s
tagi
ng
CD
4 co
unt
and
refe
r ap
prop
riat
ely
for
cont
inue
d ca
re
(c)
Spec
ific
care
for H
IV e
xpos
ed in
fant
s
bull F
or H
IV e
xpos
ed in
fant
s a
dmin
iste
r sd
NV
P 2
mg
kg s
tat
with
in 7
2 ho
urs
Giv
e A
ZT
4 m
gkg
BID
for
6 w
eeks
and
3T
C 4
mg
kg B
ID f
or 1
w
eek
Ref
er t
o C
hapt
er 4
bull R
efer
to C
hapt
er 8
for
deta
ils o
n in
fant
fee
ding
opt
ions
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
5
52
Cha
pter
ref
eren
ces
1
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
Nat
ional
Guid
elin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
ata
l Car
e (2
004)
2
2R
epublic
of
Ken
ya M
inis
try
of
Hea
lth
Ess
ential
Obst
etri
c C
are
Man
ual
for
Hea
lth
Ser
vice
Pro
vider
s in
Ken
ya 3
rd E
ditio
n (
Jan 2
006)
Foo
tnot
es
1
WH
O r
ecom
men
ds
that
all
vacc
ines
should
be
giv
en t
o H
IV-s
ero-n
egat
ive
child
ren
and t
o a
sym
pto
mat
ic s
ero-p
osi
tive
s
The
only
vac
cines
to b
e w
ithhel
d f
rom
child
ren w
ith s
ympto
mat
ic A
IDS a
re B
CG
and
Yel
low
fev
er v
acc
ines
2
The
ldquoTen
Ste
psrdquo
of
BFH
I R
ecom
men
ded
Pra
ctic
es f
or
Mat
ernity
Ser
vice
s ad
apte
d f
or
W
HO
UN
ICEF
1989
Cha
pter
6
Late
Pos
tnat
al C
are
and
Fam
ily P
lann
ing
61
INTR
OD
UC
TIO
N
Late
pos
tnat
al c
are
is p
rovi
ded
to t
he m
othe
r an
d th
e ch
ild 4
8 ho
urs
to 6
wee
ks a
fter
deliv
ery
Dur
ing
this
per
iod
the
heal
th o
f the
mot
her
and
child
is a
sses
sed
and
clos
ely
mon
itore
d
The
risk
of M
TCT
duri
ng th
e po
stpa
rtum
per
iod
can
be r
educ
ed b
y pr
ovid
ing
HIV
cou
nshyse
lling
and
test
ing
pos
t-ex
posu
re p
roph
ylax
is fo
r ex
pose
d ba
bies
cou
nsel
ling
on a
ppro
shypr
iate
infa
nt fe
edin
g op
tions
and
bre
ast c
are
Pos
tpar
tum
car
e fo
r H
IV p
ositi
ve w
omen
shou
ld in
clud
e cl
inic
al s
tagi
ng C
D4
coun
t and
AR
T fo
r th
ose
who
qua
lify
Fam
ily p
lann
ing
serv
ices
are
am
ong
the
core
inte
rven
tions
of P
MTC
T pr
ovid
ed to
hel
pw
omen
det
erm
ine
futu
re c
hild
bear
ing
patt
erns
inc
ludi
ng t
he p
reve
ntio
n of
HIV
-in
fect
ed b
irth
s
Rep
rodu
ctiv
e he
alth
cou
nsel
ling
can
help
a w
oman
pra
ctis
e sa
fer
sex
and
dete
rmin
e he
r fu
ture
ch
ildbe
arin
g pa
tter
ns
on
a m
ore
resp
onsi
ble
and
info
rmed
bas
is1
62
OPE
RA
TIO
NA
L G
UID
ELIN
ES
Opt
imal
pos
tpar
tum
car
e fo
r all
wom
en
This
ent
ails
rou
tine
care
inc
ludi
ng b
reas
t ex
amin
atio
n e
xam
inat
ion
of t
he u
teru
s
exam
inat
ion
of t
he p
erin
eum
and
loch
ia p
assa
ge o
f uri
ne r
egul
arly
pro
per
hygi
ene
topr
even
t in
fect
ion
che
ckin
g fo
r si
gns
of a
nem
ia
feve
r an
d ta
chyc
ardi
a an
d do
ing
peri
neal
exe
rcis
es
Add
ition
al c
are
incl
udes
bull C
ouns
ellin
g an
d te
stin
g fo
r m
othe
rs o
f un
know
n H
IV s
tatu
s bull
Pro
visi
on o
f co
ndom
s an
d ris
k re
duct
ion
coun
selli
ng
bull C
ouns
ellin
g on
con
trac
eptiv
e op
tions
in
clud
ing
dual
met
hod
use
bull D
iscu
ssin
g m
ater
nal n
utrit
ion
bull M
alar
ia p
reve
ntio
n bull
Scr
eeni
ng f
or S
TI a
nd c
ervi
cal c
ance
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
3
54
A
ppen
dix
VII
I Li
st o
f Con
trib
utor
s
Dr
Ayi
si R
ober
t K
Dep
uty
Hea
d N
ASC
OP
PMTC
T Pr
grm
Mng
r
MO
H-N
ASC
OP
Dr
Abd
alla
h S
aade
H
IV T
rain
er J
HPI
EG
O
Ms
Ake
lola
Rut
h
Nut
ritio
n amp
HIV
Man
ager
MO
H-N
ASC
OP
Mr
Dey
a J
osph
at
PMTC
T Pr
ogra
m O
ffice
r M
OH
-NA
SCO
P
Dr
Die
lem
ans
Pau
l
Mat
erna
l Neo
nata
l Hea
lth (M
NH
) Adv
isor
EH
SD
RH
Ms
Gitu
to A
nnie
W
Prog
ram
Offi
cer
MO
H-D
RH
Dr
Inw
ani
Iren
e
Paed
iatr
icia
n IC
AR
T K
NH
Mr
Isav
wa
Ant
hony
D
ata
Prog
ram
Man
ager
CD
C K
enya
Dr
Kar
anja
Dom
inic
PM
TCT
Prog
ram
Man
ager
PA
THFI
ND
ER
Inte
rnat
iona
l
Dr
Kia
rie
Jam
es N
PM
TCT
Prog
ram
Man
ager
KN
HU
ON
Dr
Kig
en B
atile
l Pr
ogra
m M
anag
er M
OH
-DR
H
Ms
Koe
ch R
osel
ine
Pr
ogra
m O
ffice
r M
OH
-DR
H
Dr
Mac
hari
a S
heila
R
H S
ervi
ces
Spec
ialis
t U
SAID
K
Dr
Mat
u L
ucy
PM
TCT
Prog
ram
Man
ager
USA
IDK
Ms
Mau
a J
udith
Pr
ogra
m O
ffice
r D
RH
-MO
H
Prof
Mbo
ri-N
gach
a D
Se
nior
Tec
hnic
al A
dvis
or A
ssoc
iate
Pro
fess
or
of P
aedi
atri
cs C
DC
Ken
ya U
oN
Dr
Mud
any
Mild
red
Te
chni
cal A
dvis
or C
DC
Ken
ya
Ms
Muh
enje
Ody
lia
Beh
avio
ral S
cien
tist
CD
C K
enya
Ms
Mut
sots
o W
infr
ed
PMTC
T Te
chni
cal A
dvis
orP
rogr
am M
anag
er C
DC
Ken
ya
Ms
Mut
uku
Ter
esia
H
IV T
rain
er J
HPI
EG
O
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
104
App
endi
x V
II
103
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Ms
Mw
anga
ngi
Alic
e Pr
ogra
m O
ffice
r D
RH
-MO
H
Ms
Mw
angi
Nan
cy
PMTC
T A
dmin
istr
ativ
e A
ssis
tant
CD
C K
enya
Mr
Ndw
iga
Fra
ncis
Pr
ogra
m O
ffice
r M
OH
-NA
SCO
P
Prof
Ndu
ati
Rut
h
Ass
ocia
te P
rofe
ssor
of P
aedi
atri
cs U
oN
Dr
Nju
guna
Cha
rles
Pr
ogra
m A
ssoc
iate
MSH
RPM
Plu
s
Mr
Nya
beri
Dav
id
Prog
ram
Offi
cer
MO
H-D
RH
Mr
Ode
ra J
W
Prog
ram
Coo
rdin
ator
GTZ
Ms
Olu
och
Pat
rici
a Te
chni
cal A
dvis
or C
DC
Ken
ya
Mr
Olu
och
Tom
Te
chni
cal A
dvis
or C
DC
Ken
ya
Dr
Onrsquo
gech
Joh
n
Prog
ram
Coo
rdin
ator
KN
H
Dr
Otie
no-N
yuny
a B
Se
nior
Lec
ture
rH
ead
of D
epar
tmen
t PM
TCT
Dir
ecto
rM
oi U
nive
rsity
AM
PATH
Dr
Oum
a C
hris
PM
TCT
Prog
ram
Offi
cer
UN
ICE
F
Dr
Saw
e F
redr
ick
K
Dep
uty
Dir
ecto
r W
RP
Mr
Soo
Leo
nard
Pr
ogra
m M
anag
er W
RP
Dr
Vak
il S
obha
N
Tech
nica
l Adv
isor
AR
T Pr
ogra
m N
ASC
OP
Ms
Way
ua R
uth
Prog
ram
Offi
cer
MO
H-D
RH
Dr
Yon
ga I
sabe
lla
PMTC
T Te
chni
cal A
dvis
or E
GPA
F
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
Tabl
e of
Con
tent
s Li
st o
f con
trib
utor
s 3
Tabl
e of
con
tent
s 5
Ack
now
ledg
emen
ts
10
Fore
wor
d 11
Abb
revi
atio
ns a
nd A
cron
yms
12
Exe
cutiv
e Su
mm
ary
16
Cha
pter
1
Bac
kgro
und
20
11T
he G
loba
l Pan
dem
ic
20
12
Mag
nitu
de o
f HIV
in P
regn
ancy
in
22
13
Ris
ks o
f Tra
nsm
issi
on o
f MTC
T at
Diff
eren
t Tim
e Pe
riod
s 23
14
Ris
k Fa
ctor
s of
MTC
T of
HIV
24
15
Ben
efits
of P
MTC
T of
HIV
25
16
Ben
efits
of H
IV C
ouns
ellin
g amp
Tes
ting
25
17
The
Four
-pro
nged
App
roac
h to
PM
TCT
26
18
Ove
rvie
w o
f the
New
PM
TCT
Gui
delin
es
28
19
Obj
ectiv
es amp
Org
anis
atio
n of
the
Gui
delin
es
28
110
U
sing
the
Gui
delin
es
29
Cha
pter
2 A
nten
atal
Car
e an
d Pr
even
tion
of M
TCT
of H
IV
32
21
Intr
oduc
tion
32
5
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4 B
acte
riolo
gica
l con
firm
atio
n
App
ropr
iate
clin
ical
sam
ples
incl
ude
sput
um
gast
ric
aspi
rate
s an
d ce
rtai
n ot
her
mat
eria
ls
Sin
ce m
ost
TB
in c
hild
ren
is in
infa
nts
and
youn
g ch
ildre
n s
putu
m
indu
ctio
n m
ay b
e do
ne fi
rst
or g
astr
ic a
spira
tions
and
exp
ecto
ratio
ns
a S
putu
m In
duct
ion
Spu
tum
indu
ctio
n is
saf
e an
d ef
fect
ive
in c
hild
ren
of a
ll ag
es a
nd t
he b
acte
rial
yi
elds
a]r
e as
goo
d or
bet
ter
that
for
gas
tric
asp
irate
s
b G
astr
ic a
spira
tion
Thi
s is
per
form
ed in
you
ng c
hild
ren
who
are
una
ble
or u
nwill
ing
to
expe
ctor
ate
sput
um
A g
astr
ic a
spir
ate
shou
ld b
e ob
tain
ed o
n ea
ch o
f th
e th
ree
cons
ecut
ive
mor
ning
s
c E
xpec
tora
tions
S
putu
m s
houl
d al
way
s be
obt
aine
d in
adu
lts a
nd o
lder
chi
ldre
n gt1
0 ye
ars
of
age
susp
ecte
d of
hav
ing
pulm
onar
y T
B
Bac
teri
al y
ield
s ar
e hi
gher
in o
lder
chi
ldre
n
Thr
ee s
putu
m s
peci
men
s sh
ould
be
obta
ined
an
on-
the
ndashspo
t sp
ecim
en (
at t
he
first
eva
luat
ion)
an
ear
ly m
orni
ng s
peci
men
and
a s
econ
d on
-the
-spo
t sp
ecim
en
Spu
tum
indu
ctio
n is
saf
e an
d ef
fect
ive
in c
hild
ren
of a
ll ag
es a
nd t
he b
acte
rial
yi
elds
are
as
good
or
bett
er t
han
for
gast
ric a
spira
tes
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
102
NO
TES
1 H
isto
ry
bull A
sk f
or s
ympt
oms
cons
iste
nt w
ith T
B in
clud
ing
chro
nic
coug
hgt 2
wee
ks
feve
r- b
ody
tem
pera
ture
of
38 o C
for
14 d
ays
afte
r co
mm
on c
ause
s su
ch a
s m
alar
ia a
nd p
neum
onia
hav
e be
en e
xclu
ded
wei
ght
loss
or
failu
re t
o th
rive
(
also
look
at
the
grow
th c
hart
) a
nd o
r ni
ght
swea
ts
Enq
uire
whe
ther
the
pat
ient
has
bee
n in
clo
se c
onta
ct w
ith s
mea
r-po
sitiv
e pu
lshym
onar
y T
B (
usua
lly a
par
ent
or o
ther
mem
ber
of th
e fa
mily
)
2 C
linic
al e
xam
inat
ion
a P
hysi
cal s
igns
hig
hly
sugg
estiv
e of
ext
ra p
ulm
onar
y T
B
bull O
ften
the
mai
n cl
inic
al f
indi
ng is
just
fai
lure
to
thriv
e
bull G
ibus
es
peci
ally
of
rece
nt o
nset
(re
sulti
ng f
rom
ver
tebr
al T
B)
bull N
on-p
ainf
ul e
nlar
ged
cerv
ical
lym
phad
enop
athy
with
fis
tula
for
mat
ion
b P
hysi
cal s
igns
req
uiri
ng in
vest
igat
ions
to
excl
ude
extr
a pu
lmon
ary
TB
bull M
enin
gitis
not
res
pond
ing
to a
ntib
iotic
s tr
eatm
ent
bull P
leur
al e
ffus
ion
bull P
eric
ardi
al e
ffus
ion
bull D
iste
nded
abd
omen
with
asc
itis
bull N
on-p
ainf
ul e
nlar
ged
lym
ph n
odes
with
out
fistu
la f
orm
atio
n
bull N
on-p
ainf
ul e
nlar
ged
join
t
Sig
ns o
f tu
berc
ulin
hyp
erse
nsiti
vity
3 M
anto
ux te
st
A m
anto
ux t
est
shou
ld b
e re
gard
ed p
ositi
ve a
s fo
llow
s
bull I
n hi
gh-r
isk
child
ren
(inc
lude
s H
IV-i
nfec
ted
child
ren
and
seve
rely
mal
shyno
uris
hed
child
ren
) gt
5mm
dia
met
er o
f in
dura
tion
bull I
n al
l oth
er c
hild
ren(
whe
ther
the
y ha
ve r
ecei
ved
BC
G o
r no
t)
gt10m
m d
ishyam
eter
of i
ndur
atio
n
101
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
22
Ope
ratio
nal G
uide
lines
32
23
Job
Aid
s 34
24
App
endi
ces
13
Cha
pter
3 I
ntra
part
um C
are
38
31
Intr
oduc
tion
38
32
Ope
ratio
nal G
uide
lines
38
Cha
pter
4
Use
of A
RVs
in P
regn
ancy
for T
reat
men
t amp P
MTC
T of
HIV
infe
ctio
n 42
41
Intr
oduc
tion
42
42
Ope
ratio
nal G
uide
lines
43
Cha
pter
5 I
mm
edia
te P
ostn
atal
and
Neo
nata
l Car
e
51
51
Intr
oduc
tion
51
52
Ope
ratio
nal G
uide
lines
51
Cha
pter
6 L
ate
Post
nata
l Car
e an
d Fa
mily
Pla
nnin
g
54
61
Intr
oduc
tion
54
62
Ope
ratio
nal G
uide
lines
54
Cha
pter
7 H
IV D
iagn
osis
in C
hild
ren
58
71
Intr
oduc
tion
58
72
Ope
ratio
nal G
uide
lines
59
72
0 G
uide
lines
for
HIV
Dia
gnos
is in
Chi
ldre
n
59
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
72
1 H
IV N
egat
ive
Infa
nt a
t 6 w
eeks
or
Firs
t Con
tact
59
72
2 H
IV P
ositi
ve In
fant
by
DN
A P
CR
60
72
3 C
ompr
ehen
sive
Car
e fo
r H
IV-e
xpos
ed In
fant
61
D
IAG
NO
STIC
ALG
OR
ITH
MFO
R P
ULM
ON
AR
Y T
B IN
CH
ILD
REN
Cha
pter
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
Bor
n to
HIV
infe
cted
mot
hers
62
81
Intr
oduc
tion
62
82
Ope
ratio
nal G
uide
lines
on
Infa
nt F
eedi
ng (0
-6 m
onth
s)
63
83
Ope
ratio
nal G
uide
lines
on
Feed
ing
Chi
ldre
n 6
mon
ths
and
olde
r 64
84
Nut
ritio
nal C
are
and
Supp
ort o
f HIV
infe
cted
Chi
ldre
n 64
85
Ext
ract
s fr
om R
esea
rch
on In
fant
Fee
ding
and
HIV
AID
S 65
Cha
pter
9
Car
e an
d Fo
llow
up
of C
hild
ren
of H
IV-in
fect
ed m
othe
rs 7
3
91
Intr
oduc
tion
73
92
Ope
ratio
nal G
uide
lines
74
Cha
pter
10
Mon
itorin
g an
d Ev
alua
tion
of P
MTC
T se
rvic
es
83
101
In
trod
uctio
n 83
102
O
pera
tiona
l Gui
delin
es
85
Bib
liogr
aphy
91
Job
Aid
sR
efer
ence
s
91
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
App
endi
x V
I
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
100
App
endi
x V
C
OM
MO
N A
DV
ERSE
EFF
ECTS
OF
AR
V U
SE D
UR
ING
PR
EGN
AN
CY
Cla
ss
Adv
erse
effe
cts
Nuc
leos
ide
Nuc
leot
ide
Rev
erse
Tra
nscr
ipta
se In
hibi
tors
( NR
TIs)
Zido
vudi
ne(A
ZT)
Nau
seau
La
miv
idin
e (3
TC)
Dia
rhoe
a
Stav
udin
e (d
4T)
Hyp
erse
nsiti
vity
(AB
C)
Aba
cavi
r(A
BC
) A
naem
ia(A
ZT)
Teno
fovi
r(TF
VTD
F)
Emitr
icita
bine
(FTC
)
Non
- Nuc
leos
ide
Rev
erse
Tra
nscr
ipta
se In
hibi
tors
(NN
RTI
s)
Nev
irapi
ne(N
VP)
Del
avird
in
Efav
irenz
(EFV
)
Pro
teas
e In
hibi
tors
(PIs
)
Saqu
inav
ir(SQ
V)
Indi
navi
r(ID
V)
Rito
navi
r(R
TV)
Nel
finav
ir(N
LF)
Lopi
navi
rrito
navi
r(LP
Vr)
A
taza
navi
r(A
TV)
Fose
mpr
enav
ir Ti
pana
vir(
TPV)
D
arun
avir(
DR
V)
Ras
h
Elev
ated
live
r enz
ymes
(c
omm
on w
ith N
VP in
hig
h C
D4
co
unt)
EFV
CN
S ef
fect
s(se
datio
n in
-so
mni
a v
ivid
dre
ams
diz
zine
ss
conf
usio
n fe
elin
g of
lsquod
isen
gage
men
trsquo
Tera
toge
nici
ty
GI i
ntol
eran
ce
Hep
atot
oxic
ity
Lipo
dyst
roph
y
Dys
lipid
emia
s
Insu
lin re
sist
ance
Hyp
ergl
ycae
mia
La
ctic
aci
dosi
s an
d he
patic
ste
a-to
sis
Cou
nsel
ing
and
Follo
w-u
p Ti
ps
May
not
be
wel
l-tol
erat
ed in
ear
l pr
egna
ncy
whe
n
mor
ning
sic
knes
s is
com
mon
M
ay in
crea
se ri
sk o
f non
-ad
here
nce
May
hav
e in
adeq
uate
blo
od le
vels
A
ll A
RVs
sho
uld
be d
isco
ntin
ued
and
rest
arte
d w
hen
Namp
V is
gon
e or
effe
ctiv
ely
trea
ted
Fo
llow
-up
labs
CB
C L
FTs
If ra
sh in
1st
2 w
ks d
o no
t inc
reas
e N
VP d
ose
and
cont
act c
linic
ian
Mild
rash
may
be
man
aged
with
an
tihis
tam
ines
A
void
cor
ticos
tero
ids
durin
g N
VP
dose
esc
alat
ion
EFV
shou
ld b
e ta
ken
initi
ally
at
bed
time
Avo
id E
FV in
wom
en o
f hig
h ch
ild-b
earin
g po
tent
ial
Do
not o
pera
te h
eavy
mac
hine
ry
Mon
itor g
luco
se le
vels
A
sk re
gula
rly fo
r sym
ptom
s of
hy
perg
lyca
emia
M
onito
r hep
atic
tran
sam
inas
es
(ALT
and
AST
) par
ticul
arly
dur
ing
the
first
18
wee
ks o
f the
rapy
w
hen
this
toxi
city
is m
ost l
ikel
y Ta
ke w
ith fo
od
Ant
iem
etic
s A
ntim
otili
ty
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
App
endi
ces
92
App
endi
x I
WH
O C
linic
al S
tagi
ng o
f HIV
AID
S fo
r A
dults
and
A
dole
scen
ts w
ith C
onfir
med
HIV
infe
ctio
n 92
App
endi
x II
C
ontr
acep
tive
Opt
ions
for
Peop
le L
ivin
g w
ith H
IV
95
App
endi
x II
I U
se o
f AR
Vs
for
Trea
tmen
t and
PM
TCT
of H
IV in
AN
C
97
App
endi
x IV
Use
Of A
RV
s fo
r PM
TCT
of H
IV in
Lab
our
And
Del
iver
y U
nit
98
App
endi
x V
Com
mon
Adv
erse
Effe
cts
of A
RV
Use
Dur
ing
Preg
nanc
y 99
App
endi
x V
I D
iagn
ostic
alg
orith
m fo
r pu
lmon
ary
TB in
Chi
ldre
n 10
0
App
endi
x V
II I
nteg
rate
d M
onito
ring
and
Eval
uatio
n Re
port
For
m M
OH
726
10
3
App
endi
x V
III
Rep
rodu
ctiv
e H
ealth
HIV
AID
S R
epor
t For
m M
OH
711
10
4
Lis
t of T
able
s
Tabl
e 1
1 A
dult
HIV
-pre
vale
nce
Est
imat
e by
Pro
vinc
e in
200
6 21
Tabl
e 1
2 E
stim
ated
Mag
nitu
de o
f MTC
T in
Ken
ya 2
007
22
Tabl
e 1
3 Tr
ansm
ission
Pat
tern
s in
Brea
stfee
ding
and
Non
bre
astfe
edin
g Pop
ulat
ions
23
Tabl
e 1
4 R
isk
Fact
ors
for
MTC
T of
HIV
24
Tabl
e 1
5 Th
e Fo
ur-p
rong
ed A
ppro
ach
App
lied
to th
e PM
TCT
Gui
delin
es
30
Tabl
e 2
1 E
ssen
tial P
acka
ge o
f Int
egra
ted
Ant
enat
al C
are
Serv
ices
33
Tabl
e 4
1 R
ecom
men
datio
ns fo
r In
itiat
ing
AR
V T
reat
men
t in
Preg
nant
Wom
en B
ased
on
Clin
ical
Sta
ge a
nd A
vaila
bilit
y of
CD
4 co
unt
44
Tabl
e 4
2 R
ecom
men
ded
Firs
t Lin
e A
RT
Reg
imen
for
Trea
ting
Preg
nant
Wom
en a
nd P
roph
ylac
tic R
egim
en fo
r In
fant
s 45
Tabl
e 4
3a R
ecom
men
ded
Firs
t Lin
e A
RV
Pro
phyl
axis
to P
reve
nt H
IV
46
Infe
ctio
n in
Infa
nts
Am
ong
preg
nant
Wom
en P
rese
ntin
gB
efor
e 38
Wee
ks
Tabl
e 4
3b A
ltern
ativ
e A
RV
Pro
phyl
axis
to P
reve
nt H
IV In
fect
ion
in In
fant
s 4
6 A
mon
g Pr
egna
nt W
omen
Pre
sent
ing
Bef
ore
38 W
eeks
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
9
9
47
IV
Wom
en w
ho h
ave
not r
ecei
ved
Intr
apar
tum
AR
T or
A
RV
Pro
phyl
axis
with
H
IV
Infe
ctio
n
Tabl
e 4
4 A
RV
Pro
phyl
axis
for
PMTC
T am
ong
Preg
nant
Wom
en w
ho h
ave
not r
ecei
ved
Ant
enat
al A
RT
or P
roph
ylax
is
App
endi
x Ta
ble
45
Cho
ice
of H
AA
RT
for
Preg
nant
Wom
en b
ased
on
CD
4 co
unt
47
Tabl
e 4
6 A
RV
Pro
phyl
actic
Reg
imen
s fo
r In
fant
s B
orn
to H
IV-p
ositi
ve
49
Tabl
e 9
1 D
ose
of C
o-tr
imox
azol
e fo
r PC
P pr
ophy
laxi
s 76
Tabl
e 9
2 W
HO
Rec
omm
enda
tions
for
Follo
w-u
p of
an
HIV
-exp
osed
Chi
ld
79
Tabl
e 10
1 C
ontr
acep
tive
Met
hods
for
Use
in C
oupl
es a
nd W
omen
Liv
ing
96
Figu
re 2
1 R
apid
HIV
Ser
ial T
estin
g A
lgor
ithm
35
Figu
re 8
1 G
uide
lines
for
Cou
nsel
ling
on H
IV a
nd In
fant
feed
ing
66
Job
Aid
s an
d IE
C M
ater
ials
on
Infa
nt a
nd Y
oung
Chi
ld F
eedi
ng
67
List
of F
igur
es
Figu
re 1
01
Mon
itori
ng a
nd E
valu
atio
n D
ata
Flow
in K
enya
84
September 0 8
USE OF ARVs FOR PMTCT OF HIV IN LABOUR AND DELIVERY UNITSALL MOTHERS
1 History 2 Examination3 Establish motherrsquos HIV status4 Offer HIV counseling and testing for mother with unknown HIV status5 Provide standard obstetrical management and care
HIV NEGATIVECounsel on risk reduction
HIV POSITIVE
Establish Motherrsquos use of ARVs in pregnancy and give appropriate ARVs as shown in boxesbelow
Regardless of Duration received HAART
Action
i Give mother ARV dose as per regimen
ii Post partu m Infant Give Infant sd Nevi rapine 2mgkg with in 72 hours of birthPL US 3T C 4mgkg BD for 1 w eek an d AZT syrup 4 m gkg BD for 6 w eeks
iii Post partum mother Continue w ith AR Vs as per regimen
MOTHE R RECEIVED HAART IN PREGNANCY
F OR MORE INFORMAT ION CONT ACT THE NATIONAL AIDSSTD CONTROL PROGRAMME (NASCOP)PO BO X 19361-00202 NAIROBI TEL 0202729502 FAX 020 2710518
MINISTRY OF HEALTH
bull G ive mo ther sd Nevirap ine 200m g AZT 600mg and 3TC 150 mg stat
bull Post partum Infant Give Infant sd Nevirapine 2mgkg within 72 ho urs of birth PL US
3TC syrup 4mg kg BD for 1 week and AZT syrup 4 mg kg BD fo r 6 w eeks
bull Post partum mother Give moth er AZT 300mg amp 3TC 150 mg BID for 7 d ays
MO THER RECEIVED AZT IN PREGNANCY OR NO ARVs TAKE N IN PREGNANCY
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
98
MINISTRY OF HEALTH
USE OF ARVs FOR TREATMENT AND PMTCT OF HIV IN ANC
App
endi
x II
I
Ack
now
ledg
emen
ts
ALL M O THERS1 History 2 Health Information3 Examination4 In vestigations (with informed consent for HIV test)
HIV NEGATIVE1 P rov id e pos t-te s t HIV pr ev e nti v e
i nter ve ntion s defi ned i n na tion alHT C gui de li nes
2 Re fe r for othe r p os t-te st HIVp re ve ntive inte rv e nti ons no tavai lable in the cli nic b ut avail ab le w ithi n the fa c ili ty
HIV PO SI TI VE1 C ounsel on risk reduction2 Per form WH O clinical staging for H IV disease3 D etermine CD 4 level (if testing facilities available)4 D etermine Gestation age and HB level5 Give ARVrsquos as shown below6 Provide or refer for other post-test HIV interventions defined in national HTC
guidelines
1 WHO clin ica l stage I o r II w ith CD4 cell co unt gt 350mm3 OR 2 WHO clin ica l stage I o r II no CD4 cell co unt do ne3 HB =8 gdl OR n o clinical feat ures of anaemia
bull Initiate AZT 30 0mg BD daily at 28 weeks gestation or any time periodimmediately there after
bull Monitor for clinical featur es of anemia and treatbull Dispense ANC Nev ir apine 200mg PLUS AZT 600mg + 3TC 1 50mg for
moth er to tak e at onset of labourbull Dispense NVP syrup to give infant at birth
bull At on set o f l abo uro Administer Nevirapine 20 0mg AZT 600mg 3TC 150 mg
stat to moth erbull Post p artum
o Give Infa nt sd Nevirapine 2mgk g within 72 hours ofbirth PLUS 3TC 4mg BD for 1 w eek and AZT syrup 4 mgkg BD for 6 w eeks
o Give mother AZT30 0 mg 3 TC 150 BID for 7 day s
1 WHO clinical stag e I or II with CD4 c ell count gt 35 0 mm3 OR 2 WHO clinical stag e I or II w ith no C D4 c ell c ount done
bull Dispense ANC Nevirapine 2 00mg PLUS AZ T 600 mg + 3TC 150mgfo r mo ther to take at onse t of labour
bull Dispense NVP sy rup to give infant at birthbull At Onset of lab our
o Administe r sd Nevirapine AZT 6 00 mg and 3TC1 50mg stat
bull Po st Par tu mo G iv e Infant sd Nev ir apine 2mg kg w ithin 72
h ours of bir th PLUS 3T C 4mgkg BD fo r 1 week a nd AZT syrup 4mgkg BD for 6 we eks
o G iv e mother AZ T300 mg 3TC 1 50 mg BID for 7d ays
1 Any gest ational age2 WHO clin ica l stage III or IV of HIV dis ease regardles s of CD4 cell count OR3 WHO clin ica l stages I or II of HIV d is ease with CD4 cell count =350mm3 ()
bull Refer to Clinician for Evaluation and initiation of NNRTI based ART as pernation al ART guidelines
bull At O nset of Lab ou ro G ive mo ther ARV dos e as per r egimen
bull Post par tumo G ive Infan t sd Nev ira pine 2mgkg within 72 hours of b irth PLUS
3TC 4mgkg and AZT syr up 4 mgkg BD for 6 weeks o G ive mo ther ARVs as per regimen
4 If no HAART av ailable man age the wo man as ind icated in box no2 a nd refer to ARTsite appro priately
F O R M OR E IN FOR M AT IO N CO N T AC T T H E N ATI ON A L A IDS STD C O NTR O L PR O G RAM ME ( N ASC O P)P O B OX 19361-00202 N AIR OBI TEL 0202729502 FAX 020 2710518
EL IGIBL E FO R T R EATMEN T
N O T E LIG IBLE FO R TR EA TM ET AN D PR ESE NTING B ELO W 3 8 W EE KSGESTA TIO N N OT ELIGIB LE FOR TREA TMEN T AN D PR ESE NTING gt 3 8 W EEK S
GE STATIO N
Plea se notebull Pregnan t w omen with WHO clinical stag e I or II plus CD4 cell co unt gt250 mm3 and = 350 mm3 can be initiated on ART wher e a PI based HAART re gimen is av ailable NVP hypersen sitivity h as been previously r eported amon g women in this gr oup initiated on N NRT I based
ART re gimens Where PI ba sed ART reg imen is not av ailab le r efer the patient to a site whe re th e regimen is availab le or c ontinue to ma nage th e w oman a s is indicated in box No 2bull The grading of ana emia in pregna ncy is gt 8-10 Milda nemia gt 6 -8 Moderate anem ia lt 6 Sever e anemiabull Treatment if common p ath ologies ruled out Mild anae mia haematinics irrespectiv e of gestatio n Moder ate a naemia tr ansfusion if close to term gt36 weeks otherwise give haema tinics Severe an aemia transfus ion irr espe ctive of ge statio n Do not stop AZT if Hb dr op s but
would manage it as above and only stop if continues to fall or fails to res pon d des pite transfusion
The
thir
d ed
ition
of
Gui
delin
es f
or P
reve
ntio
n of
Mot
her-
to-C
hild
Tra
nsm
issi
on o
f H
IV A
IDS
in K
enya
is a
res
ult o
f effo
rts
of m
any
indi
vidu
als
and
orga
niza
tions
in th
eco
untr
y T
he T
echn
ical
Wor
king
Gro
up o
n PM
TCT
led
thes
e ef
fort
s M
embe
rs o
f the
te
am r
evie
wed
all
the
mod
ules
rev
ised
and
in s
ome
case
s re
-wro
te th
e m
odul
es b
ased
on
the
seco
nd e
ditio
n to
mak
e th
em u
p to
dat
e an
d in
line
with
cur
rent
sci
entif
ic e
vishy
denc
e an
d ex
peri
ence
We
ackn
owle
dge
the
cont
ribu
tors
and
rev
iew
ers
of t
he c
urre
ntan
d pr
evio
us e
ditio
ns O
f sp
ecia
l m
entio
n ar
e th
e fo
llow
ing
Ken
ya O
bste
tric
al a
nd
Gyn
aeco
logi
cal S
ocie
ty (K
OG
S) t
he U
nive
rsity
of N
airo
bi a
nd M
oi U
nive
rsity
We
wou
ld l
ike
to t
hank
the
fol
low
ing
inst
itutio
ns f
or t
echn
ical
as
wel
l as
fin
anci
al
supp
ort
duri
ng t
he r
evis
ion
of t
he g
uide
lines
N
atio
nal A
IDS
and
STD
Con
trol
Pro
shygr
amm
e (N
ASC
OP)
the
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
Cen
ters
for
Dis
ease
Con
trol
and
Prev
entio
n (C
DC
) It
is n
ot p
ossi
ble
to m
entio
n al
l ind
ivid
uals
and
org
aniz
atio
ns
that
par
ticip
ated
in th
is im
port
ant e
xerc
ise
To
all o
f you
Asa
nte
Sana
Min
istr
y of
Hea
lth
September 2008
97
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
10
Fore
wor
d
The
Min
istr
y of
Hea
lth (
MoH
) is
com
mitt
ed t
o de
velo
pmen
t of
effe
ctiv
e PM
TCT
proshy
gram
mes
Gui
delin
es a
re a
n im
port
ant
part
of t
he G
over
nmen
t st
rate
gy t
o re
duce
MTC
Tan
d is
in
line
with
the
Nat
iona
l H
ealth
Sec
tor
Stra
tegi
c Pl
an I
I (N
HSS
PII)
and
Ken
yaN
atio
nal A
IDS
Stra
tegi
c Pl
an (K
NA
SP) 2
000-
2010
whi
ch fo
cuse
s on
pri
ority
are
as o
f pre
shyve
ntio
n of
new
infe
ctio
ns i
mpr
ovin
g qu
ality
of l
ife o
f tho
se in
fect
ed a
nd a
ffect
ed a
nd m
itishy
gatio
n of
soc
ial a
nd e
cono
mic
impa
ct o
f the
infe
ctio
n
MTC
T is
the
pre
dom
inan
t m
ode
of t
rans
mis
sion
of
HIV
in
infa
nts
and
youn
g ch
ildre
n
This
tra
nsm
issi
on o
ccur
s du
ring
pre
gnan
cy
labo
ur a
nd d
eliv
ery
and
am
ong
brea
stfe
d ba
bies
in
the
post
-par
tum
per
iod
Mem
bers
of t
he T
echn
ical
Wor
king
Gro
up (T
WG
) on
PMTC
T re
view
ed t
he m
odul
es o
f the
se
cond
edi
tion
rev
ised
and
in s
ome
case
s re
-wro
te th
e m
odul
es b
ased
on
up to
dat
e kn
owlshy
edge
and
in
line
with
cur
rent
sci
entif
ic e
vide
nce
and
expe
rien
ce T
he T
WG
con
sist
s of
agr
oup
of p
rofe
ssio
nals
dra
wn
from
var
ious
dis
cipl
ines
tha
t ar
e im
plem
entin
g an
dor
man
shyag
ing
PMTC
T T
he g
roup
ado
pted
and
ada
pted
the
late
st r
ecom
men
datio
ns o
f the
WH
O o
nPM
TCT
as w
ell a
s va
riou
s na
tiona
l gui
delin
es o
n H
IV p
reve
ntio
n tr
eatm
ent a
nd c
are
A f
our-
pron
ged
appr
oach
thr
ough
the
var
ious
rep
rodu
ctiv
e lif
e cy
cles
as
prop
osed
by
the
Inte
r-A
genc
y Ta
sk T
eam
(IA
TT)
on c
hild
ren
and
HIV
and
AID
S w
as a
dopt
ed i
n th
ese
guid
elin
es w
ith e
mph
asis
bei
ng p
lace
on
all t
he fo
ur p
rong
s
For
any
of t
he P
MTC
T in
terv
entio
ns t
o be
suc
cess
fully
impl
emen
ted
coun
selin
g an
d te
stshy
ing
(CT)
mus
t fir
st b
e do
ne R
outin
e H
IV te
stin
g w
ith o
pt-o
ut o
ptio
n is
rec
omm
ende
d T
his
is fo
llow
ed b
y ap
prop
riat
e m
edic
al s
urgi
cal i
nter
vent
ions
incl
udin
g an
tiret
rovi
ral p
roph
yshyla
xis
saf
er o
bste
tric
pra
ctic
es a
s w
ell a
s in
fant
feed
ing
coun
selin
g an
d pr
ovis
ion
of a
ppro
shypr
iate
infa
nt fe
edin
g H
IV-p
ositi
ve w
omen
are
ass
esse
d cl
inic
ally
usi
ng W
HO
sta
ging
and
whe
re f
easi
ble
imm
unol
ogic
al a
sses
smen
t us
ing
CD
4 ce
ll co
unt
HIV
exp
osed
infa
nts
are
test
ed th
roug
h ea
rly
infa
nt d
iagn
osis
(EID
)
In th
ese
guid
elin
es m
ore
effic
acio
us r
egim
ens
are
intr
oduc
ed fo
r th
e fir
st ti
me
whi
le in
forshy
mat
ion
and
coun
selin
g on
inf
ant
feed
ing
follo
ws
the
AFA
SS (
Ava
ilabl
e f
easi
ble
acc
eptshy
able
saf
e an
d su
stai
nabl
e) c
rite
ria
The
mod
ule
on m
onito
ring
and
eva
luat
ion
addr
esse
s is
sues
of d
ata
colle
ctio
n c
olla
tion
and
repo
rtin
g as
wel
l as
use
of d
ata
for
deci
sion
-mak
ing
at th
e fa
cilit
y-le
vel
We
hope
that
app
ropr
iate
impl
emen
tatio
n in
stru
men
ts w
ill b
e us
ed to
ope
ratio
naliz
e th
ese
guid
elin
es
Tabl
e 11
1
Con
trac
eptiv
e M
etho
ds fo
r Use
in
Cou
ples
and
Wom
en L
ivin
g w
ith H
IV In
fect
ion
MET
HO
D
CO
MM
ENTS
Con
dom
s bull
M
ale
amp f
emal
e co
ndom
s av
aila
ble
bull
P
rovi
de d
ual p
rote
ctio
n ag
ains
t STI
sH
IV
amp p
regn
ancy
bull
R
equi
re a
ttent
ion
amp ca
re
for c
orre
ct u
se e
ach
time
bull
M
ay re
quire
co-
oper
atio
n of
par
tner
Hor
mon
al
bull V
ery
effe
ctiv
e an
d ea
sy to
use
M
etho
ds
bull S
uita
ble
for s
hort-
or lo
ng-
term
use
bull
Rev
ersi
ble
bull A
ssoc
iate
d w
ith n
on-
cont
race
ptiv
e he
alth
ben
efits
bull
Ser
ious
com
plic
atio
ns
extre
mel
y ra
re
Intra
uter
ine
bull
H
ighl
y ef
fect
ive
long
-term
C
ontra
cept
ive
reve
rsib
le m
etho
d
Dev
ice
bull
Rem
ains
in p
lace
up
to 1
2 ye
ars
bull
A
lmos
t 100
per
cent
ef
fect
ive
bull
H
as n
o ef
fect
on
ferti
lity
whe
n us
ed b
y nu
llipar
ous
wom
en
bull
Sho
uld
not b
e pr
ovid
ed to
w
omen
with
hig
h ris
k se
xual
life
styl
e bull
B
acte
rial S
TIs
shou
ld b
e sc
reen
ed fo
r and
or
treat
ed a
s a
prec
autio
n pr
ior t
o in
serti
on o
f IU
CD
Ste
riliz
atio
n bull
Goo
d v
ery
effe
ctiv
e fo
r co
uple
s or
indi
vidu
als
who
w
ant n
o m
ore
child
ren
bull S
afe
sim
ple
surg
ical
pr
oced
ure
Con
side
red
perm
anen
t
US
E IN
HIV
PO
SITI
VE
PA
TIE
NTS
bull
Can
and
sho
uld
be u
sed
at a
ll st
ages
of H
IV
infe
ctio
n bull
C
an a
nd s
houl
d be
use
d by
pat
ient
s on
AR
T
bull
Cor
rect
and
con
sist
ent u
se b
y H
IV in
fect
ed p
atie
nts
is
reco
mm
ende
d re
gard
less
of t
he u
se o
f oth
er m
etho
ds
of c
ontra
cept
ion
(dua
l con
trace
ptio
n)
bull C
an b
e us
ed w
ithou
t res
trict
ion
in H
IV+
wom
en n
ot o
n AR
T bull
Can
be
used
with
out r
estri
ctio
n in
all
HIV
+ w
omen
for
emer
genc
y co
ntra
cept
ion
bull S
ome
AR
V dr
ugs
may
redu
ce m
etho
d ef
fect
iven
ess
bull
DM
PA
Im
plan
ts c
an h
owev
er b
e us
ed w
ith A
RT
reshy
inje
ctio
n of
DM
PA
sho
uld
be d
one
at 1
0-12
wee
ks
bull If
horm
onal
met
hod
is c
hose
n c
ondo
ms
shou
ld s
till b
e us
ed c
orre
ctly
and
con
sist
ently
bull
Attr
activ
e m
etho
d fo
r wom
en w
ith H
IV w
ho d
esire
ver
y re
liabl
e pr
egna
ncy
prot
ectio
n bull
C
an b
e in
serte
d in
HIV
+ w
omen
who
do
not h
ave
WH
O
Sta
ge 4
dis
ease
AID
S d
efin
ing
illne
ss
bull
For w
omen
with
sta
ge 4
dis
ease
IUD
can
be
inse
rted
once
they
are
on
ART
and
have
con
trolle
d sy
mpt
oms
of s
ever
e ill
ness
bull N
o m
edic
al re
ason
s to
den
y st
eriliz
atio
n to
clie
nts
w
ith H
IV
bull P
roce
dure
may
be
dela
yed
in e
vent
of a
cute
HIV
-rel
ated
in
fect
ion
or s
tage
4 d
isea
se p
endi
ng im
mun
e re
cons
titut
ion
bull E
ncou
rage
con
dom
use
as
wel
l
DM
PA =
Dep
ot M
edro
xypr
oges
tero
ne A
ceta
te (D
epo-
Prov
era)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
1
96
App
endi
x II
CO
NTR
AC
EPTI
VE
OPT
ION
SFO
R P
EOPL
E L I
VIN
G W
ITH
HIV
It
has
bee
n sh
own
in a
num
ber
of s
tudi
es o
f coh
orts
of H
IV p
ositi
ve w
omen
tha
t so
me
choo
se t
o co
ntin
ue s
exua
l act
ivity
des
pite
kno
wle
dge
of t
heir
sta
tus
Evi
denc
e of
con
shyce
ptio
n ha
s de
mon
stra
ted
that
fert
ility
in H
IV p
ositi
ve w
omen
for
the
mos
t pa
rt is
unshy
affe
cted
H
owev
er c
erta
in c
ondi
tions
may
affe
ct fe
rtili
ty s
uch
as lo
w b
ody
mas
s in
dex
A
IDS
and
inte
rcur
rent
illn
ess
esp
ecia
lly t
uber
culo
sis
Put
ting
wom
en w
ho a
re H
IV
infe
cted
on
cont
race
ptiv
es is
one
of t
he m
eans
of p
reve
ntin
g m
othe
r to
chi
ld t
rans
mis
shysi
on o
f HIV
(PM
TCT)
It is
the
rig
ht o
f HIV
infe
cted
wom
en t
o m
ake
thei
r ow
n de
cisi
ons
rega
rdin
g re
prod
ucshy
tion
The
y m
ay w
ish
to h
ave
mor
e ba
bies
lim
it th
eir
fam
ilies
or
avoi
d pr
egna
ncy
alto
shyge
ther
The
hea
lth c
are
prov
ider
s th
ey c
onsu
lt sh
ould
ena
ble
them
to
mak
e in
form
edch
oice
s by
them
selv
es
The
follo
win
g co
ntra
cept
ive
met
hods
are
ava
ilabl
e in
Ken
ya -
pro
gest
eron
e on
ly p
ills
lo
w d
ose
com
bine
d or
al c
ontr
acep
tives
de
pot
med
roxy
prog
este
rone
ace
tate
(D
MPA
shyde
po)
levo
norg
estr
el a
nd e
tono
gest
rel i
mpl
ants
Em
erge
ncy
cont
race
ptiv
e pi
lls c
oppe
rin
trau
teri
ne c
ontr
acep
tive
devi
ces
bar
rier
met
hods
fem
ale
and
mal
e st
erili
satio
n ar
e al
so a
vaila
ble
Som
e dr
ugs
inte
ract
with
hor
mon
al c
ontr
acep
tives
A
nd c
oncu
rren
t us
e sh
ould
be
avoi
ded
The
se d
rugs
incl
ude
bull P
rote
ase
inhi
bito
rs ndash
Rito
navi
r N
elfin
avir
Lop
inav
ir w
ith R
itona
vir
bull N
on-n
ucle
otid
e re
vers
e tr
ansc
ript
ase
inhi
bito
rs (
NN
RT
Is)
ndash N
evir
apin
e
bull E
favi
renz
bull A
nti-T
B d
rugs
ndash R
ifam
pici
n an
d R
ifabu
tin
bull O
ther
dru
gs ndash
Gris
eofu
lvin
P
heno
barb
itone
C
arba
maz
epin
e P
heny
toin
All
the
abov
e do
not
app
ly i
n th
e fa
ce o
f ot
her
med
ical
con
ditio
ns t
hat
are
cont
ra-
indi
catio
ns f
or t
he v
ario
us m
etho
ds e
g k
now
n ca
rdio
vasc
ular
dis
ease
hep
atic
con
dishy
tions
sm
okin
g h
igh
bloo
d pr
essu
re a
nd th
rom
boem
bolic
dis
orde
rs
The
follo
win
g ta
ble
sum
mar
ises
maj
or is
sues
reg
ardi
ng u
se o
f diff
eren
t co
ntra
cept
ives
by H
IV-p
ositi
ve w
omen
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Abb
revi
atio
ns a
nd A
cron
yms
AFA
SS
Acc
epta
ble
Fea
sibl
e A
fford
able
Sus
tain
able
and
Saf
e
Ab
Ant
i-bod
y
AID
S A
cqui
red
Imm
une
Def
icie
ncy
Synd
rom
e
ALT
Ala
nine
Tra
nsfe
rase
AN
C
Ant
enat
al C
are
AR
M
Art
ifici
al R
uptu
re o
f Mem
bran
es
AR
T
Ant
iret
rovi
ral T
hera
py
A
RV
A
ntir
etro
vira
l
AZT
A
zido
thym
idin
e (Z
idov
udin
e or
ZD
V)
AZT
3TC
Com
bivi
r
3TC
Lam
ivud
ine
BC
C
Beh
avio
ur C
hang
e C
omm
unic
atio
n
BC
G
Bac
ille
Cal
met
te G
ueri
ne v
acci
ne
BFH
I B
aby
Frie
ndly
Hos
pita
l Ini
tiativ
e
BID
BD
ldquoT
wic
e a
dayrdquo
CD
C (K
) C
entr
es fo
r D
isea
se C
ontr
ol a
nd P
reve
ntio
n K
enya
CN
S C
entr
al N
ervo
us S
yste
m
CS
Cae
sare
an S
ectio
n
CT
Cou
nsel
ling
and
Test
ing
CTX
CTZ
Cot
rim
oxaz
ole
d4T
Stav
udin
e
D
ASC
O
Dis
tric
t AID
SST
I Coo
rdin
ator
G
uid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
5
12
DB
S D
ried
Blo
od S
pot s
peci
men
DN
A
Deo
xyri
bonu
clei
c A
cid
DR
H
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
EC
V
Ext
erna
l Cep
halic
Ver
sion
EFV
Efa
vire
nz
EID
E
arly
Infa
nt D
iagn
osis
ELI
SA
Enz
yme
Link
ed Im
mun
osor
bent
Ass
ay
FBC
Fu
ll B
lood
Cou
nt
GTZ
G
erm
an T
echn
ical
Coo
pera
tion
HA
AR
T
Hig
hly
Act
ive
Ant
iret
rovi
ral T
hera
py
Hb
Hae
mog
lobi
n
HIV
H
uman
Imm
unod
efic
ienc
y Vi
rus
IATT
Inte
r-A
genc
y Ta
sk T
eam
IMC
I In
tegr
ated
Man
agem
ent o
f Chi
ldho
od Il
lnes
s
IPPT
Inte
rmitt
ent P
resu
mpt
ive
Trea
tmen
t for
Mal
aria
ITN
s In
sect
icid
es T
reat
ed N
ets
IUC
D
Intr
a U
teri
ne C
ontr
acep
tive
Dev
ice
KD
HS
Ken
ya D
emog
raph
ic a
nd H
ealth
Sur
vey
KE
PI
Ken
ya E
xpan
ded
Prog
ram
me
on Im
mun
izat
ion
KO
GS
Ken
ya O
bste
tric
al a
nd G
ynae
colo
gica
l Soc
iety
KN
H
Ken
yatt
a N
atio
nal H
ospi
tal
LAM
Lact
atio
nal A
men
orrh
oea
Met
hod
Mamp
E
Mon
itori
ng a
nd E
valu
atio
n
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
Cyt
omeg
alov
irus
infe
ctio
n (r
etin
itis
or in
fect
ion
of o
ther
org
ans)
9
Cen
tral
ner
vous
sys
tem
tox
opla
smos
is
10
HIV
enc
epha
lopa
thy
11
Ext
rapu
lmon
ary
cryp
toco
ccos
is in
clud
ing
men
ingi
tis
12
Dis
sem
inat
ed n
on-t
uber
culo
us m
ycob
acte
rial
infe
ctio
n
13
Pro
gres
sive
mul
tifoc
al le
ukoe
ncep
halo
path
y
14
Chr
onic
cry
ptos
pori
dios
is
15
Chr
onic
isos
poria
sis
16
Dis
sem
inat
ed m
ycos
is (
extr
apul
mon
ary
hist
opla
smos
is
or c
occi
diom
ycos
is)
17
Rec
urre
nt s
eptic
aem
ia (
incl
udin
g no
n-ty
phoi
dal S
alm
onel
la)
18
Lym
phom
a (c
ereb
ral o
r B
-cel
l non
-Hod
gkin
s)
19
Inv
asiv
e ce
rvic
al c
arci
nom
a
20
Aty
pica
l dis
sem
inat
ed le
ishm
ania
sis
21
Sym
ptom
atic
HIV
-ass
ocia
ted
neph
ropa
thy
or s
ympt
omat
ic H
IV-
asso
ciat
ed
22
Car
diom
yopa
thy
Ple
ase
note
S
igns
and s
ympto
ms
of
HIV
was
ting s
yndro
me
incl
ude
Unex
pla
ined
invo
lunta
ry w
eight
loss
(gt
10
base
line
body
wei
ght)
with o
bvi
ous
was
ting o
f body
mas
s in
dex
lt185
PLU
S
unex
pla
ined
chro
nic
dia
rrhoea
(lo
ose
or
wat
ery
stools
thre
e or
more
tim
es d
aily
) re
port
ed
for
longer
than
one
month
OR r
eport
s of
feve
r or
nig
ht
swea
ts f
or
more
than
one
month
w
ithout
oth
er c
ause
and lack
of
resp
onse
to a
ntibio
tics
or
antim
ala
rial ag
ents
M
ala
ria
must
be
excl
uded
in m
ala
ria
pro
ne
area
s
Fo
r th
e purp
ose
of
the
WH
O s
tagin
g s
yste
m
adole
sents
and a
dults
are
def
ined
as
adults
aged
ge15 y
ears
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
3
94
CLI
NIC
AL
STA
GE
3 1
Une
xpla
ined
sev
ere
wei
ght
loss
(gt1
0 o
f pr
esum
ed o
r m
easu
red
bo
dy w
eigh
t)
2
Une
xpla
ined
chr
onic
dia
rrho
ea fo
r lo
nger
tha
n on
e m
onth
3
Une
xpla
ined
per
sist
ent
feve
r (a
bove
37
5degC
inte
rmitt
ent
or c
onst
ant
for
long
er t
han
one
mon
th)
4
Per
sist
ent
oral
can
didi
asis
5
Ora
l hai
ry le
ukop
laki
a
6
Pul
mon
ary
tube
rcul
osis
7
Tub
ercu
lous
Lym
phad
enop
athy
8
Sev
ere
bact
eria
l inf
ectio
ns (
such
as
pneu
mon
ia
empy
ema
pyo
myo
sitis
bo
ne o
r jo
int
infe
ctio
n m
enin
gitis
or
bact
erae
mia
)
9
Acu
te n
ecro
tizin
g ul
cera
tive
stom
atiti
s g
ingi
vitis
or
perio
dont
itis
10
Une
xpla
ined
ana
emia
(lt8
gdl
) n
eutr
opae
nia
(lt0
5 times1
09 pe
rlitr
e) a
ndo
r ch
roni
c th
rom
bocy
topa
enia
(lt5
0times10
9 per
litr
e)
CLI
NIC
AL
STA
GE
4 1
HIV
was
ting
synd
rom
e
2
Pne
umoc
ystis
pne
umon
ia
3
Rec
urre
nt s
ever
e ba
cter
ial p
neum
onia
4
Chr
onic
her
pes
sim
plex
infe
ctio
n (o
rola
bial
ge
nita
l or
anor
ecta
l of
mor
e th
an o
ne
mon
thrsquos
dur
atio
n or
vis
cera
l at
any
site
)
5
Oes
opha
geal
can
didi
asis
(or
can
didi
asis
of
trac
hea
bro
nchi
or
lung
s)
6
Ext
rapu
lmon
ary
tube
rcul
osis
exc
ept
Tub
ercu
lous
Lym
ph a
deno
path
y
7
Kap
osirsquos
sar
com
a
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
MC
H
Mat
erna
l and
Chi
ld H
ealth
MoH
M
inis
try
of H
ealth
MSF
M
edic
ins
Sans
Fro
ntie
rs
M
TCT
Mot
her-
To-C
hild
Tra
nsm
issi
on
NA
SCO
P N
atio
nal A
IDS
and
STD
Con
trol
Pro
gram
me
NV
P
Nev
irap
ine
OD
ldquoO
nce
a D
ayrdquo
OI
Opp
ortu
nist
ic In
fect
ion
OPV
O
ral P
olio
Vac
cine
PASC
O
Prov
inci
al A
IDS
STI C
oord
inat
or
PCP
Pneu
moc
ystis
jiro
veci
i pne
umon
ia
PCR
Po
lym
eras
e C
hain
Rea
ctio
n
PI
Prot
ease
Inhi
bito
r
PLW
HA
Pe
rson
sPe
ople
Liv
ing
With
HIV
AID
S
PMTC
T
Prev
entio
n of
Mot
her
To C
hild
Tra
nsm
issi
on
RD
A
Rec
omm
ende
d D
aily
Allo
wan
ce
RH
Rep
rodu
ctiv
e H
ealth
RN
A
Rib
onuc
leic
Aci
d
SdN
VP
Si
ngle
dos
e N
evir
apin
e
SRH
Se
xual
and
Rep
rodu
ctiv
e H
ealth
STD
Se
xual
ly T
rans
mitt
ed D
isea
se
STI
Sexu
ally
Tra
nsm
itted
Infe
ctio
n
TB
Tube
rcul
osis
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
3
14
TBA
s Tr
aditi
onal
Bir
th A
tten
dant
s
TLC
To
tal L
ymph
ocyt
e C
ount
TT
Teta
nus
Toxo
id v
acci
ne
UN
ICE
F U
nite
d N
atio
ns C
hild
renrsquo
s Fu
nd
UN
GA
SS
Uni
ted
Nat
ions
Gen
eral
Ass
embl
y Sp
ecia
l Ses
sion
on
HIV
AID
S
UoN
Uni
vers
ity o
f Nai
robi
VC
T V
olun
tary
Cou
nsel
ling
and
Test
ing
VIA
V
isua
l Ins
pect
ion
usin
g A
ceto
ne
VD
RL
Ven
erea
l Dis
ease
Res
earc
h La
bora
tory
(tes
t for
syp
hilis
)
WH
O
Wor
ld H
ealth
Org
anis
atio
n
WR
P W
alte
r R
eed
Prog
ram
App
endi
x I
WH
O C
LIN
ICA
L S T
AG
ING
OF
HIV
AID
S FO
R A
DU
LTS
AN
D A
DO
LES-
CEN
TSW
ITH
CO
NFI
RM
ED H
IV IN
FEC
TIO
N
CLI
NIC
AL
STA
GE
1
bull
Asy
mpt
omat
ic
bull
Per
sist
ent
gene
raliz
ed ly
mph
aden
opat
hy
CLI
NIC
AL
STA
GE
2 1
Une
xpla
ined
mod
erat
e w
eigh
t lo
ss (
lt10
of
pres
umed
or
mea
sure
d bo
dy w
eigh
t)
2
Rec
urre
nt u
pper
res
pira
tory
tra
ct in
fect
ions
(si
nusi
tis
tons
illiti
s
otiti
s m
edia
and
pha
ryng
itis)
3
Her
pes
Zos
ter
4
Ang
ular
Che
ilitis
5
Rec
urre
nt o
ral u
lcer
atio
n
6
Pap
ular
pru
ritic
eru
ptio
ns
7
Seb
orrh
oeic
der
mat
itis
8
Fun
gal n
ail i
nfec
tions
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
5
92
Bib
liog
raph
y 1
Offic
e of
the
Pres
iden
t N
ational
AID
S C
ontr
ol Counci
l K
enya
Nat
ional H
IVA
IDS
Str
ate
gic
pla
n 2
0056
-20091
0
2
Rep
ublic
of
Ken
ya
Nat
ional AID
S C
ontr
ol C
ounci
l N
atio
nal H
IVA
IDS M
onitori
ng
and E
valu
atio
n F
ram
ework
3
Rep
ublic
of
Ken
ya
Nat
ional AID
S C
ontr
ol C
ounci
l N
atio
nal H
IVA
IDS M
onitori
ng
and E
valu
atio
n I
mple
men
tation M
anual
Job
Aid
sR
efer
ence
s 1
MoH
AN
C R
egis
ters
2
MoH
Mat
ernity
Reg
iste
rs
3
MoH
Post
-nata
l Reg
iste
rs
4
Mat
ernal
and C
hild
Wel
fare
Han
dbook
5
Rep
roduct
ive
Hea
lth S
ervi
ces
month
ly r
eport
6
MoH
Form
726
(Appen
dix
IV)
7
MoH
Form
727
8
MO
H F
orm
711
Exec
utiv
e Su
mm
ary
The
Rev
ised
Gui
delin
es (3
rd
editi
on) f
or P
reve
ntio
n of
Mot
her
to C
hild
Tra
nsm
issi
on(P
MTC
T) o
f H
IV a
nd A
IDS
addr
esse
s th
e ri
sks
of m
othe
r-to
-chi
ld t
rans
mis
sion
(MTC
T) o
f H
IV a
nd A
IDS
usin
g m
ore
effic
acio
us in
terv
entio
ns t
han
in t
he p
revi
ous
editi
ons
The
Gui
delin
es a
re i
n lin
e w
ith K
enya
rsquos N
atio
nal
Hea
lth S
ecto
r St
rate
gic
Plan
II
(NH
SSP
II)
and
are
anch
ored
on
the
Ken
ya N
atio
nal
AID
S St
rate
gic
Plan
(KN
ASP
) 20
00-2
010
whi
ch f
ocus
es o
n th
e pr
iori
ty a
reas
of
prev
entio
n of
new
inf
ecshy
tions
im
prov
ing
the
qual
ity o
f life
of p
eopl
e in
fect
ed a
nd a
ffect
ed b
y H
IV a
nd A
IDS
and
miti
gatio
n of
the
soc
ial a
nd e
cono
mic
impa
ct o
f the
infe
ctio
n O
ne o
f the
pri
ority
ar
eas
of N
HSS
P II
is
adhe
renc
e to
set
clin
ical
and
pub
lic h
ealth
sta
ndar
ds
The
Gui
delin
es w
ere
deve
lope
d th
roug
h a
part
icip
ator
y an
d co
nsul
tativ
e pr
oces
s th
at
drew
par
ticip
ants
fro
m p
ublic
hea
lth i
nstit
utio
ns
NG
Os
FB
Os
aca
dem
ic a
nd r
eshyse
arch
ins
titut
ions
and
dev
elop
men
t pa
rtne
rs
The
proc
ess
was
co-
ordi
nate
d by
N
ASC
OP
with
tech
nica
l and
fina
ncia
l sup
port
from
CD
C (K
)
HIV
infe
ctio
n ha
s re
vers
ed g
ains
rea
lised
in c
hild
hea
lth a
nd s
urvi
val i
n th
e la
st d
ecshy
ade
in K
enya
The
infe
ctio
n ha
s al
so c
ontr
ibut
ed s
igni
fican
tly t
o th
e co
mm
on c
ompl
ishyca
tions
of
preg
nanc
y in
man
y co
untr
ies
Glo
bally
mor
e th
an 6
300
00 c
hild
ren
wer
ein
fect
ed w
ith H
IV t
hrou
gh M
TCT
in 2
003
In
2007
K
enya
had
a p
opul
atio
n es
tishym
ated
at
34 m
illio
n t
he n
umbe
r of
bir
ths
per
annu
m w
as 1
73
mill
ion
the
HIV
prev
alen
ce a
mon
g pr
egna
nt m
othe
rs w
as 6
7 p
er c
ent
and
the
tota
l num
ber
of b
irth
s to
HIV
-infe
cted
mot
hers
exp
osed
to
MTC
T w
as 1
638
00
Ass
umin
g a
tran
smis
sion
rate
of 4
0 pe
r ce
nt a
nd in
the
abs
ence
of a
ny in
terv
entio
n t
he n
umbe
r of
HIV
pos
ishytiv
e in
fant
s pe
r an
num
wou
ld b
e 65
520
Ken
ya A
IDS
Indi
cato
r su
rvey
(KA
IS) 2
007
HIV
ser
opre
vale
nce
amon
g ad
ults
age
d 15
-49
year
s is
78
Var
ious
inte
rven
tions
hav
e be
en p
ut in
pla
ce t
o re
spon
d to
the
em
ergi
ng c
halle
nges
an
d co
nstr
aint
s to
MTC
T ac
ross
the
cou
ntry
Ana
lysi
s of
effe
ctiv
enes
s of
the
var
ious
ap
proa
ches
nee
ded
to m
anag
e ri
sks
of M
TCT
prov
ides
val
uabl
e in
sigh
ts th
at n
eces
sishy
tate
the
ado
ptio
n of
mor
e ef
ficac
ious
car
e an
d tr
eatm
ent
regi
men
s T
hese
ins
ight
s ha
ve in
form
ed t
he d
evel
opm
ent
of n
ew G
uide
lines
The
Gui
delin
es in
corp
orat
e th
ese
chan
ges
and
are
reco
mm
ende
d fo
r us
e by
hea
lth p
rofe
ssio
nals
and
hea
lth in
stitu
tions
at a
ll le
vels
of c
are
The
Gui
delin
es w
ill e
nhan
ce th
e ca
paci
ty o
f hea
lth c
are
prov
ider
sto
giv
e m
ore
effic
ient
and
effe
ctiv
e se
rvic
es t
o H
IV p
ositi
ve e
xpec
tant
mot
hers
and
ne
wbo
rns
The
Gui
delin
es h
ave
ten
chap
ters
and
cov
er th
e fo
llow
ing
just
ifyin
g th
e ne
ed fo
r sp
eshyci
fic m
anag
emen
t of
HIV
pos
itive
wom
en c
are
befo
re d
urin
g an
d af
ter
preg
nanc
yus
e of
ant
iret
rovi
ral t
hera
py in
pre
gnan
cy p
ostn
atal
car
e fa
mily
pla
nnin
g e
arly
inshy
fant
dia
gnos
is
feed
ing
car
e an
d fo
llow
-up
of H
IV-in
fect
ed i
nfan
ts
and
mon
itori
ng
and
eval
uatio
n A
dditi
onal
inf
orm
atio
n on
WH
O s
tagi
ng
cont
race
ptiv
e op
tions
for
PLW
As
and
a su
mm
ary
of A
RV
use
in P
MTC
T is
giv
en in
the
appe
ndic
es
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
1
16
The
Gui
delin
es h
ave
also
inc
orpo
rate
d ba
sic
info
rmat
ion
that
pro
gram
man
ager
sne
ed in
ord
er to
mak
e th
eir
inst
itutio
ns P
MTC
T-fr
iend
ly T
his
info
rmat
ion
is fo
und
in
the
boxe
s an
d ap
pend
ices
Sum
mar
ies
of t
he i
nfor
mat
ion
cont
aine
d in
the
tex
t ar
e fo
und
in th
e ta
bles
The
Gui
delin
es p
rovi
de a
bac
kgro
und
to t
he P
MTC
T pr
oble
m in
the
wor
ld i
n A
fric
a an
d in
Ken
ya T
hey
also
giv
e de
tails
on
HIV
in p
regn
ancy
the
tran
smis
sion
pat
tern
sof
MTC
T an
d de
scri
be t
he b
enef
its o
f pr
even
ting
mot
her-
to-c
hild
tra
nsm
issi
on(P
MTC
T) T
hey
also
pro
vide
info
rmat
ion
on in
terv
entio
ns n
eces
sary
to
redu
ce M
TCT
that
incl
ude
coun
selli
ng a
nd te
stin
g la
bora
tory
inve
stig
atio
ns o
bste
tric
inte
rven
tions
and
trea
tmen
tpro
phyl
axis
The
ante
nata
l man
agem
ent
for
HIV
pos
itive
wom
en i
nclu
ding
pol
icy
guid
e jo
b ai
dsw
ith s
umm
aris
ed e
ssen
tial p
acka
ge o
f int
egra
ted
ante
nata
l car
e se
rvic
es a
re d
etai
led
in C
hapt
er 2
Cha
pter
3 p
rovi
des
info
rmat
ion
on i
ntra
part
um c
are
Thi
s is
the
man
agem
ent
ofw
omen
from
the
onse
t of l
abou
r to
del
iver
y A
t thi
s st
age
it is
impo
rtan
t to
esta
blis
hth
e H
IV s
tatu
s of
wom
en p
rior
to d
eliv
ery
or d
urin
g la
bour
Gui
delin
es s
houl
d be
folshy
low
ed fo
r al
l wom
en a
dmitt
ed to
labo
ur a
nd d
eliv
ery
To
cond
uct v
agin
al d
eliv
erie
s fo
r H
IV p
ositi
ve w
omen
m
odifi
ed r
outin
e ca
re i
s gi
ven
The
gui
delin
es p
rovi
de a
reshy
min
der
on th
e ac
tiviti
es e
ssen
tial t
o ca
rry
out f
or s
afe
vagi
nal d
eliv
ery
for
all w
omen
no
t ju
st fo
r th
ose
infe
cted
with
HIV
It
is r
ecom
men
ded
that
the
re s
houl
d be
no
disshy
crim
inat
ion
or is
olat
ion
of H
IV p
ositi
ve w
omen
dur
ing
labo
ur a
nd d
eliv
ery
Del
iver
y th
roug
h el
ectiv
e ca
esar
ean
sect
ion
redu
ces
the
risk
of
HIV
MTC
T as
com
pare
d to
vagi
nal d
eliv
ery
amon
g H
IV p
ositi
ve w
omen
Whe
re C
S is
per
form
ed a
s an
em
erge
ncy
or e
lect
ivel
y a
ntib
iotic
s sh
ould
be
give
n
Ant
iret
rovi
ral (
AR
V) t
hera
py is
dis
cuss
ed in
det
ail i
n C
hapt
er 4
Thi
s in
clud
es t
hershy
apy
for
the
mot
her
befo
re la
bour
dur
ing
labo
ur a
nd a
fter
del
iver
y a
nd fo
r th
e in
fant
afte
r de
liver
y C
urre
ntly
N
evir
apin
e is
the
rec
omm
ende
d re
gim
en H
owev
er
shor
tco
urse
effi
caci
ous
AR
V d
rug
regi
men
s ca
n be
im
plem
ente
d in
res
ourc
e lim
ited
setshy
tings
AR
Vs
are
used
bot
h fo
r tr
eatm
ent
and
for
PMTC
T in
HIV
inf
ecte
d pr
egna
ntw
omen
and
thei
r ne
onat
es
Gui
delin
es f
or t
he p
ostp
artu
m c
are
of t
he m
othe
r an
d ca
re f
or H
IV e
xpos
ed in
fant
s ar
e de
taile
d in
Cha
pter
5 I
n C
hapt
er 6
the
Gui
de p
rovi
des
deta
iled
info
rmat
ion
on
late
pos
tnat
al c
are
and
fam
ily p
lann
ing
HIV
pos
itive
wom
en c
an u
se a
ll ty
pes
of fa
mshy
ily p
lann
ing
base
d on
sta
ndar
d el
igib
ility
cri
teri
a as
exp
licitl
y ou
tline
d in
the
text
Gui
delin
es fo
r in
fant
dia
gnos
is c
are
and
trea
tmen
t ar
e di
scus
sed
in C
hapt
er 7
Cur
shyre
ntly
the
re is
no
test
to
diffe
rent
iate
bet
wee
n an
tibod
ies
from
the
mot
her
and
thos
e pr
oduc
ed b
y th
e ba
by T
o id
entif
y H
IV in
fect
ed in
fant
s le
ss t
han
18 m
onth
s D
NA
or
RN
A ndash
PC
R te
st is
cur
rent
ly r
ecom
men
ded
HIV
exp
osed
infa
nts
at 6
wee
ks a
nd s
ick
infa
nts
at 1
2 m
onth
s sh
ould
hav
e ac
cess
to
DB
S fo
r D
NA
PC
R H
IV e
xpos
ed in
fant
ssh
ould
be
star
ted
on c
otri
mox
azol
e fr
om 6
wee
ks A
ll m
othe
rs w
ith 6
wee
k ol
d in
fant
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
E
Upt
ake
of c
ouns
ellin
g an
d te
stin
g in
Mat
erni
ty c
linic
Rat
io o
f m
ater
nity
clie
nts
with
unk
now
n H
IV s
tatu
s w
ho a
re c
ouns
elle
d an
d te
sted
for H
IV in
mat
erni
ty
Num
erat
or
Num
ber o
f pre
gnan
t wom
en a
dmitt
ed in
to m
ater
nity
with
un
know
n H
IV s
tatu
s th
at a
re c
ouns
elle
d an
d te
sted
for H
IV
durin
g la
bour
or a
fter d
eliv
ery
Den
omin
ator
N
umbe
r of p
regn
ant w
omen
adm
itted
into
mat
erni
ty
with
unk
now
n H
IV s
tatu
s
F
Mat
erni
ty m
othe
r AR
V pr
ophy
laxi
s up
take
R
atio
of H
IV in
fect
ed m
othe
rs in
mat
erni
ty c
linic
rece
ivin
g pr
even
tive
A
RV
pro
phyl
axis
Num
erat
or
Num
ber o
f HIV
-infe
cted
mot
hers
adm
itted
in m
ater
nity
takshy
ing
or re
porte
d to
hav
e ta
ken
the
mot
her d
ose(
s) o
f pre
venshy
tive
AR
V p
roph
ylax
is
Den
omin
ator
N
umbe
r of p
regn
ant w
omen
adm
itted
into
mat
erni
ty w
ho
are
HIV
-infe
cted
G
Infa
nt A
RV
prop
hyla
xis
upta
ke
Rat
io o
f inf
ants
bor
n to
HIV
-infe
cted
mot
hers
in m
ater
nity
clin
ic
rece
ivin
g pr
even
tive
AR
V p
roph
ylax
is
Num
erat
or
Num
ber o
f inf
ants
bor
n to
HIV
-infe
cted
mot
hers
who
rece
ive
prev
entiv
e
Den
omin
ator
N
umbe
r of i
nfan
ts b
orn
to H
IV-in
fect
ed m
othe
rs
Num
ber o
f pre
gnan
t wom
en a
dmitt
ed in
to m
ater
nity
who
are
H
IV-in
fect
ed is
use
d to
app
roxi
mat
e th
is n
umbe
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
7
90
With
the
mea
sure
men
ts li
sted
abo
ve t
he fo
llow
ing
perf
orm
ance
indi
cato
rs
for m
onito
ring
PMTC
T ac
tiviti
es a
re c
alcu
late
d
A
Upt
ake
of c
ouns
ellin
g an
d te
stin
g in
Ant
enat
al c
linic
R
atio
of a
nten
atal
clie
nts
who
wer
e co
unse
lled
and
test
ed fo
r HIV
Num
erat
or
This
is n
umbe
r of p
regn
ant w
omen
atte
ndin
g th
eir f
irst
ante
nata
l clin
ic v
isit
who
are
test
ed fo
r HIV
Den
omin
ator
N
umbe
r of n
ew v
isits
to th
e an
tena
tal c
linic
B
Ant
enat
al H
IV s
erop
reva
lenc
e
Rat
io o
f Ant
enat
al p
regn
ant w
omen
test
ed fo
r HIV
that
are
HIV
infe
cted
Num
erat
or
Num
ber o
f clie
nts
who
test
HIV
pos
itive
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
test
ed fo
r HIV
in a
nten
ashyta
l clin
ic
C
Ant
enat
al m
othe
r AR
V pr
ophy
laxi
s up
take
R
atio
of k
now
n H
IV in
fect
ed p
regn
ant w
omen
in a
nten
atal
clin
ic
rece
ivin
g A
RV
pre
vent
ive
prop
hyla
xis
Num
erat
or
Tota
l num
ber o
f HIV
-infe
cted
pre
gnan
t wom
en in
ant
enat
al
clin
ic re
ceiv
ing
mot
her p
reve
ntiv
e A
RV
pro
phyl
axis
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
who
are
HIV
-infe
cted
in
the
ante
nata
l clin
ic
D
Ant
enat
al in
fant
AR
V pr
ophy
laxi
s up
take
R
atio
of k
now
n H
IV-in
fect
ed p
regn
ant w
omen
in a
nten
atal
clin
ic w
ho
rece
ive
infa
nt d
ose(
s) o
f pre
vent
ive
AR
V p
roph
ylax
is
Num
erat
or
Tota
l num
ber o
f HIV
infe
cted
pre
gnan
t wom
en in
an
tena
tal c
linic
rece
ivin
g in
fant
dos
e(s)
pre
vent
ive
A
RV
pro
phyl
axis
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
who
are
HIV
-infe
cted
in
the
ante
nata
l clin
ic
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
shou
ld h
ave
rout
ine
HIV
ant
ibod
y te
st
Gui
delin
es f
or f
eedi
ng in
fant
s an
d yo
ung
child
ren
born
to
HIV
infe
cted
mot
hers
are
di
scus
sed
in C
hapt
er 8
The
Min
istr
y of
Hea
lth r
ecom
men
ds p
rom
otio
n of
exc
lusi
vebr
east
feed
ing
for
the
first
6 m
onth
s of
life
Whe
re r
epla
cem
ent f
eedi
ng is
acc
epta
ble
feas
ible
af
ford
able
su
stai
nabl
e an
d sa
fe (
AFA
SS)
avoi
danc
e of
bre
astf
eedi
ng b
yH
IV-in
fect
ed w
omen
is
reco
mm
ende
d (W
HO
200
6) D
iscu
ssio
n on
diff
eren
t ty
pes
offe
edin
g al
tern
ativ
es t
o br
east
feed
ing
is c
aptu
red
in t
he t
ext
Thes
e op
tions
exi
st f
orth
e m
othe
r to
cho
ose
with
the
aid
of
coun
selli
ng I
deal
ly c
oupl
e de
cisi
on-m
akin
g is
enco
urag
ed f
or t
he H
IV p
ositi
ve m
othe
r F
or t
he H
IV n
egat
ive
mot
her
exc
lusi
ve
brea
stfe
edin
g is
rec
omm
ende
d fo
r 6
mon
ths
or le
ss fo
llow
ed b
y w
eani
ng
Car
e an
d fo
llow
-up
of c
hild
ren
of H
IV-in
fect
ed m
othe
rs is
dis
cuss
ed in
det
ail i
n C
hapshy
ter
9 A
ll ch
ildre
n bo
rn t
o H
IV i
nfec
ted
mot
hers
sho
uld
be f
ollo
wed
up
clos
ely
from
birt
h th
roug
h 2
year
s T
able
92
pro
vide
s th
e W
HO
rec
omm
ende
d fo
llow
up
deta
ils
Sim
ilarl
y t
he m
othe
rs s
houl
d be
sup
port
ed t
o pr
ovid
e op
timal
infa
nt fe
edin
g an
d to
av
oid
mix
ed fe
edin
g w
ithin
6 m
onth
s
In C
hapt
er 1
0 t
he G
uide
lines
exp
lain
the
ben
efits
of
mon
itori
ng a
nd e
valu
atio
n of
PMTC
T pr
ogra
ms
Mamp
E p
rovi
des
an o
ppor
tuni
ty t
o m
easu
re a
nd a
ppra
ise
perf
orm
shyan
ce w
ithin
def
ined
tim
e fr
ame
to e
nsur
e ac
com
plis
hmen
t of s
et g
oals
and
obj
ectiv
es
PMTC
T se
rvic
es m
ust
be g
uide
d by
tim
ely
and
accu
rate
dat
a re
port
ed f
rom
the
heal
th f
acili
ties
thr
ough
the
dis
tric
t an
d pr
ovin
cial
lev
els
to
the
natio
nal
leve
l at
NA
SCO
P
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
9
18
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
(xiii
) H
IV in
fect
ed in
mat
erni
ty w
ard
Num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to
mat
erni
ty c
linic
who
are
HIV
infe
cted
In
clud
es b
oth
thos
e w
ho w
ere
adm
itted
al
read
y kn
owin
g th
ey a
re H
IV-i
nfec
ted
and
thos
e w
ho w
ere
test
ed a
nd r
ecei
ved
thei
r re
sults
in m
ater
nity
clin
ic T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(xiv
) P
reve
ntiv
e A
RV
pro
phyl
axis
in m
ater
nity
war
d (m
othe
r do
se)
Num
ber
of
preg
nant
wom
en a
dmitt
ed in
mat
erni
ty t
akin
g or
rep
orte
d to
hav
e ta
ken
the
mot
her
dose
(s)
of p
reve
ntiv
e A
RV
pro
phyl
axis
T
his
is o
btai
ned
from
the
m
ater
nity
reg
iste
r
(xv)
Inf
ant
prev
entiv
e A
RV
pro
phyl
axis
in m
ater
nity
clin
ic
war
d N
umbe
r of
inshy
fant
s bo
rn in
mat
erni
ty r
ecei
ving
the
infa
nt p
reve
ntiv
e A
RV
pro
phyl
axis
in t
he
mat
erni
ty c
linic
T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(xvi
) D
eliv
erie
s T
otal
num
ber
of p
regn
ant
wom
en d
eliv
erin
g at
the
hea
lth fa
cilit
y
(xvi
i) C
ouns
ellin
g on
infa
nt f
eedi
ng o
ptio
ns
Num
ber
of m
othe
rs d
eliv
erin
g at
the
he
alth
fac
ility
cou
nsel
led
on in
fant
fee
ding
opt
ions
T
his
is o
btai
ned
from
the
m
ater
nity
reg
iste
r
(xvi
ii) I
nfan
t te
stin
g at
6 w
eeks
bull N
umbe
r of
infa
nts
test
ed f
or H
IV a
t 6
wee
ks o
ld
bull N
umbe
r of
infa
nts
test
ing
HIV
-pos
itive
T
his
is o
btai
ned
from
labo
rato
ry
regi
ster
(xix
) R
efer
red
for
care
and
tre
atm
ent
bull N
umbe
r of
HIV
infe
cted
wom
en a
ttend
ing
ante
nata
l clin
ic t
hat
is r
efer
red
for
HIV
car
e an
d tr
eatm
ent
bull N
umbe
r of
HIV
infe
cted
wom
en in
mat
erni
ty t
hat
is r
efer
red
for
HIV
car
e an
d tr
eatm
ent
bull N
umbe
r H
IV in
fect
ed in
fant
s re
ferr
ed f
or H
IV c
are
and
trea
tmen
t T
his
is
ob
tain
ed f
rom
ant
enat
al a
nd m
ater
nity
reg
iste
rs
(xx)
Ini
tiate
d on
Cot
rim
oxaz
ole
Num
ber
of H
IV in
fect
ed p
regn
ant
wom
en a
ttend
ing
ante
nata
l clin
ic th
at h
as
been
initi
ated
on
Cot
rimox
azol
e T
his
is o
btai
ned
from
the
ant
enat
al r
egis
ter
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
9
88
Th
e da
ta is
pre
sent
ed u
sing
def
ined
per
form
ance
indi
cato
rs th
at in
clud
e th
e fo
llow
ing
(i)
New
clie
nts
first
ant
enat
al c
linic
vis
its
Num
ber
of p
regn
ant
wom
en a
ttend
ing
thei
r fir
st a
nten
atal
vis
it fo
r th
e cu
rren
t pr
egna
ncy
at t
he h
ealth
fac
ility
T
his
is
obta
ined
fro
m t
he a
nten
atal
reg
iste
r
(ii)
Ret
urn
visi
tsr
evis
its
Num
ber
of r
etur
n an
tena
tal c
linic
vis
itsr
evis
its
atte
nded
by
the
preg
nant
wom
en a
t th
e fa
cilit
y T
his
is o
btai
ned
from
the
an
tena
tal r
egis
ter
(iii)
C
ouns
ellin
g an
d te
stin
g fo
r H
IV in
ant
enat
al c
linic
Tot
al n
umbe
r of
pre
gnan
t w
omen
cou
nsel
led
and
test
ed f
or H
IV a
t th
e an
tena
tal c
linic
w
heth
er t
his
is d
one
on th
e fir
st a
nten
atal
vis
it or
a la
ter
visi
t T
his
is o
btai
ned
from
the
an
tena
tal r
egis
ter
(iv)
H
IV c
ouns
ellin
g an
d te
stin
g at
fir
st a
nten
atal
clin
ic v
isit
Num
ber
of p
regn
ant
wom
en a
tten
ding
the
ir fir
st a
nten
atal
clin
ic v
isit
for
curr
ent
preg
nanc
y w
ho a
re
test
ed f
or H
IV
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(v)
Lear
ning
HIV
sta
tus
in a
nten
atal
clin
ic
Num
ber
of a
nten
atal
clin
ic p
regn
ant
wom
en t
este
d fo
r H
IV w
ho r
ecei
ve t
heir
HIV
res
ults
w
heth
er t
his
is d
one
on t
he
first
ant
enat
al c
linic
vis
it or
at
a la
ter
visi
t T
his
is o
btai
ned
from
the
ant
enat
al
regi
ster
(vi)
HIV
infe
cted
in a
nten
atal
clin
ic
Num
ber
of a
nten
atal
clin
ic p
regn
ant
wom
en
who
are
HIV
-inf
ecte
d on
the
late
st t
est
durin
g th
e pr
egna
ncy
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(vii)
Pre
vent
ive
AR
V p
roph
ylax
is in
ant
enat
al c
linic
(m
othe
r do
se)
Num
ber
of
preg
nant
wom
en in
the
ant
enat
al c
linic
rec
eivi
ng t
he m
othe
r do
se(s
) of
pre
venshy
tive
AR
V p
roph
ylax
is
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(viii
) P
reve
ntiv
e A
RV
pro
phyl
axis
in a
nten
atal
clin
ic (
infa
nt d
ose)
N
umbe
r of
pr
egna
nt w
omen
in t
he A
nten
atal
clin
ic is
sued
with
the
infa
nt d
ose(
s) o
f pr
even
shytiv
e A
RV
pro
phyl
axis
T
his
is o
btai
ned
from
the
ant
enat
al r
egis
ter
(ix)
New
clie
nts
in m
ater
nity
clin
ic
Num
ber
of p
regn
ant
wom
en a
tten
ding
the
Mashy
tern
ity c
linic
for
the
firs
t tim
e T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(x)
Unk
now
n H
IV s
tatu
s at
mat
erni
ty
Num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to
the
mat
erni
ty w
ith u
nkno
wn
HIV
sta
tus
Thi
s is
obt
aine
d fr
om t
he m
ater
nity
reg
isshy
ter
(xi)
Cou
nsel
ling
and
test
ing
for
HIV
in m
ater
nity
war
dT
otal
num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to m
ater
nity
with
unk
now
n st
atus
tha
t ar
e co
unse
lled
and
test
ed fo
r H
IV d
urin
g la
bour
or
afte
r de
liver
y T
his
is o
btai
ned
from
the
mat
erni
ty
regi
ster
(xii)
Lea
rnin
g H
IV s
tatu
s in
mat
erni
ty w
ard
Num
ber
of p
regn
ant
wom
en a
dmitt
ed
into
mat
erni
ty a
nd t
este
d fo
r H
IV w
ho r
ecei
ved
thei
r H
IV r
esul
ts
Thi
s is
obt
aine
d fr
om t
he m
ater
nity
reg
iste
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Cha
pter
1
Bac
kgro
und
11
THE
GLO
BA
L P A
ND
EMIC
Ove
r 38
mill
ion
peop
le a
re li
ving
with
HIV
AID
S w
orld
wid
e a
nd a
bout
two-
thir
ds o
r 25
m
illio
n of
PLW
HA
liv
e in
sub
-Sah
aran
Afr
ica1
H
IVA
IDS
mai
nly
affe
cts
peop
le o
fre
prod
uctiv
e ag
e an
d in
crea
sing
ly a
ffect
s w
omen
w
ho n
ow a
ccou
nt f
or 5
7 o
f ne
win
fect
ions
in s
ub-S
ahar
an A
fric
a w
here
wom
en a
re 3
0 m
ore
likel
y to
be
livin
g w
ith
HIV
AID
S th
an m
en a
nd y
oung
wom
en a
ged
15-2
4 ar
e ne
arly
four
tim
es m
ore
likel
y to
be
inf
ecte
d th
an t
heir
mal
e co
unte
rpar
ts2
Youn
g m
arri
ed w
omen
w
ho a
re o
ften
m
onog
amou
s h
ave
beco
me
one
of t
he g
roup
s m
ost
vuln
erab
le t
o H
IV i
n th
e re
gion
Th
is r
equi
res
new
and
rap
id r
espo
nses
that
bro
aden
the
focu
s be
yond
trad
ition
al ldquoh
igh
risk
rdquo gro
ups
like
com
mer
cial
sex
wor
kers
tru
ck d
rive
rs a
nd d
rug
user
s
To r
each
you
ng m
arri
ed w
omen
w
ho m
ay n
ot b
e aw
are
of t
heir
vul
nera
bilit
y H
IV
AID
S pr
even
tion
ca
re
and
supp
ort
activ
ities
m
ust
be
inte
grat
ed
into
al
read
yes
tabl
ishe
d he
alth
ser
vice
s th
at a
re u
sed
by t
he g
ener
al p
opul
atio
n A
n es
timat
ed
630
000
child
ren
wor
ld-w
ide
beca
me
infe
cted
with
HIV
in
2003
mdash m
ost
thro
ugh
MTC
T3
The
risk
of
an H
IV-in
fect
ed m
othe
r pa
ssin
g th
e vi
rus
to h
er i
nfan
t du
ring
pr
egna
ncy
labo
ur a
nd d
eliv
ery
or in
the
post
nata
l per
iod
is 1
in 3
if n
othi
ng is
don
e to
re
duce
this
ris
k I
n ot
her
wor
ds o
ut o
f 100
infa
nts
born
to w
omen
with
HIV
AID
S an
d w
ithou
t in
terv
entio
n 6
0-75
of t
hem
will
not
be
infe
cted
Of t
he o
ne-t
hird
who
bec
ome
infe
cted
abo
ut 5
-10
babi
es w
ill b
e in
fect
ed d
urin
g pr
egna
ncy
15
will
be
infe
cted
dur
ing
labo
ur a
nd d
eliv
ery
whi
le 5
-15
will
be
infe
cted
dur
ing
brea
stfe
edin
g l
arge
ly b
eing
de
pend
ent
on b
reas
tfee
ding
pra
ctic
es a
nd o
n th
e du
ratio
n of
bre
astfe
edin
g4 I
n 20
03
near
ly 5
000
00 c
hild
ren
died
of A
IDS-
rela
ted
caus
es M
ost
child
ren
born
with
HIV
die
befo
re th
ey r
each
thei
r fif
th b
irth
day
with
mos
t not
sur
vivi
ng b
eyon
d tw
o ye
ars5
The
high
rat
es o
f M
TCT
in d
evel
opin
g co
untr
ies
com
pare
d to
muc
h lo
wer
rat
es i
nri
cher
cou
ntri
es
illus
trat
e gr
owin
g in
equa
litie
s in
glo
bal
heal
th
In t
he w
ealth
y co
untr
ies
the
rat
e of
MTC
T is
les
s th
an 2
b
ecau
se o
f w
ides
prea
d ac
cess
to
antishy
retr
ovir
al th
erap
y (A
RT)
pla
nned
cae
sare
an s
ectio
ns (C
S) t
he m
eans
to s
afel
y fo
rmul
afe
ed a
nd a
cces
s to
qua
lity
med
ical
ser
vice
s I
n po
orer
cou
ntri
es li
ke K
enya
the
re is
a
30-4
0 c
hanc
e th
at a
n H
IV-p
ositi
ve b
reas
tfee
ding
mot
her
will
pas
s H
IV to
her
chi
ld in
th
e ab
senc
e of
the
se s
ervi
ces
In
such
set
tings
it
is c
ritic
al t
hat
prev
entio
n pr
oced
ures
be i
nteg
rate
d in
to e
xist
ing
sexu
al a
nd r
epro
duct
ive
heal
th (
SRH
) an
d m
ater
nal
and
child
hea
lth (
MC
H)
serv
ices
re
achi
ng a
s m
any
wom
en a
s po
ssib
le a
nd l
ower
ing
tran
smis
sion
rat
es A
lthou
gh p
harm
aceu
tical
com
pany
don
atio
ns d
onor
sup
port
and
othe
r go
vern
men
t in
itiat
ives
hav
e he
lped
exp
and
acce
ss t
o H
IV t
estin
g fo
r pr
egna
ntw
omen
and
use
of a
ntir
etro
vira
l dru
gs li
ke N
evir
apin
e w
hich
red
uce
the
chan
ce o
f HIV
tr
ansm
issi
on s
till o
nly
10
of p
regn
ant w
omen
glo
bally
hav
e ac
cess
to th
ese
drug
s6
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
7
20
HIV
AID
S tr
ansm
issi
on fr
om m
othe
r to
chi
ld in
Ken
ya is
one
of t
he b
igge
st h
ealth
and
de
velo
pmen
t cha
lleng
es in
Ken
ya A
ccor
ding
to th
e 20
03 D
emog
raph
ic a
nd H
ealth
Sur
shyve
y7 6
7
or
over
12
mill
ion
Ken
yan
adul
ts w
ere
livin
g w
ith H
IVA
IDS
in 2
003
The
re
has
been
a s
tead
y de
clin
e in
HIV
ser
opre
vale
nce
in K
enya
In
2005
the
pre
vale
nce
rate
w
as e
stim
ated
at 5
9
and
as
per
the
2006
sta
tistic
s th
e pr
eval
ence
rat
e am
ong
adul
tsha
d dr
oppe
d to
51
8
Acc
ordi
ng t
o 20
07 K
enya
AID
S In
dica
tor
Surv
ey (
KA
IS)8a
the
H
IV s
erop
reva
lenc
e in
Ken
ya is
cur
rent
ly 7
8
am
ong
adul
ts a
ged
15-4
9 ye
ars
bei
nghi
gher
in
wom
en (
87
) th
an i
n m
en (
56
) Y
oung
wom
en a
re m
ore
vuln
erab
le i
n K
enya
tha
n m
en a
s ev
iden
ced
by a
nea
rly
9 p
reva
lenc
e ra
te a
mon
g w
omen
and
unshy
der
5 a
mon
g m
en9
Ther
e ar
e w
ide
vari
atio
ns b
etw
een
urba
n an
d ru
ral
area
s b
etw
een
regi
ons
bet
wee
n ad
ults
and
you
ng p
eopl
e an
d be
twee
n m
en a
nd w
omen
The
re h
as b
een
a no
tabl
e dr
op
in t
he n
umbe
r of
new
inf
ectio
ns
with
an
estim
ated
60
000
new
inf
ectio
ns i
n 20
05
drop
ping
to 5
500
0 in
200
6 In
fant
s an
d yo
ung
child
ren
unde
r 15
yea
rs a
ccou
nt fo
r 16
of
all
new
HIV
infe
ctio
ns m
ainl
y as
a r
esul
t of M
TCT
Mos
t of t
he n
ew in
fect
ions
occ
ur
amon
g yo
ung
peop
le i
n w
hom
the
mai
n m
ode
of t
rans
mis
sion
is t
hrou
gh s
exua
l int
ershy
cour
se
Tabl
e 1
1 A
dult
HIV
-Pre
vale
nce
Estim
ate
by P
rovi
nce
in 2
006
Prov
ince
N
umbe
r of H
IV +
Pre
vale
nce
()
Nai
robi
Cen
tral
Coa
st
Eas
tern
N E
aste
rn
Nya
nza
Rift
Val
ley
Wes
tern
Tota
l
197
000
960
00
930
00
720
00
900
0 18
300
0
171
000
112
000
11
milli
on
Tota
l
101
41
59
28
14
78
38
53
51
Mal
e
80
17
50
11
09
61
26
42
35
Fem
ale
123
65
69
44
18
96
49
64
67
Mal
eFe
mal
e R
atio
15
38
14
40
20
16
19
15
19
all t
he d
ata
from
the
prov
ince
s (a
nd r
efer
ral h
ospi
tals
) Th
e ag
greg
ated
dat
a is
di
ssem
inat
ed t
o th
e H
ealth
Man
agem
ent
Info
rmat
ion
Syst
em N
atio
nal A
IDS
Con
trol
Cou
ncilrsquo
s (N
AC
C)
natio
nal
data
ban
k an
d re
sour
ce c
entr
e T
he f
ocal
pe
rson
s he
re a
re t
he d
irec
tor
NA
CC
and
the
Mamp
E m
anag
er D
ata
is d
isse
mishy
nate
d ba
ck to
the
prov
ince
s an
d re
ferr
al h
ospi
tals
for
use
in d
ecis
ion-
mak
ing
7
Dat
a flo
w f
rom
fac
ility
lev
el t
o na
tiona
l le
vel
At
the
heal
th f
acili
ty P
MTC
T in
divi
dual
le
vel d
ata
reco
rded
in t
he M
oH s
tand
ardi
sed
regi
ster
s (A
NC
Mashy
tern
ity a
nd P
ostn
atal
) is
sum
mar
ised
ag
greg
ated
on
a m
onth
ly b
asis
ont
o M
oH F
orm
726
F
orm
726
is
then
for
war
ded
upw
ards
to
the
dist
rict
Lev
el
(DA
SCO
rsquos O
ffice
) for
agg
rega
tion
of th
e D
istr
ict l
evel
dat
a on
to F
orm
727
Cop
shyie
s of
For
m 7
26 a
nd F
orm
727
are
forw
arde
d to
the
Nat
iona
l Offi
ce (N
ASC
OP)
w
ith a
noth
er c
opy
of F
orm
727
bei
ng s
ent t
o th
e Pr
ovin
cial
Offi
ce (P
ASC
O)
8
Dat
a di
ssem
inat
ion
Thi
s is
car
ried
out
at
all
leve
ls s
tart
ing
from
fac
ility
to
natio
nal l
evel
It i
s th
e re
spon
sibi
lity
of N
AC
C to
coo
rdin
ate
the
diss
emin
atio
n an
d us
e of
all
HIV
AID
S da
ta a
nd in
form
atio
n fo
r na
tiona
l res
pons
e J
APR
a
join
t pro
gram
me
of a
ll st
akeh
olde
rs in
HIV
AID
S re
ceiv
es a
nd u
ses
the
data
to
disc
uss
the
chal
leng
es a
chie
vem
ents
and
les
sons
lea
rnt
from
HIV
AID
S an
d gi
ves
feed
back
for n
atio
nal r
espo
nse
9
PMTC
T in
dica
tors
and
thei
r so
urce
s H
ealth
car
e fa
cilit
ies
colle
ct th
e fo
llow
ing
data
as
a m
inim
um t
o be
use
d in
the
mon
itori
ng o
f PM
TCT
prog
ram
s T
he
data
is
to b
e ag
greg
ated
on
a m
onth
ly b
asis
ont
o th
e M
inis
try
of H
ealth
In
tegr
ated
Mon
itori
ng a
nd E
valu
atio
n R
epor
t For
m M
oH 7
26 u
sing
dat
a fr
om
the
Min
istr
y of
Hea
lth
Ken
ya A
nten
atal
and
Mat
erni
ty R
egis
ters
(D
eliv
ery
Reg
iste
r) M
oH 4
05 a
nd M
oH 3
33 r
espe
ctiv
ely
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
1
86
102
O
PER
ATI
ON
AL
GU
IDEL
INES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed in
the
mon
itorin
g an
d ev
alua
-tio
n of
PM
TCT
serv
ices
1
W
ithin
PM
TCT
prog
ram
s d
ata
is c
olle
cted
and
rep
orte
d at
the
fol
low
ing
leve
ls I
ndiv
idua
l fa
cilit
y d
istr
ict
prov
inci
al a
nd n
atio
nal
2
Indi
vidu
al l
evel
The
com
bine
d m
othe
r an
d ch
ild h
ealth
boo
klet
pro
vide
s de
shyta
iled
info
rmat
ion
on t
he w
oman
and
chi
ld i
nclu
ding
the
HIV
sta
tus
oth
er
HIV
car
e se
rvic
es d
rugs
del
iver
y in
form
atio
n im
mun
isat
ion
gro
wth
mon
itorshy
ing
and
othe
r par
amet
ers
3
Faci
lity
leve
l da
ta c
aptu
re t
ools
The
MoH
has
sta
ndar
dise
d re
gist
ers
for
reshy
cord
ing
data
at
faci
litie
s T
hese
inc
lude
the
Rev
ised
AN
C R
egis
ter
Rev
ised
M
ater
nity
Reg
iste
r an
d Po
st N
atal
Reg
iste
r an
d W
orkl
oad
MO
H 7
17 O
ther
re
gist
ers
incl
ude
Chi
ld H
ealth
and
Nut
ritio
n In
form
atio
n Sy
stem
and
Inshy
patie
nt M
orbi
dity
and
Mor
talit
y F
orm
711
and
the
Rep
rodu
ctiv
e H
ealth
Ser
shyvi
ces
mon
thly
rep
orts
are
use
d fo
r m
akin
g fa
cilit
y le
vel s
umm
arie
s on
PM
TCT
and
repr
oduc
tive
heal
th s
ervi
ces
3 F
acili
ty le
vel d
ata
capt
ure
tool
s T
he M
oH
has
stan
dard
ized
reg
iste
rs f
or r
ecor
ding
dat
a at
fac
ilitie
s T
hese
inc
lude
the
R
evis
ed A
NC
Reg
iste
r R
evis
ed M
ater
nity
Reg
iste
r an
d Po
st N
atal
Reg
iste
r an
d w
orkl
oad
MO
H 7
17 O
ther
reg
iste
rs in
clud
e C
hild
Hea
lth a
nd N
utri
tion
Info
rmat
ion
Syst
em a
nd I
n-pa
tient
mor
bidi
ty a
nd m
orta
lity
Fo
rm 7
26 a
nd
the
Rep
rodu
ctiv
e he
alth
ser
vice
s m
onth
ly r
epor
ts a
re u
sed
for
mak
ing
faci
lity
leve
l sum
mar
ies
on P
MTC
T an
d re
prod
uctiv
e he
alth
ser
vice
s
4
Dis
tric
t le
vel
data
For
m 7
27 i
s us
ed t
o su
mm
aris
e an
d re
port
dis
tric
t le
vel
data
Oth
er s
umm
ary
repo
rtin
g to
ols
are
also
use
d to
rep
ort
dist
rict
leve
l inshy
form
atio
n A
t th
e di
stri
ct le
vel
the
DAS
CO
rsquos of
fice
aggr
egat
es d
ata
from
sev
shyer
al h
ealth
faci
lity
spec
ific
Form
726
ont
o Fo
rm 7
27 th
at is
use
d to
sum
mar
ise
and
repo
rt d
istr
ict l
evel
dat
a
5
Prov
inci
al l
evel
dat
a A
t th
e pr
ovin
cial
lev
el t
he P
ASC
O r
ecei
ves
Form
727
da
ta f
rom
the
res
pect
ive
DA
SCO
rsquos of
fices
in
the
prov
ince
for
the
ir o
wn
data
us
e an
d re
cord
s A
cop
y of
the
sam
e is
sen
t to
the
Nat
iona
l Offi
ce (N
ASC
OP)
by
the
DA
SCO
rsquos of
fice
At
the
prov
inci
al le
vel
the
dist
rict
leve
l dat
a is
agg
reshy
gate
d to
giv
e th
e pr
ovin
cial
leve
l dat
a
6 N
atio
nal
leve
l da
ta
At
the
natio
nal
leve
l th
e M
ampE
Man
ager
rec
eive
s da
ta
from
the
PASC
Os
for
each
of t
he p
rovi
nces
Dat
a is
als
o re
ceiv
ed fr
om th
e R
eshyfe
rral
hos
pita
ls a
nd o
ther
fac
ilitie
s at
the
ref
erra
l ho
spita
l or
ter
tiary
lev
el
The
data
rec
eive
d at
the
nat
iona
l lev
el is
als
o co
pied
to
the
Hea
d of
NA
SCO
P an
d PM
TCT
prog
ram
me
man
ager
The
Mamp
E m
anag
er a
t NA
SCO
P ag
greg
ates
85
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
12
MA
GN
ITU
DE
OF
HIV
IN P
REG
NA
NC
YIN
KEN
YA
Ken
ya N
atio
nal
AID
SST
I C
ontr
ol P
rogr
amm
e (N
ASC
OP)
est
imat
es t
hat
ther
e w
ere
12
mill
ion
babi
es b
orn
in 2
006
in K
enya
and
that
as
man
y as
9
of p
regn
ant w
omen
inK
enya
wer
e liv
ing
with
HIV
AID
S10
At
leas
t 50
000
to
600
00 i
nfan
ts i
n K
enya
wer
e th
ough
t to
hav
e be
en i
nfec
ted
with
H
IV a
s a
resu
lt of
MTC
T th
at y
ear
With
an
estim
ated
pop
ulat
ion
of 3
72
mill
ion
in th
eye
ar 2
007
the
num
ber
of b
irth
s in
200
7 w
as 1
73
mill
ion
With
an
HIV
pre
vale
nce
of 6
7
the
num
ber
of H
IV -
expo
sed
babi
es is
114
101
and
at
leas
t 45
640
HIV
-pos
itive
bab
ies
are
born
ass
umin
g a
40
tran
smis
sion
(Tab
le 1
2)
Tabl
e 1
2 E
stim
ated
mag
nitu
de o
f MTC
T in
Ken
ya 2
007
Popu
latio
n (E
stim
ates
200
7)
372
mill
ion
Birt
hs p
er a
nnum
1
73 m
illio
n
HIV
pre
vale
nce
in m
othe
rs
67
Tota
l num
ber o
f birt
hs to
HIV
-infe
cted
mot
hers
exp
osed
14
110
1 to
MTC
T as
sum
ing
no m
ultip
le p
regn
ancy
Num
ber o
f HIV
pos
itive
infa
nts
per a
nnum
in K
enya
45
640
as
sum
ing
40
tran
smis
sion
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
22
13
RIS
KS
OF
T RA
NSM
ISSI
ON
OF
MTC
T A
T D
IFFE
REN
T
T
IME
P ER
IOD
S
In K
enya
an
estim
ated
40
000
to 5
000
0 in
fant
s ar
e in
fect
ed w
ith H
IV a
nnua
lly d
ue to
m
othe
r-to
-chi
ld t
rans
mis
sion
Th
is c
an o
ccur
in u
tero
dur
ing
labo
ur a
nd d
eliv
ery
and
thro
ugh
brea
stfe
edin
g D
urin
g pr
egna
ncy
abo
ut 5
to
8 pe
rcen
t of
HIV
-exp
osed
bab
ies
beco
me
infe
cted
thr
ough
tra
nsm
issi
on a
cros
s th
e pl
acen
ta L
abou
r an
d de
liver
y po
ses
the
grea
test
ris
k fo
r tr
ansm
issi
on w
ith 1
0 to
20
perc
ent
of e
xpos
ed i
nfan
ts b
ecom
ing
infe
cted
at t
his
time
Bre
astf
eedi
ng a
lso
expo
ses
infa
nts
to H
IV
Whe
n m
othe
rs b
reas
tfee
d fo
r 18
to
24m
onth
s an
othe
r 10
to 1
5 pe
rcen
t of i
nfan
ts b
ecom
e in
fect
ed T
hus
in n
on-b
reas
tfee
ding
po
pula
tions
with
out
antir
etro
vira
l tre
atm
ent
appr
oxim
atel
y 15
to
30 p
erce
nt in
fant
s w
ill b
ecom
e in
fect
ed
with
pro
long
ed b
reas
tfee
ding
25
to
45 p
erce
nt i
nfan
ts w
ill
beco
me
infe
cted
Tabl
e 1
3 T
rans
mis
sion
pat
tern
s in
bre
astfe
edin
g an
d no
n br
east
feed
ing
popu
latio
ns
Tran
smis
sion
rate
in
Tim
ing
No
Bre
astfe
edin
g B
reas
tfeed
ing
Bre
astfe
edin
g th
roug
h
thro
ugh
6
mon
ths
18 to
24
mon
ths
Dur
ing
preg
nanc
y 05
to 1
0 05
to 1
0 05
to 1
0
Dur
ing
labo
ur
10 to
20
10 to
20
10 to
20
Thro
ugh
brea
stfe
edin
g 10
to 2
0 05
to 1
0 05
to 1
0
Ear
ly (f
irst 2
mon
ths)
10
to 2
0 05
to 1
0 05
to 1
0
Late
(afte
r 2 m
onth
s)
10 to
20
01 to
05
05 to
10
Ove
rall
15 to
30
25 to
35
30 to
45
Sou
rce
De
Coc
k K
M (2
002)
Form
MoH
711
has
bee
n re
com
men
ded
to r
epla
ce F
orm
MoH
726
HIV
Mamp
E d
ata
flow
pip
elin
e fr
om t
he i
ndiv
idua
l he
alth
fac
ilitie
s t
o th
e di
stri
ct a
ndpr
ovin
cial
leve
ls u
p to
the
cent
ral o
r na
tiona
l lev
els
at N
ASC
OP
and
NA
CC
is s
umm
ashyri
sed
in F
igur
e 1
01
Figu
re 1
01
HIV
Mon
itorin
g an
d Ev
alua
tion
data
flow
pip
elin
e in
Ken
ya
HM
IS
NA
SC
OP
N
ACC
H
ead
Nat
iona
l Dat
a B
ank
amp
Res
ourc
e C
entre
M
E M
anag
er
The
Dire
ctor
P
rogr
amm
e M
anag
er
ME
Man
ager
Ref
erra
l Hos
pita
ls
CE
Os
Spe
cial
ists
The
Prov
ince
P
MO
P
AS
CO
P
AR
TO
PH
RIO
P
CO
The
Dis
trict
D
MO
D
AS
CO
Dat
a en
try
cler
k D
AR
TO
DH
RIO
Hea
lth F
acilit
y P
ublic
Sec
tor
FBO
etc
23
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
84
Cha
pter
10
Mon
itorin
g an
d Ev
alua
tion
of P
MTC
T Se
rvic
es
101
IN
TRO
DU
CTI
ON
PMTC
T pr
ogra
m m
onito
ring
and
eva
luat
ion
activ
ities
pro
vide
the
oppo
rtun
ity to
mea
sshyur
e an
d ap
prai
se p
erfo
rman
ce w
ithin
def
ined
par
amet
ers
that
ens
ure
acco
mpl
ishm
ent
of g
oals
and
obj
ectiv
es
Ken
ya is
com
mitt
ed to
the
ldquoThr
ee-o
nesrdquo
pri
ncip
les
whi
ch a
re
bull O
ne a
gree
d A
IDS
Act
ion
Fra
mew
ork
that
pro
vide
s th
e ba
sis
for
coor
dina
ting
the
wor
k pl
an o
f al
l par
tner
s
bull O
ne N
atio
nal A
IDS
Coo
rdin
atin
g A
utho
rity
with
a b
road
-bas
ed
mul
tisec
tora
l man
date
bull O
ne a
gree
d co
untr
y-le
vel M
onito
ring
and
Eva
luat
ion
(M
ampE
) sy
stem
In l
ine
with
thi
s t
he c
ount
ry h
as d
evel
oped
the
Nat
iona
l H
IVA
IDS
Mon
itori
ng a
ndE
valu
atio
n Fr
amew
ork
that
pro
vide
s st
akeh
olde
rs w
ith a
too
l fo
r w
ell
coor
dina
ted
in
terl
inke
d an
d fu
nctio
nal H
IVA
IDS
Mamp
E s
yste
m t
hat
allo
ws
for
effic
ient
mon
itori
ngof
int
erve
ntio
ns i
n ac
hiev
ing
the
natio
nal
prog
ram
mat
ic g
oals
usi
ng d
efin
ed t
arge
ts
This
pro
vide
s th
e fr
amew
ork
for M
ampE
act
iviti
es w
ithin
PM
TCT
prog
ram
s
Nat
iona
l PM
TCT
data
is
repo
rted
usi
ng M
oH I
nteg
rate
d M
onito
ring
and
Eva
luat
ion
Rep
ortin
g Fo
rms
For
m M
oH 7
11 o
r Fo
rm M
oH 7
27
Indi
vidu
al P
MTC
T da
ta is
col
shyle
cted
at
the
heal
th f
acili
ties
offe
ring
PM
TCT
serv
ices
usi
ng s
tand
ard
MoH
reg
iste
rs(A
NC
Mat
erni
ty a
nd P
ostn
atal
Reg
iste
rs)
On
mon
thly
bas
is t
he h
ealth
faci
litie
s w
ill a
ggre
gate
the
dat
a fr
om t
he r
egis
ters
on
to
Form
MoH
711
or
MO
H 7
26 w
hich
is th
en fo
rwar
ded
upw
ards
to th
e D
ASC
Orsquos
offic
e A
copy
is
left
at
the
heal
th f
acili
ty f
or t
heir
ow
n da
ta u
se
At
the
dist
rict
lev
el
the
DA
SCO
rsquos of
fice
aggr
egat
es d
ata
from
sev
eral
hea
lth f
acili
ty s
peci
fic F
orm
726
ont
o Fo
rm M
oH 7
27 (o
r Fo
rm 7
11) t
hat
is u
sed
to s
umm
aris
e an
d re
port
dis
tric
t le
vel d
ata
B
oth
Form
726
and
For
m M
oH 7
27 a
re th
en s
ent t
o N
ASC
OP
A c
opy
of th
e Fo
rm 7
27
or F
orm
711
is s
ent t
o th
e PA
SCO
and
ano
ther
to th
e he
alth
faci
litie
s in
the
dist
rict
for
thei
r ow
n da
ta u
se
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
14
RIS
K F
AC
TOR
SFO
R M
TCT
OF
HIV
M
any
fact
ors
are
know
n or
sus
pect
ed t
o in
crea
se t
he r
isk
of a
n H
IV in
fect
ed m
othe
r tr
ansm
ittin
g th
e vi
rus
to h
er i
nfan
t Th
ese
fact
ors
incl
ude
the
HIV
vir
al l
oad
in t
he
mot
her
as
wel
l as
othe
r m
ater
nal
obst
etri
cal
vira
l and
infa
nt fa
ctor
s (T
able
14
)
The
mos
t sig
nific
ant r
isk
fact
or a
ppea
rs to
be
the
HIV
vir
al lo
ad in
the
mot
her
thou
gh
the
othe
r fa
ctor
s m
ay a
lso
cont
ribu
te t
o in
crea
sing
an
infa
ntrsquos
expo
sure
or
susc
eptib
ilshyity
to
acqu
irin
g H
IV S
ome
fact
ors
may
cau
se a
bre
akdo
wn
in t
he p
rote
ctio
n of
fere
d to
the
foet
us b
y th
e pl
acen
ta w
hich
in n
orm
al c
ircu
mst
ance
s w
ould
not
allo
w H
IV to
cro
ssth
e pl
acen
ta fr
om m
othe
r to
foet
us
Tran
smis
sion
dur
ing
labo
ur a
nd d
eliv
ery
occu
rs w
hen
the
infa
nt s
ucks
im
bibe
s or
asshy
pira
tes
mat
erna
l bl
ood
or c
ervi
cal
secr
etio
ns t
hat
cont
ain
HIV
or
whe
n it
has
othe
r m
ucou
s m
embr
ane
expo
sure
Tab
le 1
4
Ris
k fa
ctor
s fo
r M
TCT
of H
IV
Stro
ng e
vide
nce
Lim
ited
evid
ence
VIR
AL
MA
TER
NA
L
OB
STE
TRIC
AL
FETA
LIN
FAN
T
BR
EA
ST-
FEE
DIN
G
Hig
h vi
ral l
oad
Imm
une
defic
ienc
y (lo
w
CD
4 co
unt)
HIV
infe
ctio
n ac
quire
d du
ring
preg
nanc
y o
r br
east
feed
ing
perio
d
Vagi
nal d
eliv
ery
(com
pare
d to
ele
ctiv
e ca
esar
ean
sect
ion)
ru
ptur
e of
the
mem
bran
es
for m
ore
than
4 h
ours
Prem
atur
ity
Dur
atio
n of
bre
astfe
edin
g
mix
ed fe
edin
g b
reas
t di
seas
e (m
astit
isc
rack
ed
nipp
les)
Vira
l res
ista
nce
(theo
retic
al p
ossi
bilit
y)
Vira
l gen
otyp
e an
d ph
enot
ype
Vita
min
A d
efic
ienc
y a
naem
ia s
exua
lly
trans
mitt
ed d
isea
ses
ch
orio
amni
oniti
s fr
eque
nt u
npro
tect
ed
sexu
al in
terc
ours
e m
ultip
le s
exua
l pa
rtner
s s
mok
ing
inje
ctin
g dr
ug a
buse
Inva
sive
or t
raum
atic
pro
cedu
res
in
stru
men
tal d
eliv
erie
s a
mni
ocen
tesi
s
epis
ioto
my
ext
erna
l cep
halic
ver
sion
(E
CV
) et
c i
ntra
partu
m h
aem
orrh
age
Lesi
ons
of s
kin
and
or m
ucou
s m
embr
anes
Ora
l thr
ush
(bab
y)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
3
24
15
BEN
EFIT
SO
F P R
EVEN
TIN
G M
OTH
ER-T
O-C
HIL
D
T
RA
NSM
ISSI
ON
OF
HIV
A
IDS
rela
ted
deat
hs a
re r
ever
sing
gai
ns m
ade
in c
hild
hea
lth a
nd s
urvi
val i
n K
enya
C
arin
g fo
r H
IV-in
fect
ed c
hild
ren
has
maj
or e
cono
mic
and
soc
ial
impa
cts
on f
amili
es
and
heal
th s
yste
ms
Thu
s at
the
nat
iona
l lev
el p
reve
ntin
g M
TCT
has
the
pote
ntia
l to
incr
ease
the
unde
rsta
ndin
g an
d ac
cept
ance
of t
he H
IVA
IDS
epid
emic
and
thos
e liv
ing
with
HIV
AID
S C
ouns
ellin
g t
estin
g an
d co
mm
unity
sen
sitis
atio
n ca
n co
ntri
bute
to
redu
cing
stig
ma
Red
uctio
n of
MTC
T of
HIV
bull
Dec
reas
es n
umbe
rs o
f H
IV in
fect
ed c
hild
ren
bull
Incr
ease
s ch
ild h
ealth
and
sur
viva
l
bull
Dec
reas
es t
he lo
ad o
n th
e he
alth
sys
tem
bull
Giv
es a
n op
port
unity
to im
prov
e an
d ex
pand
hea
lth s
ervi
ces
as w
ell a
s to
str
engt
hen
the
exis
ting
heal
th in
fras
truc
ture
16
BEN
EFIT
SO
F H
IV C
OU
NSE
LLIN
GA
ND T
ESTI
NG
(CT)
(a) I
t pro
mot
es b
ehav
iour
cha
nge
by
bull R
educ
ing
high
ris
k be
havi
our
for
HIV
bull Id
entif
ying
HIV
dis
cord
ant
coup
les
bull In
crea
sing
the
use
of
dual
met
hods
of f
amily
pla
nnin
g an
d S
TI
prev
entio
n
bull Im
prov
ing
ante
nata
l car
e
bull G
uidi
ng in
fant
fee
ding
(b) I
t ena
bles
pre
vent
ive
ther
apy
for
bull
Mal
aria
bull O
ppor
tuni
stic
infe
ctio
ns (
eg
Pne
umoc
ystis
jiro
veci
i pn
eum
onia
)
bull T
B
25
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
82
Foo
tnot
es
9
Use
oth
er o
ptions
for
child
ren o
ver
9 k
ilogra
ms
10
Use
reg
ula
r or
double
-str
ength
tab
lets
for
child
ren o
ver
16 k
ilogra
ms
NO
T A
PP
LIC
AB
LE
bullPsp
sm
ear
The
fram
ewor
k be
low
illu
stra
tes
poin
ts o
f int
egra
tion
of c
ompr
ehen
sive
HIV
ca
re p
acka
ge in
to e
xist
ing
child
hea
lth s
ervi
ces
Fram
ewor
k for
integ
ratio
n F
rom
Ped
iatr
ic H
IV P
reve
nti
on
to C
are
A
Co
nce
ptu
al F
ram
ewo
rk N
ewb
orn
In
fan
t W
om
an
H
IV e
duca
tion
Pre
gn
an
cy
prev
entio
n C
T
bull F
ocus
ed A
NC
incl
udin
g
AR
V p
roph
ylax
is s
tagi
ng
STI
syph
ilis
CT
Z p
roph
ylax
isA
RT
M
alar
ia tr
eatm
ent amp
pre
vent
ion
CD
4 w
here
ava
ilabl
e in
clud
ing
IPT
amp I
TNs
Infa
nt f
eedi
ng c
ouns
elin
g (I
FC)
Lab
ou
r an
d D
eliv
ery
U
nive
rsal
pre
caut
ions
CT
for
unt
este
d m
othe
rs in
clud
ing
bull D
eliv
ery
care
bull E
OC
-Em
erge
ncy
obst
etri
c ca
re
part
ner
bull R
efer
ral s
yste
m
AR
V p
roph
ylax
is
(mot
her
and
infa
nt)
AR
T C
TZ
pro
phyl
axis
Exc
lusi
ve b
reas
t fe
edin
g or
rep
lace
men
t fe
edin
g
Post
Na
tal
Ca
re
Infa
nt fe
edin
g co
unse
ling
bull B
reas
t hea
lth
Dia
gnos
is (
antib
ody)
if
bull Se
xual
hea
lth
expo
sure
unk
now
n bull
Fam
ily
plan
ning
D
NA
PC
R if
exp
osed
CT
Z p
roph
ylax
is I
FC-
infa
nt f
eedi
ng c
ouns
elin
g
CT
for
unt
este
d m
othe
rs
CT
for
par
tner
D
BS
resu
lt I
FC
IFC
Wea
ning
Bf
eedi
ng
cess
atio
n s
uppo
rt
bullBre
ast e
xam
D
iagn
osis
(an
tibod
y
bullPap
sm
ear
test
) C
T f
or n
egat
ive
wom
en a
nd p
artn
ers
Dia
gnos
is (
antib
ody
test
)
New
born
Ca
re
bull B
CG
bull P
olio
0
bull Is
sue
child
hea
th c
ard
bullEnt
er b
irth
wei
ght
HIV
an
d A
RV
Exp
osur
e st
atus
on
chi
ld h
ealth
car
d Tw
o w
eeks
Infa
nt fe
edin
g co
unse
ling
Six
wee
ks
Imm
uniz
atio
ngr
owth
mon
itori
ng
Ten
wee
ks
im
mun
izat
ion
GM
Fou
rtee
n w
eeks
Im
mun
izat
ion
grow
th m
onito
ring
Si
x m
onth
s
Com
plem
enta
ry fe
eds
Vita
min
A S
uppl
emen
tatio
n
9 m
onth
s
imm
uniz
atio
nG
M
12 amp
18
mon
ths
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
17
(c) I
t pro
mot
es a
cces
s to
ear
ly m
edic
al c
are
bull
Obs
tetr
ical
car
e
bull T
B th
erap
y
bull M
alar
ia t
reat
men
t
bull S
TI t
reat
men
t
bull A
RV
the
rapy
for
mot
her
and
fam
ily
(d) I
t hel
ps to
pla
n fo
r the
futu
re
bull In
fant
fee
ding
sup
port
sys
tem
s
bull F
amily
pla
nnin
g
bull P
erso
nal a
nd f
inan
cial
dec
isio
ns
(e) I
t ena
bles
pre
vent
ive
ther
apy
of m
alar
ia a
nd
othe
r opp
ortu
nist
ic in
fect
ions
suc
h a
PCP
(f) It
giv
es ti
me
to p
lan
for t
he fu
ture
eg
inf
ant
feed
ing
supp
ort s
yste
ms
TH
E F O
UR-P
RO
NG
ED A
PPR
OA
CH
TO P
MTC
T Th
e In
ter
Age
ncy
Task
Tea
m o
n Pr
even
tion
of H
IV T
rans
mis
sion
in p
regn
ant
wom
en
mot
hers
and
the
ir c
hild
ren
(IA
TT)
has
prop
osed
a f
our-
pron
ged
appr
oach
for
the
pre
shyve
ntio
n of
HIV
tra
nsm
issi
on t
hat
targ
ets
non-
preg
nant
and
pre
gnan
t w
omen
mot
hers
and
thei
r ch
ildre
n
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
1
26
The
four
pro
ngs
are
1 P
rimar
y pr
even
tion
of H
IV in
fect
ion
in w
omen
2 P
reve
ntio
n of
uni
nten
ded
preg
nanc
y am
ong
HIV
-inf
ecte
d w
omen
3 I
nter
vent
ions
to
redu
ce t
rans
mis
sion
fro
m H
IV-i
nfec
ted
preg
nant
and
la
ctat
ing
wom
en t
o th
eir
child
ren
4 C
are
and
supp
ort
of w
omen
ch
ildre
n an
d fa
mili
es in
fect
ed a
nd
affe
cted
by
HIV
and
AID
S (
The
PM
TC
T-p
lus)
Ove
rall
the
cov
erag
e of
PM
TCT
prog
ram
mes
and
the
upt
ake
of s
ervi
ces
prov
ided
thro
ugh
thes
e pr
ogra
mm
es
incl
udin
g H
IV
test
ing
and
coun
selli
ng
and
AR
V
prop
hyla
xis
are
still
ver
y lo
w I
n 20
06 w
orld
wid
e le
ss t
han
10
of
preg
nant
wom
ente
stin
g H
IV-p
ositi
ve r
ecei
ved
AR
V d
rugs
for
PMTC
T11
In K
enya
acc
ordi
ng to
the
2007
Ken
ya A
IDS
Indi
cato
r Su
rvey
(KA
IS) 7
the
re h
as b
een
a sm
all i
ncre
ase
in H
IV te
stin
g am
ong
wom
en a
nd m
en c
ompa
red
to th
e 20
03 K
DH
S
KA
IS s
how
s th
at t
houg
h a
vast
maj
ority
(83
)
of H
IV-in
fect
ed w
omen
and
men
in
Ken
ya d
o no
t kn
ow t
heir
HIV
sta
tus
the
re h
as b
een
a cl
ear
and
dram
atic
incr
ease
inco
vera
ge o
f HIV
-tes
ting
amon
g A
NC
clin
ic a
tten
dees
PMTC
T se
rvic
es a
re t
here
fore
im
port
ant
entr
y po
ints
for
HIV
pre
vent
ion
and
trea
tshym
ent
Ove
rall
AR
V c
over
age
for
HIV
infe
cted
peo
ple
who
nee
d tr
eatm
ent
in K
enya
ison
ly 3
5
bull 9
0
of K
enya
n w
omen
who
del
iver
ed in
the
last
4 y
ears
att
end
AN
C
bull 5
7 o
f th
ose
atte
ndin
g A
NC
tes
ted
for
HIV
bull A
mon
g H
IV in
fect
ed w
omen
with
rec
ent
birt
hs
47
wer
e te
sted
in
AN
C
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
(8)
HIV
dis
ease
sta
ging
in H
IV-in
fect
ed c
hild
ren
Dis
ease
sta
ging
with
or
with
out
labo
rato
ry s
uppo
rt f
ollo
ws
HIV
dia
gshyno
sis
Sta
ging
HIV
dis
ease
pro
vide
s a
guid
e to
the
prog
nosi
s an
d in
tershy
vent
ions
nee
ded
at th
e di
ffere
nt s
tage
s (R
efer
to C
hapt
er 5
and
8)
(9)
AR
V th
erap
y
Chi
ldre
n w
ho a
re e
ligib
le fo
r A
RT
shou
ld b
e lin
ked
with
the
AR
T pr
oshygr
am a
nd p
rovi
ded
with
trea
tmen
t acc
ordi
ng to
Nat
iona
l Gui
delin
es a
sso
on a
s an
HIV
dia
gnos
is i
s m
ade
Ear
ly t
reat
men
t si
gnifi
cant
ly r
eshydu
ces
mor
talit
y in
HIV
infe
cted
chi
ldre
n
(10)
C
omm
unic
atio
n
Com
mun
icat
ing
with
car
e-pr
ovid
ers
and
prov
idin
g ps
ycho
soci
al s
upshy
port
for
the
child
mot
her
care
give
r an
d fa
mily
are
a c
ruci
al c
ompo
nent
of
car
e
Pare
nts
care
give
rs a
ndo
r th
e ch
ild n
eed
to p
artic
ipat
e in
mak
ing
deci
shysi
ons
and
plan
ning
app
ropr
iate
car
e fo
r th
e ch
ild i
nclu
ding
dec
isio
nsab
out t
hera
py a
nd w
here
the
child
sho
uld
rece
ive
care
In
this
res
pect
he
alth
wor
kers
mus
t en
sure
tha
t th
e fa
mily
con
side
rs t
he s
ocia
l nee
ds
of H
IV in
fect
ed a
nd a
ffect
ed c
hild
ren
Hea
lth c
are
wor
kers
sho
uld
ensu
re th
at th
ey p
rovi
de a
dequ
ate
time
for
care
give
rs to
ask
que
stio
ns s
o th
at th
ey c
an fu
lly u
nder
stan
d th
e im
plishy
catio
ns o
f HIV
and
HIV
tes
ting
for
them
selv
es a
nd fo
r th
eir
child
ren
H
ealth
car
e w
orke
rs s
houl
d co
unse
l car
egiv
ers
on d
iscl
osur
e in
clud
ing
disc
losu
re to
the
child
(11)
R
efer
rals
Ref
erra
ls a
re a
n im
port
ant p
art o
f man
agin
g an
HIV
exp
osed
or
infe
cted
chi
ld
Thes
e in
clud
e re
ferr
als
to
bull H
ighe
r le
vels
of s
peci
alis
ed c
are
for
furt
her
inve
stig
atio
ns a
nd
trea
tmen
t
bull S
ocia
l sup
port
pro
gram
mes
bull C
omm
unity
-bas
ed c
are
prog
ram
mes
bull P
ITC
site
s fo
r pa
rent
s an
d si
blin
gs
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
7
80
Tabl
e 9
2 W
HO
Rec
omm
enda
tions
for
Follo
w-u
p of
an
HIV
-Exp
osed
Chi
ld
bull A
t birt
h (f
or in
fant
s de
liver
ed a
t ho
me)
bull A
t age
1 t
o 2
wee
ks (
mai
nly
for
infa
nt f
eedi
ng c
ouns
elin
g)
bull A
t ag
e 6
10
and
14
wee
ks (
for
imm
uniz
atio
n an
d in
fant
fee
ding
co
unse
ling)
bull A
fter
age
14
wee
ks
mon
thly
thr
ough
age
12
mon
ths
bull A
fter
age
12 m
onth
s e
very
3 m
onth
s th
roug
h 24
mon
ths
bull A
t 18
mon
ths
do
conf
irm
ator
y H
IV la
bora
tory
test
(if
ther
e ar
e no
re
sour
ces
for
an e
arlie
r an
tigen
-bas
ed t
est)
bull A
fter
2 ye
ars
a m
inim
um o
f ye
arly
vis
its
For t
he H
IV-in
fect
ed f
ollo
w th
ese
guid
elin
es
From
M
onito
r
6 w
eeks
ndash12
mon
ths
Mon
thly
12 ndash
24 m
onth
s Ev
ery
3 m
onth
s
24 m
onth
s an
d on
war
ds
Yea
rly i
f not
sym
ptom
atic
If sy
mpt
omat
ic f
ollo
w u
p as
nee
ded
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
18
OV
ERV
IEW
OF
THE
NEW
PM
TCT
GU
IDEL
INES
Ken
yarsquos
Min
istr
y of
Hea
lth (
MO
H)
thro
ugh
NA
SCO
P h
as t
aken
sev
eral
act
ions
to
expa
nd a
nd s
tren
gthe
n PM
TCT
inte
rven
tions
in
the
coun
try
In
2000
a
Nat
iona
lTe
chni
cal
Wor
king
Gro
up (
TWG
) on
PM
TCT
was
for
med
Th
e TW
G
co-c
hair
ed b
yN
ASC
OP
and
the
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
co
ordi
nate
s im
plem
enta
tion
and
prov
ides
tec
hnic
al s
uppo
rt t
o th
e N
atio
nal
PMTC
T Pr
ogra
m
The
TWG
ser
ves
as a
foru
m t
o up
date
sta
keho
lder
s an
d di
scus
s ch
alle
nges
and
upc
omin
g ac
tiviti
es
The
TWG
is
also
res
pons
ible
for
upd
atin
g na
tiona
l gu
idel
ines
for
PM
TCT
The
nat
iona
l PM
TCT
prog
ram
was
offi
cial
ly l
aunc
hed
in 2
002
NA
SCO
P al
so e
stab
lishe
d se
vera
lpi
lot P
MTC
T si
tes
thro
ugho
ut th
e co
untr
y an
d pr
epar
ed n
atio
nal P
MTC
T gu
idel
ines
The
goal
of t
he n
atio
nal P
MTC
T pr
ogra
m is
in li
ne w
ith th
e go
al s
et o
ut a
t the
Uni
ted
Nat
ions
Gen
eral
Ass
embl
y Sp
ecia
l Ses
sion
on
HIV
AID
S (U
NG
ASS
) in
2001
to
redu
ceth
e pr
opor
tion
of in
fant
s in
fect
ed w
ith H
IV b
y 20
b
y th
e ye
ar 2
005
and
50
by
2010
In
Ken
ya t
he n
atio
nal P
MTC
T pr
ogra
m p
lann
ed t
o ex
tend
its
serv
ices
to
at le
ast
80
of
all
heal
th f
acili
ties
by 2
0071
2 A
ccor
ding
to
the
2003
PM
TCT
serv
ice
stat
istic
sap
prox
imat
ely
9 o
f al
l pr
egna
nt w
omen
rec
eive
d PM
TCT
serv
ices
in
that
yea
rC
urre
ntly
mor
e th
an 5
0 o
f al
l pr
egna
nt w
omen
in
Ken
ya r
ecei
ve P
MTC
T se
rvic
es
Thes
e gu
idel
ines
are
bas
ed o
n a
publ
ic h
ealth
app
roac
h to
car
e t
akin
g in
to c
onsi
dera
shytio
n is
sues
of
feas
ibili
ty a
nd a
ccep
tabi
lity
in
addi
tion
to e
ffica
cy a
nd c
ost-
bene
fit i
ndi
ffere
nt s
ettin
gs
The
guid
elin
es a
re e
xpec
ted
to i
mpr
ove
the
upta
ke
qual
ity a
nd
effe
ctiv
enes
s of
PM
TCT
serv
ices
in th
e co
untr
y
19
OB
JEC
TIV
ESA
ND O
RG
AN
ISA
TIO
NO
FTH
E G
UID
ELIN
ES
The
PMTC
T gu
idel
ines
are
par
t of
the
impl
emen
tatio
n in
stru
men
ts t
owar
ds u
nive
rsal
ac
cess
to
PMTC
T se
rvic
es a
nd a
res
pons
e to
the
cal
l to
actio
n to
war
ds H
IV-fr
ee a
ndA
IDS-
free
gen
erat
ion
Tog
ethe
r w
ith tw
o ot
her
guid
elin
es (A
RV
Ther
apy
in A
dults
and
Ad
oles
cent
s an
d AR
V Th
erap
y in
Inf
ants
and
You
ng C
hild
ren)
th
ey f
orm
a t
rilo
gy
aim
ed a
t co
ntex
tual
isin
g an
d m
ains
trea
min
g th
e W
HO
tri
logy
of
guid
elin
es o
n H
IVA
IDS
prev
entio
n an
d tr
eatm
ent
The
cont
ext
reso
urce
s an
d de
man
ds o
f PM
TCT
prog
ram
mes
diff
er g
reat
ly a
cros
s co
unshy
trie
s an
d ev
en a
cros
s pr
ogra
mm
es w
ithin
the
sam
e co
untr
y C
onsi
deri
ng t
his
vari
abilshy
ity t
hese
gui
delin
es in
clud
e th
e cu
rren
t con
sens
us o
n be
st p
ract
ices
as
wel
l as
alte
rnashy
tives
whi
ch m
ight
be
mor
e ap
prop
riat
e in
par
ticul
ar s
ettin
gs E
xper
ts a
gree
tha
t th
e ldquos
tate
of
the
artrdquo
in
PMTC
T is
cha
ngin
g ra
pidl
y an
d th
at r
ecom
men
datio
ns w
ill c
ershy
tain
ly a
lter
with
adv
ance
s in
med
ical
sci
ence
and
as
mor
e pr
ogra
mm
e ex
peri
ence
is
docu
men
ted
and
diss
emin
ated
The
are
as o
f A
RV
pro
phyl
axis
and
inf
ant
feed
ing
are
part
icul
arly
sub
ject
to r
apid
cha
nge
In 2
005
the
WH
O is
sued
pro
pose
d re
visi
ons
to it
s re
com
men
datio
ns o
n th
e us
e of
ant
ishyre
trov
iral
dru
gs f
or P
MTC
T T
he r
ecom
men
datio
ns w
ere
the
prod
uct
of e
xper
ts w
ho
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
9
28
conv
ened
to
disc
uss
impo
rtan
t ne
w i
nfor
mat
ion
conc
erni
ng t
he d
evel
opm
ent
of r
esis
shyta
nce
in w
omen
and
chi
ldre
n us
ing
sing
le d
ose
nevi
rapi
ne (S
dNV
P) fo
r PM
TCT
as w
ell
as n
ew c
linic
al fi
ndin
gs o
n st
rate
gies
that
mig
ht r
educ
e th
e de
velo
pmen
t of r
esis
tanc
e
Bas
ed o
n th
e ne
w W
HO
gui
delin
es K
enya
rsquos TW
G h
as d
evel
oped
sim
ple
pra
ctic
al a
nd
evid
ence
-bas
ed r
ecom
men
datio
ns o
n PM
TCT
that
wou
ld w
ork
in a
var
iety
of r
esou
rce-
limite
d en
viro
nmen
ts a
nd c
linic
al s
ituat
ions
that
con
fron
t hea
lthca
re w
orke
rs n
ot o
nly
in K
enya
but
als
o in
oth
er d
evel
opin
g co
untr
ies
110
U
SIN
GTH
E G
UID
ELIN
ES
Thes
e gu
idel
ines
are
inte
nded
prim
arily
for u
se b
y PM
TCT
prov
ider
s Th
ese
inclu
de n
urse
sm
idw
ives
clin
ical o
ffice
rs d
octo
rs c
ouns
ello
rs n
utrit
ioni
sts
and
othe
r he
alth
care
pro
fesshy
sion
als
They
will
als
o be
use
ful a
s a re
fere
nce
for p
rogr
amm
e m
anag
ers a
t fac
ility
dis
trict
pr
ovin
cial
and
nat
iona
l lev
els
thro
ugho
ut th
e he
alth
sec
tor
The
guid
elin
es a
re d
ivid
ed in
tote
n ch
apte
rs a
s out
lined
in T
able
15
The
spec
ific
obje
ctiv
es o
f the
new
PM
TCT
guid
elin
es a
re to
bull O
utlin
e th
e po
licy
issu
es in
pro
vidi
ng P
MT
CT
serv
ices
bull R
ecom
men
d op
erat
iona
l gui
delin
es to
be
follo
wed
by
heal
th c
are
prov
ider
s of
PM
TC
T se
rvic
es
bull E
nabl
e pr
ovid
ers
of P
MT
CT
to s
elec
t an
d pr
escr
ibe
AR
Vs
for
prop
hyla
xis
agai
nst
MT
CT
and
for
trea
tmen
t of
pre
gnan
t w
omen
in
fant
s an
d yo
ung
child
ren
bull S
tand
ardi
se t
he c
are
and
coun
selli
ng g
iven
by
PM
TC
T s
ervi
ce
prov
ider
s re
gard
ing
risk
of
MT
CT
and
on
PM
TC
T
bull I
mpr
ove
PM
TC
T se
rvic
es u
sing
eas
y-to
-use
job
aids
and
a
stan
dard
ised
Mamp
E s
yste
m
Prev
entin
g TB
Fo
r chi
ldre
n ex
pose
d to
sm
ear p
ositi
ve tu
berc
ulos
is
bull E
xclu
de a
ctiv
e T
B th
roug
h ca
refu
l his
tory
ph
ysic
al e
xam
and
in
vest
igat
ions
bull
If
ther
e is
no
evid
ence
of
activ
e T
B
star
t on
IN
H f
or p
roph
ylax
is f
or 6
m
onth
s (I
PT
) bull
If
TB
is p
rese
nt
star
t on
TB
tre
atm
ent
as p
er N
atio
nal T
B g
uide
lines
If
a ch
ild is
bor
n to
a m
othe
r with
act
ive
TB
bull S
tart
on
INH
pro
phyl
axis
(IP
T)
and
give
for
3 m
onth
s bull
Afte
r 3
mon
ths
do a
man
toux
bull
If
man
toux
is n
egat
ive
sto
p IN
H a
nd g
ive
BC
G
bull I
f man
toux
is p
ositi
ve a
t 3
mon
ths
con
tinue
for
a f
urth
er 3
mon
ths
bull A
t the
end
of
prop
hyla
xis
re-v
alua
te f
or a
ctiv
e T
B
|
If no
evi
denc
e of
act
ive
TB d
o no
t tre
at fo
r TB
|
If th
ere
is e
vide
nce
of a
ctiv
e TB
tre
at fo
r TB
as
per N
atio
nal
TB g
uide
lines
(6)
Trea
tmen
t of a
cute
infe
ctio
ns a
nd o
ther
HIV
-rel
ated
con
ditio
ns
HIV
-exp
osed
chi
ldre
n ar
e su
scep
tible
to c
omm
on in
fect
ions
as
wel
l as
OIs
for
the
HIV
infe
cted
and
HIV
may
alte
r th
e in
cide
nce
pre
senshy
tatio
n an
d re
spon
se t
o co
nven
tiona
l th
erap
y I
n so
me
case
s m
ore
aggr
essi
ve a
nd lo
nger
tre
atm
ent
cour
ses
may
be
nece
ssar
y a
s tr
eatshy
men
t fai
lure
s ar
e m
ore
freq
uent
(7)
Reg
ular
follo
w-u
p ca
re amp
refe
rral
s
Reg
ular
follo
w-u
p is
the
back
bone
to c
arin
g fo
r th
e H
IV e
xpos
ed c
hilshy
dren
and
ens
ures
opt
imal
hea
lthca
re a
nd p
sych
osoc
ial s
uppo
rt to
the
fam
ily W
HO
has
mad
e re
com
men
datio
ns o
n fr
eque
ncy
of fo
llow
-up
as s
how
n in
Tab
le 9
2 T
his
is t
he m
inim
um a
nd m
ore
freq
uent
con
shyta
ct w
ith t
he h
ealth
car
e sy
stem
may
be
indi
cate
d fo
r H
IV in
fect
ed
child
ren
and
espe
cial
ly if
they
are
on
anti-
retr
ovir
al tr
eatm
ent
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
9
78
Pro
phyl
axis
aga
inst
Pne
umoc
ysti
s ji
rove
cii
Pne
umon
ia (
PC
P)
in c
hild
ren
whe
re C
otri
mox
azol
e is
con
trai
ndic
ated
Ta
ble
15
The
Fou
r-Pr
onge
d A
ppro
ach
App
lied
to th
e PM
TCT
Gui
delin
e
Alte
rnat
ive
drug
s to
use
if C
TX is
con
train
dica
ted
are
give
n be
low
A s
econ
d ch
oice
wou
ld b
e ei
ther
dap
sone
or
atov
aqui
ne
Dap
sone
bull C
hild
ren
gt 1
mon
th
2 m
gkg
24
hour
s or
ally
onc
e da
ily
bull I
f bot
h C
TX
and
Dap
sone
are
con
trai
ndic
ated
(e
g
in c
hilshy
dren
with
G6P
D d
efic
ienc
y w
ho g
et h
aem
olys
is w
ith C
TX
and
D
apso
ne)
the
n us
e ei
ther
Ato
vaqu
one
bull
30m
gkg
day
for
age
1-3
mon
ths
bull H
ighe
r do
se 4
5mg
kgd
ay f
or a
ge 4
-24
mon
ths
OR
Aer
osol
ized
Pen
tam
idin
e
bull 3
00 m
g in
6 m
l wat
er v
ia in
hala
tion
nebu
lizer
onc
e m
onth
ly
bull c
hild
ren
gt 5
year
s
Cha
pter
CH
AP
TER
1
Bac
kgro
und
CH
AP
TER
2
Ant
enat
al C
are
and
Pre
vent
ion
of M
TCT
of H
IV
CH
AP
TER
3
Intra
partu
m C
are
Pron
g 1
Prim
ary
prev
entio
n of
HIV
in
fect
ion
in w
omen
Pron
g 2
Prev
entio
n of
un
inte
nded
pr
egna
ncy
amon
g H
IV in
fect
ed w
omen
Pron
g 3
Inte
rven
tions
to
redu
ce
tran
smis
sion
from
H
IV in
fect
ed
preg
nant
and
la
ctat
ing
wom
en to
th
eir c
hild
ren
Pron
g 4
Car
e an
d su
ppor
t of
wom
en c
hild
ren
and
fam
ilies
in
fect
ed a
nd
affe
cted
by
HIV
A
IDS
C
HA
PTE
R 4
U
se o
f Ant
iretro
vira
l D
rugs
in P
regn
ancy
fo
r Tre
atm
ent a
nd
Pre
vent
ion
of M
othe
r to
Chi
ld
Tran
smis
sion
of H
IV
Infe
ctio
n
CH
AP
TER
5
Imm
edia
te P
ostn
atal
an
d N
eona
tal C
are
CH
AP
TER
6
Late
Pos
tnat
al C
are
and
Fam
ily P
lann
ing
CH
AP
TER
7
HIV
Dia
gnos
is in
C
hild
ren
CH
AP
TER
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
born
to
HIV
infe
cted
m
othe
rs
CH
AP
TER
9
Car
e an
d Fo
llow
-up
of C
hild
ren
of H
IV
infe
cted
mot
hers
C
HA
PTE
R 1
0
Mon
itorin
g an
d E
valu
atio
n of
PM
TCT
se
rvic
es
77
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
30
For
each
of t
hese
cha
pter
s (e
xcep
t ch
apte
r on
e on
bac
kgro
und)
the
gui
delin
es g
ive
anin
trod
uctio
n fo
llow
ed b
y po
licy
stat
emen
ts t
hen
oper
atio
nal g
uide
lines
of w
hat p
rovi
dshyer
s sh
ould
do
to r
educ
e m
othe
r-to
-chi
ld t
rans
mis
sion
of
HIV
and
or
to i
mpr
ove
thei
r pe
rfor
man
ce a
nd th
e ef
fect
iven
ess
of th
eir s
ervi
ces
A li
st o
f job
aid
s fo
r us
e by
the
hea
lthca
re p
rovi
der
follo
ws
the
oper
atio
nal g
uide
lines
and
whe
re n
eces
sary
a li
st o
f ap
pend
ices
and
add
ition
al d
ocum
ents
tha
t m
ay b
e re
shyfe
rred
to
but
are
cons
ider
ed t
oo b
ig o
r de
taile
d to
be
incl
uded
with
in t
he m
ain
body
of
the
guid
elin
es
Foo
tnot
es
1
UN
AID
S (
2004)
Rep
ort
on t
he
Glo
bal AID
S E
pid
emic
Ava
ilable
at
ww
wu
nai
ds
org
2
Ibid
2004
3
It
is
import
ant
to r
ecognis
e th
at t
he
use
of
the
phra
se M
TC
T in n
o w
ay is
inte
nded
to
pla
ce b
lam
e on t
he
moth
er
who m
ay o
r m
ay n
ot
know
her
HIV
sta
tus
who t
ransm
its
the
viru
s to
her
child
Pa
thfinder
ack
now
ledges
that
man
y tim
es p
regnant
wom
en
may
hav
e bee
n infe
cted
by
thei
r m
ale
par
tner
and d
o n
ot
hav
e th
e ab
ility
to n
egoti-
ate
safe
r se
x o
r to
see
k M
TC
T s
ervi
ces
for
fear
of
viole
nce
st
igm
a o
r ab
andonm
ent
if t
hei
r st
atu
s is
rev
eale
d
Path
finder
uphold
s th
e re
pro
duct
ive
rights
of
all w
om
en t
o
choose
if
and w
hen
to h
ave
child
ren
regar
dle
ss o
f H
IV-s
tatu
s
4
W
HO
CD
C
Dep
artm
ent
of
Hea
lth a
nd H
um
an S
ervi
ces
(2004)
Pre
vention o
f M
oth
er-t
o-C
hild
Tra
nsm
issi
on o
f H
IV
Gen
eric
Tra
inin
g P
acka
ge
Gen
eva
Sw
itze
r-la
nd
WH
O
5
U
NAID
S (
2004)
Rep
ort
on t
he
Glo
bal AID
S E
pid
emic
Ava
ilable
at
ww
wu
nai
ds
org
6
Polic
y Pro
ject
(2004)
Cove
rage
of
sele
cted
ser
vice
s fo
r H
IVA
IDS p
reve
ntion a
nd
care
in low
and m
iddle
-inco
me
countr
ies
in 2
003
Ava
ilable
at
ww
wp
olia
pro
ject
com
7
Cen
tral Bure
au o
f Sta
tist
ics
(CBS)
[Ken
ya]
Min
istr
y of
Hea
lth (
MO
H)
[Ken
ya]
and
ORC M
acro
(2004)
Ken
ya D
emogra
phic
and H
ealth S
urv
ey 2
003
Cal
vert
on
Mar
y-la
nd
CBSM
OH
an
d O
RC M
acr
o
8
Nat
ional AID
S C
ontr
ol Counci
l 2
007
8a
Ken
ya A
IDS I
ndic
ato
r Surv
ey 2
007
9
Ibid
2004
10
NASCO
P (
2002)
Surv
eilla
nce
data
as
cite
d in N
ASCO
PM
OH
(2
003)
Nat
ional
PM
CT
Str
ate
gic
Managem
ent
Pla
n 2
003-2
007
111
2 A
IDS in K
enya
Tre
nds
Inte
rven
tions
and I
mpact
7th
editio
n
(2005)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Who
Nee
ds P
CP
Prop
hyla
xis
bull A
ll in
fant
s bo
rn t
o H
IV-i
nfec
ted
mot
hers
irr
espe
ctiv
e of
any
ant
iret
rovi
ral
ther
apy
duri
ng p
regn
ancy
and
labo
ur
Pro
phyl
axis
con
tinue
s un
til th
e in
fant
is 1
2 m
onth
s or
is P
CR
neg
ativ
e or
ant
ibod
y ne
gativ
e w
hich
ever
co
mes
ear
lier
bull A
ll in
fant
s id
entif
ied
as H
IV-i
nfec
ted
duri
ng th
e fir
st y
ear
of li
fe b
y a
PC
R
test
or
by a
clin
ical
dia
gnos
is o
f H
IV in
fect
ion
and
a po
sitiv
e an
tibod
y te
st
bull C
hild
ren
olde
r th
an 1
2 m
onth
s w
ith s
ympt
omat
ic H
IV d
isea
se o
r an
A
IDS
-def
inin
g ill
ness
(W
HO
sta
ge I
I an
d III
se
e ch
apte
r 5)
or
with
CD
4 lt
15
or
TLC
150
0m
m3
bull A
ny c
hild
with
a h
isto
ry o
f P
CP
sho
uld
cont
inue
with
sec
onda
ry
prop
hyla
xis
(dai
ly C
T)
for
life
Clin
icia
ns s
houl
d cl
earl
y in
form
HIV
inf
ecte
d m
othe
rs a
t de
liver
y th
at t
heir
chi
ldre
n ne
ed p
roph
ylax
is a
gain
st P
CP
star
ting
at 6
wee
ks o
f age
unt
il it
is e
stab
lishe
d th
at th
e ch
ild i
s no
t H
IV i
nfec
ted
A p
ract
ical
way
to
ensu
re t
hat
mot
hers
and
oth
er h
ealth
wor
kers
are
inf
orm
ed i
s to
mak
e a
note
on
the
child
rsquos im
mun
izat
ion
card
at
birt
h st
atin
g ldquoP
leas
e gi
ve c
o-tr
imox
azol
e (5
mg
kgd
ay o
rally
dai
ly) f
rom
6 w
eeks
of a
gerdquo
Tabl
e 9
1 D
ose
of C
otrim
oxaz
ole
for P
CP
Prop
hyla
xis
Wei
ght o
f C
hild
(kg)
1ndash4
5ndash8
9ndash16
17ndash5
0
gt 50
CT
tabl
ets
20 m
g TM
P1
00
mg
SM
X p
edia
tric
stre
ngth
(120
mg)
1 ta
b
2 ta
bs
Cot
rimox
azol
e su
spen
sion
40
mg
TMP
200
mg
SM
X
5ml (
240
mg)
25
ml
5 m
l
10 m
l
CT
tabl
ets
80 m
g TM
P4
00 m
g S
MX
re
gula
r stre
ngth
(4
80 m
g)
frac14 ta
b
frac12 ta
b
1 ta
b
2 ta
bs
2 ta
bs
CT
Tabl
ets
160
mg
TMP
800
mg
SM
X
Dou
ble
stre
ngth
(9
60 m
g) -
frac14 ta
b
frac12 ta
b
1 ta
b
1 ta
b
In r
are
case
s a
s in
chi
ldre
n w
ith G
6PD
def
icie
ncy
CTX
may
be
cont
rain
dica
ted
G
uid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
1
76
(3)
Mon
itor
the
child
rsquos g
row
th a
nd d
evel
opm
ent
as a
mea
ns o
f id
entif
ying
the
ch
ild w
ho is
faili
ng to
thriv
e an
d al
so a
s a
tool
for m
onito
ring
the
effe
ct o
f int
ershy
vent
ions
(4)
Ens
ure
that
im
mun
isat
ions
are
sta
rted
and
com
plet
ed
acco
rdin
g to
the
re
com
men
datio
ns o
f the
nat
iona
l im
mun
isat
ion
sche
dule
|
Add
ition
al c
onsi
dera
tions
are
as
follo
ws
bull
Whe
n co
nsid
erin
g BC
G v
acci
natio
n at
a la
ter a
ge
(re-
vacc
inat
ion
for n
o sc
ar o
r mis
sed
earli
er v
acci
natio
n)
excl
ude
sym
ptom
atic
HIV
infe
ctio
n
bull
Do
not g
ive
yello
w fe
ver v
acci
ne to
sym
ptom
atic
HIV
-infe
cted
chi
lshydr
en H
owev
er a
sym
ptom
atic
chi
ldre
n in
end
emic
are
as s
houl
d re
shyce
ive
the
yello
w fe
ver v
acci
ne a
t 9 m
onth
s of
age
bull
Mea
sles
vac
cine
sho
uld
be g
iven
to H
IV in
fect
ed c
hild
ren
at 6
and
9
mon
ths
sinc
e H
IV in
fect
ed c
hild
ren
expe
rienc
e m
uch
mor
e se
vere
di
seas
e w
ith w
ild m
easl
es v
irus
whi
ch o
utw
eigh
s th
e ris
k of
a m
ilder
illn
ess
from
the
vacc
ine
(5)
Pro
vide
pro
phyl
axis
for o
ppor
tuni
stic
infe
ctio
ns
|
Pro
phyl
axis
aga
inst
Pne
umoc
ystis
jiro
veci
i Pne
umon
ia
bull
Pne
umoc
ystis
jiro
veci
i (fo
rmer
ly P
neum
ocys
tis c
arin
ii) p
neum
onia
(PC
P)
is a
sig
nific
ant c
ause
of m
orbi
dity
and
mor
talit
y am
ong
youn
g in
fant
s in
A
frica
Co-
trim
oxaz
ole
(CTX
) pro
phyl
axis
sig
nific
antly
redu
ces
the
inci
shyde
nce
and
seve
rity
of P
CP
Add
ition
al b
enef
its o
f co-
trim
oxaz
ole
incl
ude
prot
ectio
n ag
ains
t com
mon
bac
teria
l inf
ectio
ns t
oxop
lasm
osis
and
mashy
laria
All
child
ren
born
to H
IV in
fect
ed m
othe
rs s
houl
d re
ceiv
e pr
ophy
shyla
xis
agai
nst P
CP
at l
east
dur
ing
the
first
yea
r of l
ife o
r unt
il th
ey a
re
prov
en to
be
unin
fect
ed (s
ee b
ox b
elow
)
bull
CTX
is c
lear
ly th
e dr
ug o
f cho
ice
for p
roph
ylax
is b
ecau
se o
f its
hig
h
effic
acy
rela
tive
safe
ty l
ow c
ost a
nd b
road
ant
imic
robi
al s
pect
rum
In
cas
e of
CTX
hyp
erse
nsiti
vity
des
ensi
tizat
ion
is re
com
men
ded
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
CH
AP
TE
R 2
Ant
enat
al C
are
and
Prev
entio
n of
MTC
T of
HIV
21
INTR
OD
UC
TIO
N
HIV
inf
ectio
n ha
s em
erge
d in
Ken
ya a
s th
e m
ost
impo
rtan
t he
alth
ris
k fa
ctor
for
m
othe
rs a
nd t
heir
chi
ldre
n an
d ha
s a
grea
t im
pact
on
the
long
ter
m o
utco
me
ofpr
egna
ncy
and
child
sur
viva
l A
ll pr
egna
nt w
omen
sho
uld
be e
ncou
rage
d to
lear
n th
eir
HIV
infe
ctio
n st
atus
as
wel
l as
that
of t
heir
sex
ual p
artn
ers
O
nly
by k
now
ing
onersquos
H
IV s
tatu
s ca
n th
e he
alth
wor
kers
mak
e ap
prop
riat
e he
alth
car
e m
anag
emen
t re
com
men
datio
ns a
nd t
he c
oupl
e m
ake
appr
opri
ate
deci
sion
s ab
out
mai
ntai
ning
the
ir
heal
th a
nd t
hat
of t
heir
unb
orn
baby
Pr
e-co
ncep
tion
care
is
enco
urag
ed w
here
an
oppo
rtun
ity a
rise
s an
d a
birt
h pl
an is
dis
cuss
ed w
ith th
e pr
egna
nt w
oman
In m
ost
case
s t
he p
regn
ant
wom
an w
ill n
ot h
ave
HIV
infe
ctio
n P
regn
ancy
offe
rs a
n op
port
une
time
to d
iscu
ss p
reve
ntio
n of
HIV
inf
ectio
n as
man
y w
omen
com
e in
toco
ntac
t w
ith h
ealth
ser
vice
s fo
r th
e fir
st (
and
in s
ome
case
s th
e on
ly)
time
duri
ng
preg
nanc
y
In K
enya
50
o
f m
arri
ed H
IV p
ositi
ve p
erso
ns h
ave
an H
IV n
egat
ive
spou
se1
Ther
efor
e k
now
ing
the
HIV
inf
ectio
n st
atus
of
onersquos
par
tner
is
criti
cal
Add
ition
ally
th
is f
orm
s an
im
port
ant
entr
y po
int
for
esta
blis
hing
pre
vent
ion
with
po
sitiv
e (P
WP)
pro
gram
s am
ong
coup
les
as w
ell a
s pr
ovid
ing
acce
ss to
HIV
pre
vent
ion
ca
re a
nd tr
eatm
ent s
ervi
ces
for
the
who
le fa
mily
PMTC
T pr
ovid
es a
n op
port
unity
for
prev
entin
g ne
w p
aedi
atri
c H
IV in
fect
ions
as
wel
l as
for
reac
hing
the
10 to
20
of H
IV p
ositi
ve p
regn
ant w
omen
who
mee
t WH
O e
ligib
ilshyity
cri
teri
a fo
r in
itiat
ing
AR
T fo
r th
eir
own
heal
th N
ew in
fect
ions
and
hig
h vi
ral l
oads
duri
ng p
regn
ancy
pos
e th
e gr
eate
st r
isk
of M
TCT
to t
he u
nbor
n ba
by t
hus
prim
ary
prev
entio
n A
RV
pro
phyl
axis
as
wel
l as
trea
tmen
t at t
his
time
is c
ritic
al G
iven
that
25
perc
ent o
f wom
en in
Ken
ya h
ave
an u
nwan
ted
preg
nanc
y s
tren
gthe
ning
the
link
to F
P se
rvic
es a
nd c
ondo
m a
cces
s fo
r du
al p
rote
ctio
n of
fers
a c
hanc
e to
fur
ther
pre
vent
MTC
T2
22
OPE
RA
TIO
NA
L G
UID
ELIN
ES
Ant
enat
al c
are
and
prev
entio
n of
MTC
T du
ring
thi
s pe
riod
can
be
sum
mar
ised
usi
ngan
ess
entia
l pa
ckag
e of
int
egra
ted
ante
nata
l ca
re s
ervi
ces
as s
how
n in
Tab
le 2
1
This
ou
tline
s th
e pa
ckag
e of
ca
re
to
be
prov
ided
to
ev
ery
wom
an
atte
ndin
g A
NC
ser
vice
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
5
32
Tabl
e 2
1 Es
sent
ial P
acka
ge o
f Int
egra
ted
Ant
enat
al C
are
Serv
ices
Gro
up e
duca
tion
Incl
ude
info
rmat
ion
on fo
ur A
NC
vis
its b
reas
tfeed
ing
mat
erna
l and
infa
nt n
utrit
ion
per
sona
l hyg
iene
birt
h pr
epar
edne
ss d
ange
r sig
ns p
reve
ntio
n of
com
plic
atio
ns s
kille
d bi
rth a
ttend
ance
fam
ily p
lann
ing
imm
uniz
atio
n sc
hedu
le
post
-nat
al c
are
and
HIV
and
AID
S m
anag
emen
t
Clie
nt h
isto
ry O
btai
n ro
utin
e da
ta in
clud
ing
med
ical
obs
tetri
c a
nd p
sych
osoc
ial h
isto
ry D
eter
min
e dr
ug h
isto
ry k
now
n al
lerg
ies
and
use
of a
ltern
ativ
e m
edic
ines
suc
h as
her
bal p
rodu
cts
Phy
sica
l exa
min
atio
n In
clud
e vi
tal s
igns
ins
pect
ion
aus
culta
tion
and
palp
atio
n
Abd
omin
al a
nd g
enita
l exa
min
atio
n In
clud
e in
spec
tion
pal
patio
n fo
etal
aus
culta
tion
spe
culu
m a
nd b
iman
ual e
xam
inat
ions
w
here
indi
cate
d
AN
C P
rofil
e R
outin
e te
sts
for s
yphi
lis H
b b
lood
gro
up a
nd R
hesu
s fa
ctor
urin
alys
is a
nd p
rovi
de ra
pid
HIV
test
ing
to th
e pr
egna
nt w
oman
and
her
par
tner
if a
ccom
pany
ing
her
If in
dica
ted
chec
k sp
utum
for A
AFB
and
CD
4 co
unt
Cou
nsel
ing
on b
irth
prep
ared
ness
Sup
port
the
preg
nant
wom
an a
nd h
er p
artn
er to
dev
elop
an
indi
vidu
al b
irth
plan
that
in
clud
es p
lace
of d
eliv
ery
with
ski
lled
birth
atte
ndan
ce e
mer
genc
y tra
nspo
rt b
irth
com
pani
onsh
ip a
nd re
adin
ess
for i
nfan
t ca
re
Cou
nsel
ing
on p
regn
ancy
dan
ger s
igns
Pro
vide
wom
en w
ith in
form
atio
n an
d in
stru
ctio
ns o
n se
ekin
g ea
rly c
are
for p
regshy
nanc
y co
mpl
icat
ions
suc
h as
ble
edin
g fe
ver
seve
re h
eada
che
sw
olle
n fe
et f
its o
r con
vuls
ions
Cou
nsel
ing
on in
fant
feed
ing
All
wom
en re
quire
infa
nt-fe
edin
g co
unse
ling
and
supp
ort
Exc
lusi
ve b
reas
tfeed
ing
for s
ix
mon
ths
shou
ld b
e pr
omot
ed a
s th
e no
rm fo
r all
wom
en re
gard
less
of H
IV s
tatu
s W
omen
infe
cted
with
HIV
nee
d to
be
gu
ided
in th
e se
lect
ion
of s
afer
infa
nt-fe
edin
g op
tions
(ref
er to
WH
O g
uide
lines
and
MO
H c
ircul
ar o
n in
fant
and
you
ng c
hild
fe
edin
g)
Nut
ritio
nal a
sses
smen
t co
unse
ling
and
educ
atio
n In
clud
e iro
n m
ultiv
itam
in a
nd fo
late
sup
plem
enta
tion
mon
itor f
or a
naeshy
mia
ade
quat
e ca
loric
and
nut
rient
inta
ke a
nd re
com
men
d re
alis
tic d
iet a
djus
tmen
ts b
ased
on
loca
l res
ourc
es a
nd n
eeds
of
HIV
+ pr
egna
nt w
omen
(at l
east
10
mor
e of
the
RD
A)
Cou
nsel
ing
on H
IV a
nd A
IDS
Pro
vide
wom
en w
ith in
form
atio
n an
d in
stru
ctio
ns o
n se
ekin
g he
alth
car
e fo
r
sym
ptom
s of
HIV
dis
ease
pro
gres
sion
suc
h as
freq
uent
and
recu
rrent
illn
esse
s c
hron
ic p
ersi
sten
t dia
rrho
ea c
andi
dias
is
feve
r w
astin
g or
sig
ns o
f any
opp
ortu
nist
ic in
fect
ion
Lin
k w
omen
to A
IDS
trea
tmen
t and
oth
er s
uppo
rt pr
ogra
mm
es w
here
av
aila
ble
Cou
nsel
ing
the
HIV
neg
ativ
e w
oman
and
her
par
tner
Pro
vide
info
rmat
ion
on re
peat
test
ing
risk
redu
ctio
n an
d pa
rtner
test
ing
RTI
scr
eeni
ng A
ll w
omen
with
hig
h ris
k se
xual
his
tory
or p
rese
ntin
g w
ith s
igns
of R
TI s
uch
as a
bnor
mal
gen
ital d
isch
arge
ge
nita
l ulc
ers
and
pelv
ic in
flam
mat
ory
dise
ase
shou
ld b
e sc
reen
ed a
nd m
anag
ed a
ccor
ding
to K
enya
pro
toco
ls
Tube
rcul
osis
(TB
) A
ll w
omen
pre
sent
ing
for A
NC
ser
vice
s w
ith a
cou
gh o
f mor
e th
an 2
wee
ksrsquo d
urat
ion
shou
ld b
e sc
reen
ed
for T
B re
gard
less
of H
IV s
tatu
s F
ollo
w K
enya
pro
toco
ls fo
r scr
eeni
ng p
roph
ylax
is a
nd tr
eatm
ent
Teta
nus
toxo
id im
mun
isat
ions
Adm
inis
ter a
ccor
ding
to c
urre
nt K
EP
I TT
Imm
uniz
atio
n S
ched
ule
Dew
orm
ing
All
preg
nant
wom
en s
houl
d re
ceiv
e an
ti-he
lmin
thes
afte
r firs
t trim
este
r as
per t
he g
uide
lines
on
m
ater
nal n
utrit
ion
Ant
imal
aria
ls I
TNs
All
preg
nant
wom
en in
mal
aria
end
emic
are
as s
houl
d sl
eep
unde
r an
ITN
and
rece
ive
SP
inte
rmitt
ent
pres
umpt
ive
treat
men
t acc
ordi
ng to
the
Nat
iona
l Mal
aria
gui
delin
es
AR
V a
nd O
ppor
tuni
stic
Infe
ctio
ns p
roph
ylax
is (d
urin
g pr
egna
ncy)
Pro
vide
AR
V C
TX a
nd o
ther
pro
phyl
actic
m
edic
atio
ns a
ccor
ding
to th
e K
enya
AR
T pr
otoc
ol o
n O
I pro
phyl
axis
and
use
of A
RV
s in
pre
gnan
cy
AR
V tr
eatm
ent d
urin
g pr
egna
ncy
Pro
vide
HA
AR
T w
ithin
the
MC
H s
ettin
g ac
cord
ing
to th
e K
enya
pro
toco
l on
use
of A
RV
s
Est
ablis
h cl
ear r
efer
ral n
etw
orks
with
sen
ior c
linic
ians
Pre
vent
ion
with
Pos
itive
s E
ncou
rage
pos
itive
livi
ng d
iscl
osur
e c
orre
ct a
nd c
onsi
sten
t con
dom
use
and
pro
vide
psy
chos
oshyci
al s
uppo
rt to
the
affe
cted
fam
ilies
For
the
HIV
-infe
cted
and
affe
cted
fam
ilies
est
ablis
h an
dor
stre
ngth
en li
nkag
es to
car
e
treat
men
t and
sup
port
serv
ices
incl
udin
g po
st-p
artu
m fo
llow
up
Effe
ctiv
e co
ntra
cept
ion
plan
Cou
nsel
abo
ut o
ther
fam
ily p
lann
ing
met
hods
em
phas
izin
g on
par
tner
invo
lvem
ent
and
dual
pro
tect
ion
met
hods
to a
void
unw
ante
d pr
egna
ncy
new
infe
ctio
n re
-infe
ctio
n an
d fu
rther
tran
smis
sion
Sourc
e K
enya
Nat
ional PM
TC
T T
rain
ing C
urr
iculu
m
2005
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
92
OPE
RA
TIO
NA
L G
UID
ELIN
ES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed in
the
care
and
fo
llow
-up
of c
hild
ren
of H
IV-in
fect
ed m
othe
rs
bull A
ll ch
ildre
n bo
rn t
o H
IV in
fect
ed m
othe
rs s
houl
d be
see
n in
the
he
alth
car
e fa
cilit
y w
ithin
tw
o w
eeks
of
deliv
ery
bull F
or a
ll H
IV e
xpos
ed in
fant
s m
onth
ly f
ollo
w u
p vi
sits
are
re
com
men
ded
begi
nnin
g at
six
wee
ks t
hrou
gh 2
yea
rs
bull W
here
pos
sibl
e v
isits
sho
uld
be li
nked
to
the
imm
unis
atio
n an
d
grow
th m
onito
ring
vis
its
bull A
ll H
IV e
xpos
ed in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e
prop
hyla
xis
from
6 w
eeks
of
age
bull F
or in
fant
s w
ho te
st H
IV p
ositi
ve b
y D
NA
PC
R b
efor
e 18
mon
ths
or
by a
ntib
ody
test
aft
er 1
8 m
onth
s of
age
co
-trim
oxaz
ole
shou
ld b
e gi
ven
daily
for
life
bull F
or in
fant
s w
ho te
st H
IV n
egat
ive
|
If th
ey h
ave
stop
ped
brea
stfe
edin
g fo
r 2 m
onth
s or
mor
e s
top
C
otrim
oxaz
ole
|
If st
ill br
east
feed
ing
con
tinue
Cot
rimox
azol
e un
til tw
o m
onth
s af
ter
com
plet
e ce
ssat
ion
of b
reas
tfeed
ing
bull C
ompr
ehen
sive
car
e fo
r th
e H
IV e
xpos
ed o
r in
fect
ed in
fant
s sh
ould
be
pro
vide
d in
the
bro
ader
con
text
of
othe
r ch
ild h
ealth
car
e st
rate
gies
Hea
lth w
orke
rs s
houl
d pr
ovid
e th
e fo
llow
ing
pack
age
of c
are
as a
min
imum
to
thes
e ch
ildre
n
(1)
Con
firm
HIV
sta
tus
as e
arly
as
poss
ible
(R
efer
to C
hapt
er 7
)
(2)
M
othe
rs s
houl
d be
sup
porte
d to
pro
vide
opt
imal
infa
nt fe
edin
g an
d pa
rticu
larly
to
avoi
d m
ixed
feed
ing
in th
e fir
st 6
mon
ths
of li
fe I
t is
impo
rtant
that
infa
nt fe
edin
g ch
oice
s at
initi
atio
n of
feed
ing
follo
win
g ea
rly in
fant
dia
gnos
is a
t wea
ning
and
at
the
time
of in
trodu
ctio
n of
com
plem
enta
ry fe
eds
are
guid
ed b
y th
e A
FAS
S c
riter
ia
(Ref
er to
Cha
pter
8)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
3
74
Cha
pter
9
Car
e an
d Fo
llow
-up
of C
hild
ren
of H
IV-in
fect
ed M
othe
rs
91
INTR
OD
UC
TIO
N
PMTC
T in
terv
entio
ns re
duce
but
do
not e
limin
ate
the
risk
of H
IV tr
ansm
issi
on fr
om m
othshy
ers t
o th
eir i
nfan
ts a
nd y
oung
child
ren
Bot
h H
IV-in
fect
ed a
nd u
ninf
ecte
d ex
pose
d ch
ildre
n ha
ve in
crea
sed
risk
s of
infe
ctio
n an
d de
ath
from
com
mon
chi
ldho
od in
fect
ions
The
sur
shyvi
val o
f H
IV-e
xpos
ed c
hild
ren
whe
ther
or
not
they
are
inf
ecte
d i
s cl
osel
y lin
ked
to t
he
heal
th a
nd s
urvi
val o
f the
ir m
othe
rs T
here
fore
lon
g-te
rm b
enef
its o
f PM
TCT
prog
ram
s w
ill o
nly
be s
usta
ined
if t
here
is o
ngoi
ng c
ompr
ehen
sive
car
e fo
r th
e ch
ildre
n an
d th
eir
mot
hers
and
or c
are
give
rs
HIV
exp
osed
chi
ldre
n ar
e vu
lner
able
to
the
com
mon
illn
esse
s af
fect
ing
othe
r ch
ildre
n
Thes
e in
fect
ions
incl
ude
neon
atal
infe
ctio
ns m
alar
ia p
neum
onia
dia
rrho
ea m
easl
es a
nd
othe
r vac
cine
pre
vent
able
dis
ease
s H
IV in
fect
ed ch
ildre
n ar
e lik
ely
to s
uffe
r mor
e se
vere
ly
and
have
a h
ighe
r lik
elih
ood
of d
ying
from
com
mon
chi
ldho
od il
lnes
ses
than
non
-infe
cted
ch
ildre
n W
here
as m
alnu
triti
on c
ause
s 53
o
f all
child
hood
dea
ths
HIV
exp
osed
chi
ldre
n ar
e m
ore
vuln
erab
le to
it th
an n
on-in
fect
ed c
hild
ren
Thi
s is
bec
ause
HIV
exp
osed
child
ren
have
hig
her
calo
ric
requ
irem
ents
as
a re
sult
of th
eir
HIV
infe
ctio
n th
e pr
esen
ce o
f opp
orshy
tuni
stic
infe
ctio
ns a
nd o
ther
com
plic
atio
ns re
late
d to
AID
S
Regu
lar
follo
w u
p ca
re is
cri
tical
for
an in
fant
bor
n to
a m
othe
r w
ith H
IVA
IDS
The
com
shypr
ehen
sive
car
e of
HIV
exp
osed
chi
ldre
n in
clud
ing
nutr
ition
im
mun
isat
ion
mon
itori
ng o
f gr
owth
and
dev
elop
men
t pr
even
tion
and
trea
tmen
t of
opp
ortu
nist
ic in
fect
ions
and
ear
ly
infa
nt d
iagn
osis
of
HIV
is f
easi
ble
in r
esou
rce-
cons
trai
ned
sett
ings
and
sig
nific
antly
imshy
prov
es th
e su
rviv
al o
f the
se ch
ildre
n
23
JOB A
IDS
Prov
ider
s ar
e en
cour
aged
to re
fer t
o th
e ap
prop
riate
job
aid(
s) w
hen
deal
ing
with
spe
cific
issu
es
bull P
MT
CT
test
ing
and
coun
selli
ng t
ools
bull C
oupl
e co
unse
lling
tool
s
bull A
NC
alg
orith
ms
for
AR
V p
roph
ylax
is a
nd in
fant
fee
ding
gui
delin
es
as a
dapt
ed f
rom
WH
O g
uide
lines
bull P
reve
ntio
n w
ith p
ositi
ves
tool
kit
on d
iscl
osur
e
bull F
ocus
ed a
nte-
nata
l car
e
bull M
alar
ia in
pre
gnan
cy
bull T
B in
pre
gnan
cy
bull K
EP
I S
ched
ule
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
3
34
A ra
pid
HIV
test
ing
algo
rithm
for s
eria
l tes
ting
is il
lust
rate
d be
low
35
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Pre-Test Education and or Counselling
First HIV Rapid Test ndashDETERMINE
Negative TestResult
Counsel for Negative Result
Positive TestResult
Second HIV Rapid Test ndashBIOLINE
Positive Test ResultCounsel for
Positive Result
NegativeTestResult
Third HIV Rapid Test ndashUNIGOLD
Positive Test ResultCounsel for
Positive Result
Negative Test ResultCounsel for
Negative Result
Figure 32 Rapid HIV testing algorithm Serial testing
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
72
M
othe
r and
Chi
ld H
ealth
Boo
klet
71
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
36
Cha
pter
ref
eren
ces
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
National G
uid
e-lin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
atal Car
e (
2004)
WH
O
UN
FPA
UN
ICEF
World B
ank
Manag
ing C
om
plic
atio
ns
in P
regnan
cy a
nd C
hild
birth
A g
uid
e fo
r m
idw
ives
and d
oct
ors
(2003)
WH
O
Sta
ndar
ds
for
Mat
ernal
and N
eonat
al C
are
(2006)
WH
O
Antire
trovi
ral dru
gs
for
trea
ting p
regnan
t w
om
en a
nd p
reve
nting H
IV infe
ctio
ns
in
infa
nts
in r
esourc
e lim
ited
set
tings
Tow
ard
s U
niv
ersa
l Acc
ess
Rec
om
men
dations
for
a public
hea
lth a
ppro
ach (
2006)
Min
istr
y of
Hea
lth
Nat
ional AID
S amp
STD
Contr
ol Pro
gra
mm
e (N
ASCO
P)
Guid
elin
es f
or
Antire
trovi
ral dru
g t
her
apy
in K
enya
(2005)
Min
istr
y of
Hea
lth
Ken
ya N
atio
nal
Rep
roduct
ive
Hea
lth I
nst
ruct
ional M
anual
for
Ser
vice
Pro
vider
s (M
arch
2005)
Nat
ional AID
S amp
STD
Contr
ol Pro
gra
mm
e K
enya
AID
S I
ndic
ator
Syr
vey
Foo
tnot
es
1
2Ken
ya D
emogra
phic
and H
ealth S
urv
ey (
KD
HS)
2003
37
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
70
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
CH
AP
TE
R 3
Intr
apar
tum
Car
e 3
1 IN
TRO
DU
CTI
ON
Intr
apar
tum
car
e is
the
man
agem
ent
of w
omen
fro
m t
he o
nset
of
labo
ur t
o de
liver
y T
his
peri
od p
oses
the
grea
test
ris
k fo
r tr
ansm
issi
on o
f HIV
from
the
mot
her
to th
e ch
ild (M
TCT)
w
ith 1
0 to
20
perc
ent o
f exp
osed
infa
nts
beco
min
g in
fect
ed a
t thi
s tim
e in
the
abse
nce
of a
ny
inte
rven
tion
1 In
the
con
text
of
HIV
AID
S it
is t
here
fore
im
port
ant
to e
stab
lish
the
HIV
stat
us o
f wom
en p
rior
to o
r du
ring
labo
ur a
nd d
eliv
ery
and
prov
ide
inte
rven
tions
aim
ed a
t re
duci
ng th
e ri
sk o
f tra
nsm
issi
on W
ith a
ppro
pria
te in
terv
entio
ns t
he r
isk
of M
TCT
can
bere
duce
d si
gnifi
cant
ly
32
OPE
RA
TIO
NA
L G
UID
ELIN
ES
a) O
ptim
al In
trap
artu
m C
are
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed fo
r all
wom
en a
dmitt
ed
to la
bour
and
del
iver
y un
its 2
3
1 M
inim
ise
vagi
nal e
xam
inat
ions
2 U
se a
sept
ic t
echn
ique
s in
con
duct
ing
deliv
ery
3 A
void
rou
tine
artif
icia
l rup
ture
of m
embr
anes
(A
RM
)
4 A
void
pro
long
ed la
bour
5 A
void
unn
eces
sary
trau
ma
duri
ng d
eliv
ery
6 M
inim
ise
the
risk
of p
ostp
artu
m h
aem
orrh
age
7 U
se s
afe
bloo
d tr
ansf
usio
n pr
actic
es
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
9
38
b) S
peci
fic M
anag
emen
t of H
IV P
ositi
ve P
regn
ant W
omen
Pro
phyl
acti
c A
ntir
etro
vira
l the
rapi
es4
The
AR
V p
roph
ylac
tic r
egim
en d
epen
ds o
n w
heth
er th
e m
othe
r ha
d A
RV
s du
ring
pre
gshyna
ncy
or n
ot T
hus
the
heal
th c
are
wor
ker s
houl
d es
tabl
ish
the
regi
men
use
d du
ring
th
e A
NC
whe
ther
the
wom
an h
ad ta
ken
the
SdN
VP
and
AZT
at t
he o
nset
of l
abou
r an
d de
term
ine
the
appr
opri
ate
intr
a-pa
rtum
AR
V c
are
as p
er th
e al
gori
thm
s on
pag
e80
(App
endi
x II
I) p
age
81 (A
ppen
dix
IV) a
nd a
s su
mm
aris
ed b
elow
No
AR
Vs t
aken
in p
regn
ancy
Mot
her i
n ea
rly la
bour
(up
to 4
cm c
ervi
cal d
ilata
tion)
bull
Int
rapa
rtum
per
iod
Giv
e m
othe
r S
dNV
P 2
00m
g A
ZT
600
mg
and
3T
C 1
50m
g st
at
bull P
ostp
artu
m m
othe
r G
ive
mot
her
AZ
T 3
00m
g an
d 3T
C 1
50m
g B
D
for
7 da
ys
bull P
ostp
artu
m p
erio
d G
ive
infa
nt S
d N
evir
apin
e 2
mg
kg w
ithin
72
hour
s of
birt
h P
LUS
3T
C 4
mg
kg B
D fo
r 1
wee
k an
d A
ZT
syr
up 4
mg
kg
BD
for
6 w
eeks
Mot
her r
ecei
ved
AZT
300
mg
BD
in P
regn
ancy
bull P
ostp
artu
m
Giv
e in
fant
Sd
Nev
irap
ine
2mg
kg w
ithin
72
hour
s of
birt
h
PLU
S 3
TC
4m
gkg
BD
for
1 w
eek
and
AZ
T sy
rup
4 m
gkg
BD
for
6 w
eeks
Mot
her r
ecei
ved
HA
AR
T in
Pre
gnan
cy
Reg
ardl
ess
of d
urat
ion
rece
ived
HA
AR
T bull
Giv
e m
othe
r A
RV
dos
e as
per
reg
imen
bull P
ostp
artu
m
Giv
e In
fant
Sd
Nev
irap
ine
2mg
kg w
ithin
72
hour
s of
bir
th
PLU
S 3
TC
4m
gkg
BD
for
1 w
eek
and
AZ
T sy
rup
4 m
gkg
BD
for
6 w
eeks
Mod
e of
del
iver
y E
lect
ive
caes
area
n se
ctio
n (C
S) r
educ
es t
he r
isk
of H
IV M
TCT
as c
ompa
red
to v
agin
al
deliv
ery
but
will
not
be
avai
labl
e in
man
y se
ttin
gs in
our
cou
ntry
Whe
re C
S is
per
shyfo
rmed
(ele
ctiv
e or
em
erge
ncy)
in H
IV p
ositi
ve w
omen
the
y sh
ould
rec
eive
pro
phyl
actic
an
tibio
tics
If
the
CS
is p
erfo
rmed
aft
er p
rolo
nged
lab
our
or r
uptu
re o
f m
embr
anes
lo
nger
cour
ses
of a
ntib
iotic
s sh
ould
be
cons
ider
ed
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
9
68
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Supp
ort d
urin
g la
bour
E
mot
iona
l su
ppor
t du
ring
lab
our
is i
mpo
rtan
t fo
r al
l w
omen
and
may
be
even
mor
ene
cess
ary
for
an H
IV p
ositi
ve w
oman
who
is c
once
rned
abo
ut h
er c
ondi
tion
and
risk
of
HIV
tran
smis
sion
to c
hild
Whe
neve
r po
ssib
le d
urin
g la
bour
war
d st
aff m
ust b
e se
nsishy
tive
to t
he fe
ars
and
conc
erns
of t
he H
IV p
ositi
ve m
othe
r ab
out
her
infe
ctio
n a
nd h
owm
uch
she
had
told
her
par
tner
Indu
ctio
n of
labo
ur
Indu
ctio
n of
labo
ur m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f H
IV M
TCT
Car
eful
asshy
sess
men
t of
the
nee
d fo
r an
d de
sira
bilit
y of
ind
uctio
n ra
ther
tha
n C
S is
nec
essa
ry
Whe
n in
duct
ion
of la
bour
is c
hose
n m
embr
anes
sho
uld
be le
ft in
tact
for
as lo
ng a
s po
sshysi
ble
Syn
toci
non
shou
ld n
ot b
e us
ed w
ith in
tact
mem
bran
es
Indi
catio
ns fo
r ele
ctiv
e C
S A
lthou
gh e
lect
ive
CS
will
not
be
avai
labl
e in
mos
t hea
lth fa
cilit
ies
as a
rou
tine
for
HIV
posi
tive
wom
en t
here
may
be
som
e ca
ses
that
mer
it co
nsid
erat
ion
for
CS
The
se i
nshycl
ude
preg
nanc
ies
whe
re l
abou
r is
exp
ecte
d to
be
prol
onge
d or
whe
re o
ther
obs
tetr
ic
com
plic
atio
ns m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f tra
nsm
issi
on (e
g a
brup
tio p
lashy
cent
ae
plac
enta
pra
evia
pr
e-te
rm r
uptu
re o
f m
embr
anes
pr
evio
us C
S an
d br
eech
pr
esen
tatio
n)
Man
agem
ent o
f lab
our a
nd d
eliv
ery
Labo
ur a
nd d
eliv
ery
man
agem
ent
shou
ld fo
llow
opt
imal
obs
tetr
ic m
anag
emen
t gu
ideshy
lines
(R
efer
to
Opt
imal
Int
rapa
rtum
car
e ab
ove
and
Nat
iona
l G
uide
lines
for
Qua
lity
Obs
tetr
ics
and
IMPA
C C
are
Man
ual)
RO
LEO
FTH
E C
OM
MU
NIT
Y
A la
rge
prop
ortio
n (6
0) o
f wom
en in
Ken
ya is
del
iver
ed o
utsid
e th
e he
alth
sys
tem
s by
fam
ilym
embe
rs n
eigh
bour
s and
TBA
s
bull T
here
is n
eed
to e
duca
te th
e co
mm
unity
on
the
risk
of M
TC
T an
d w
ays
of
prev
entio
n
bull T
hose
ass
istin
g th
e de
liver
ies
need
to u
nder
stan
d th
eir
own
risk
of in
fect
ion
and
how
to p
rote
ct th
emse
lves
bull T
he c
omm
unity
sho
uld
be e
ncou
rage
d to
faci
litat
e m
othe
rs to
del
iver
in
heal
th fa
cilit
ies
bull T
he c
omm
unity
sho
uld
be e
ncou
rage
d to
ref
er to
hea
lth fa
cilit
ies
all c
hild
ren
born
at h
ome
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
7
40
Fi
gure
81
Gui
delin
es fo
r Cou
nsel
ling
on H
IV a
nd In
fant
feed
ingJ
ob A
ids
Cha
pter
ref
eren
ces
an
d IE
C M
ater
ials
on
Infa
nt a
nd Y
oung
Chi
ld F
eedi
ng
1R
epublic
of
Ken
ya
Min
istr
y of
Hea
lth
Ess
ential
Obst
etric
Car
e M
anual
for
Hea
lth
Ser
vice
Pro
vider
s in
Ken
ya (
3rd
Editio
n J
an 2
006)
Foo
tnot
es
1 D
e Cock
KM
2002
2 K
enya
National
Rep
roduct
ive
Hea
lth I
nst
ruct
ion M
anual
for
Ser
vice
Pro
vider
s (2
006)
3 D
ivis
ion o
f Rep
roduct
ive
Hea
lth
Guid
elin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
ata
l Car
e
(2004)
4 W
HO
Antire
tovi
ral dru
gs
for
trea
ting p
regnan
t w
om
en a
nd p
reve
nting H
IV infe
ctio
n in
infa
nts
to
ward
s univ
ersa
l acc
ess
(2006)
41
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
66
85
EXTR
AC
TSFR
OM
RES
EAR
CH
ON
I NFA
NT
F EED
ING
A
ND H
IVA
IDS
Evid
ence
ava
ilabl
e fr
om c
urre
nt re
sear
ch d
ata
show
s th
at
bull I
ncre
ased
ris
k of
mor
talit
y w
ith r
epla
cem
ent
feed
ing
is s
igni
fican
t
bull H
IV f
ree
surv
ival
rat
e at
18
mon
ths
of a
ge d
oes
not
sign
ifica
ntly
var
y be
twee
n a
brea
stfe
d an
d re
plac
emen
t fed
chi
ld
bull M
odifi
ed a
nim
alrsquos
milk
doe
s no
t pr
ovid
e ad
equa
te n
utrit
ion
for
ch
ildre
n le
ss t
han
6 m
onth
s he
nce
mic
ronu
trie
nts
shou
ld b
e gi
ven
un
der
thes
e ci
rcum
stan
ces
bull A
brup
t ce
ssat
ion
of b
reas
tfee
ding
is n
o lo
nger
rec
omm
ende
d
bull E
xclu
sive
bre
astf
eedi
ng u
p to
6 m
onth
s is
rec
omm
ende
d un
less
re
plac
emen
t fee
ding
can
mee
t AF
AS
S c
rite
ria
Cha
pter
4
Use
of A
ntire
trov
iral D
rugs
in P
regn
ancy
for T
reat
men
t and
for
Prev
entio
n of
Mot
her-
to-C
hild
Tra
nsm
issi
on o
f HIV
Infe
ctio
n
41
INTR
OD
UC
TIO
N
With
out
any
inte
rven
tion
up
to 4
0 pe
rcen
t of
HIV
pos
itive
wom
en w
ill t
rans
mit
the
infe
ctio
n to
the
ir c
hild
ren
duri
ng p
regn
ancy
lab
our
and
brea
stfe
edin
g U
se o
f ant
iret
shyro
vira
l dru
gs (A
RV
s) o
bste
tric
inte
rven
tions
and
avo
idan
ce o
f all
brea
stfe
edin
g fo
r pr
eshyve
ntio
n of
mot
her
to c
hild
tran
smis
sion
of H
IV in
fect
ion
(PM
TCT)
has
red
uced
the
risk
of m
othe
r to
chi
ld tr
ansm
issi
on o
f HIV
infe
ctio
n (M
TCT)
to le
ss th
an 2
per
cent
in d
evel
shyop
ed c
ount
ries
Shor
t cou
rse
effic
acio
us A
RV
dru
g re
gim
ens
can
redu
ce th
e ri
sk o
f MTC
T to
2-4
per
cent
and
can
be i
mpl
emen
ted
in r
esou
rce-
limite
d se
ttin
gs o
n a
popu
latio
n-ba
sed
publ
ic
heal
th s
cale
AR
Vs
are
used
bot
h fo
r th
e tr
eatm
ent
of H
IV d
isea
se a
nd fo
r PM
TCT
in
HIV
-infe
cted
pre
gnan
t w
omen
and
the
ir n
eona
tes
Ant
iret
rovi
ral t
reat
men
t (A
RT)
for
wom
en w
ho q
ualif
y fo
r it
pro
long
s an
d im
prov
es t
he q
ualit
y of
the
ir l
ives
The
sur
shyvi
val
of t
he c
hild
is
clos
ely
inte
rlin
ked
with
the
hea
lth a
nd s
urvi
val
of t
he m
othe
r
Wom
en e
ligib
le fo
r A
RT
shou
ld b
e st
arte
d on
trea
tmen
t as
soon
as
poss
ible
Pre
gnan
cy
is n
ot a
rea
son
to d
elay
AR
T W
omen
who
are
alr
eady
on
AR
T be
fore
bec
omin
g pr
egshy
nant
sho
uld
cont
inue
with
thei
r tr
eatm
ent
In c
erta
in s
ituat
ions
mod
ifica
tions
may
be
need
ed to
mak
e tr
eatm
ent s
afer
for
the
mot
her
and
the
unbo
rn b
aby
The
bene
fits
of u
sing
AR
Vs
to t
reat
HIV
-infe
cted
pre
gnan
t w
omen
and
or
PMTC
T ou
tshyw
eigh
the
ris
ks H
owev
er w
hen
AR
T or
oth
er s
hort
cou
rse
AR
V r
egim
ens
are
used
ba
selin
e ev
alua
tion
and
mon
itori
ng is
enc
oura
ged
to e
nsur
e th
e sa
fety
of t
he m
othe
rsan
d th
eir
new
born
s L
inka
ges
of H
IV-in
fect
ed p
regn
ant
wom
en a
nd t
heir
chi
ldre
n to
ot
her
care
and
sup
port
pro
gram
s at
hea
lth f
acili
ty a
nd c
omm
unity
lev
els
shou
ld b
e en
sure
d
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
5
42
42
OPE
RA
TIO
NA
L G
UID
ELIN
ES
All
HIV
-infe
cted
pre
gnan
t w
omen
sho
uld
be c
ouns
elle
d on
com
preh
ensi
ve H
IV c
are
incl
udin
g us
e of
AR
Vs
for
thei
r ow
n he
alth
and
for
PMTC
T
All
HIV
-infe
cted
pre
gnan
t wom
en s
houl
d ha
ve th
eir H
IV d
isea
se
stag
ed u
sing
bull W
HO
clin
ical
sta
ging
(se
e A
ppen
dix
1) a
nd
bull I
mm
unol
ogic
al s
tagi
ng (
CD
4 co
unt)
(se
e ta
ble
1)
The
wom
en s
houl
d al
so b
e sc
reen
ed a
nd tr
eate
d fo
r op
port
unis
tic in
fect
ions
(OIs
) inc
ludi
ngTu
berc
ulos
is (T
B)
All
HIV
-infe
cted
pre
gnan
t wom
en s
houl
d ha
ve b
asel
ine
labo
rato
ry a
nd o
ther
nec
essa
rydi
agno
stic
eva
luat
ions
Thes
e di
agno
stic
s sh
ould
incl
ude
bull R
outin
e an
tena
tal c
are
labo
rato
ry in
vest
igat
ions
that
are
nor
mal
ly
done
for
all
preg
nant
wom
en
haem
oglo
bin
(Hb)
rh
esus
blo
od
grou
p an
d A
BO
typ
ing
VD
RL
uri
ne a
naly
sis
and
scre
enin
g fo
r S
TI
bull A
LT a
nd c
reat
inin
e le
vels
for
wom
en e
ligib
le f
or H
AA
RT
Prop
hyla
xis
amp m
icro
nutr
ient
sup
plem
enta
tion
bull
Cot
rimox
azol
e (C
TX) o
ne d
oubl
e st
reng
th o
r tw
o si
ngle
stre
ngth
tabl
ets
once
dai
ly
bull
Mul
tivita
min
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
83
OPE
RA
TIO
NA
L G
UID
ELIN
ESO
N F
EED
ING
CH
ILD
REN
6 M
ON
THS
AN
DO
LDER
The
follo
win
g sh
ould
gui
de fe
edin
g fo
r chi
ldre
n 6
mon
ths
and
olde
r
bull A
t 6
mon
ths
oth
er f
orm
s of
milk
alo
ne a
re n
ot a
dequ
ate
to m
eet
the
baby
rsquos n
utrit
iona
l req
uire
men
ts
bull C
ompl
emen
tary
foo
ds s
houl
d be
intr
oduc
ed w
ith c
ontin
ued
br
east
feed
ing
or w
ith r
epla
cem
ent
feed
ing
until
a n
utrit
iona
lly
adeq
uate
die
t ca
n be
sus
tain
ed w
ithou
t m
ilk
bull A
brup
t ces
satio
n of
bre
astf
eedi
ng s
houl
d be
dis
cour
aged
to
avoi
d
trau
ma
for
both
the
mot
her
and
the
baby
bull M
ilk s
houl
d co
ntin
ue a
s an
impo
rtan
t co
mpo
nent
of
the
diet
bull C
ompl
emen
tary
foo
ds s
houl
d be
enr
iche
d fr
om lo
cally
ava
ilabl
e
fam
ily f
oods
84
NU
TRIT
ION
AL
CA
RE
AN
D S
UPP
OR
TO
F H
IV
INFE
CTE
DC
HIL
DR
EN
bull E
nerg
y ne
eds
for
asym
ptom
atic
HIV
infe
cted
chi
ldre
n in
crea
se b
y 10
pe
rcen
t to
mai
ntai
n gr
owth
as
com
pare
d to
the
non-
infe
cted
chi
ldre
n
bull T
here
is n
o ev
iden
ce o
f in
crea
sed
prot
ein
requ
irem
ents
The
re
quir
emen
ts s
houl
d be
bas
ed o
n in
divi
dual
sym
ptom
s an
d ne
eds
bull M
icro
nutr
ient
req
uire
men
ts d
o no
t ch
ange
W
HO
rec
omm
ends
not
m
ore
than
one
RD
A
(For
fur
ther
det
ails
re
fer
to K
enya
n G
uide
lines
on
nutr
ition
and
HIV
A
IDS
)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
3
64
82
OPE
RA
TIO
NA
L G
UID
ELIN
ESO
N I N
FAN
TFE
EDIN
G (0
-6 M
ON
THS)
The
follo
win
g sh
ould
gui
de in
fant
feed
ing
for t
he fi
rst 6
mon
ths
bull A
ll w
omen
and
men
irre
spec
tive
of th
eir
HIV
sta
tus
shou
ld r
ecei
ve
coun
selin
g an
d de
mon
stra
tions
on
how
to s
afel
y fe
ed t
heir
babi
es
duri
ng t
he a
nten
atal
and
pos
tnat
al f
ollo
w u
p
bull T
he m
ost
appr
opria
te in
fant
fee
ding
opt
ion
for
an H
IV in
fect
ed
mot
her
shou
ld c
ontin
ue t
o de
pend
on
indi
vidu
al c
ircu
mst
ance
s an
d
the
av
aila
ble
supp
ort
bull E
very
HIV
infe
cted
wom
an s
houl
d be
eva
luat
ed a
t ev
ery
visi
t to
ch
eck
whe
ther
her
soc
ial
econ
omic
and
hea
lth s
tatu
s ha
s ch
ange
d
suff
icie
ntly
eno
ugh
to a
ffec
t he
r in
fant
fee
ding
opt
ion
bull E
xclu
sive
bre
astf
eedi
ng fo
r H
IV in
fect
ed w
omen
for
the
firs
t 6
mon
ths
of t
he in
fant
rsquos li
fe is
adv
isab
le
unle
ss r
epla
cem
ent f
eedi
ng is
ac
cept
able
fea
sibl
e a
ffor
dabl
e s
usta
inab
le a
nd s
afe
for
them
and
th
eir
infa
nts
befo
re t
hat t
ime
bull W
hen
repl
acem
ent
feed
ing
is a
ccep
tabl
e f
easi
ble
aff
orda
ble
su
stai
nabl
e an
d sa
fe
avoi
danc
e of
exc
lusi
ve b
reas
tfee
ding
by
HIV
in
fect
ed w
omen
is r
ecom
men
ded
bull I
f th
e co
nditi
ons
for
repl
acem
ent
feed
ing
are
still
not
met
for
6
mon
ths
then
co
ntin
uatio
n of
bre
astf
eedi
ng w
ith a
dditi
onal
co
mpl
emen
tary
fee
ding
is r
ecom
men
ded
giv
ing
prio
rity
to t
he lo
cally
av
aila
ble
food
s
bull I
nfan
t fe
edin
g de
cisi
ons
for
all H
IV e
xpos
ed in
fant
s sh
ould
be
base
d on
the
AF
AS
S c
riter
ia e
ven
whe
re e
arly
infa
nt d
iagn
osis
(E
ID)
is
avai
labl
e
bull B
reas
tfeed
ing
mot
hers
of
infa
nts
and
youn
g ch
ildre
n w
ho a
re k
now
n to
be
HIV
infe
cted
sho
uld
be s
tron
gly
enco
urag
ed to
con
tinue
bre
ast
feed
ing
How
ever
br
east
feed
ing
HIV
infe
cted
mot
hers
sho
uld
be
give
n nu
triti
on s
uppo
rt (
nutr
ition
al c
ouns
elin
g e
duca
tion
foo
d an
d nu
triti
onal
sup
plem
ents
)
63
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
44
Sulp
hur-
base
d in
term
itten
t pr
esum
ptiv
e m
alar
ia t
reat
men
t (I
PT) s
houl
d no
t be
giv
en
to w
omen
who
are
on
CTX
pro
phyl
axis
AR
V us
e
bull A
RV
s ar
e us
ed fo
r tr
eatin
g H
IV-i
nfec
ted
elig
ible
wom
en a
ndo
r fo
r pr
even
tion
of m
othe
r-to
-chi
ld tr
ansm
issi
on
bull H
IV-i
nfec
ted
preg
nant
wom
en e
ligib
le f
or A
RT
sho
uld
initi
ate
AR
T
as s
oon
as p
ossi
ble
as s
how
n in
Tab
le 4
1
bull H
IV-i
nfec
ted
preg
nant
wom
en a
lread
y on
AR
T b
efor
e be
com
ing
preg
nant
sho
uld
cont
inue
AR
T
The
bab
y sh
ould
be
give
n A
RV
pr
ophy
laxi
s so
on a
fter
birt
h as
sho
wn
in T
able
42
Tabl
e 4
1 R
ecom
men
datio
ns fo
r ini
tiatin
g A
RV
trea
tmen
t in
preg
nant
w
omen
bas
ed o
n cl
inic
al s
tage
and
ava
ilabi
lity
of C
D4
Cou
nt
WH
O
CD
4 te
stin
g
CD
4 te
stin
g
Clin
ical
Sta
ge
not a
vaila
ble
avai
labl
e
1 D
o no
t Tre
at
Trea
t if C
D4le
350
cells
mm
3
2 D
o no
t Tre
at
Trea
t if C
D4 le
350
cells
mm
3
3 Tr
eat
Trea
t irre
spec
tive
of C
D4
coun
t (c
onsi
der C
D4
valu
es fo
r bet
ter
man
agem
ent)
4 Tr
eat
Trea
t irre
spec
tive
of C
D4
cell
coun
t
Sourc
e A
dopte
d f
rom
WH
O
Anti-r
etro
vira
l dru
gs
for
trea
ting p
regnant
wom
en a
nd p
re-
venting H
IV infe
ctio
ns
Tabl
e 4
2 R
ecom
men
ded
first
-line
AR
T re
gim
en fo
r tre
atin
g pr
egna
nt w
omen
and
pro
phyl
actic
regi
men
for i
nfan
ts
Mot
her
Ant
epar
tum
AZ
T +
3TC
+ N
VP D
aily
Intra
partu
m
AZT
+ 3T
C +
NVP
Dai
ly
Pos
tpar
tum
AZ
T +
3TC
+ N
VP D
aily
Infa
nt p
roph
ylax
is
Sd
NV
P 2
mg
kg s
tat w
ithin
72
hour
s 3T
C X
1 w
eek
(4
mg
kg B
ID)
AZT
X 6
wee
ks (4
mg
kg B
ID)
Mat
erna
l dos
ages
AZT
300
mg
BID
3TC
150
mg
BID
NV
P 2
00 m
g O
D fo
r tw
o w
eeks
the
reaf
ter 2
00 m
g B
ID
Infa
nt D
osag
es
NV
P
2mg
kg s
tat w
ithin
72
hour
s
AZT
4mg
kg B
ID X
6 w
eeks
3TC
4m
gkg
BID
X 1
wee
k
Cha
pter
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
Bor
n to
HIV
Infe
cted
Mot
hers
81
INTR
OD
UC
TIO
N T
RA
NSM
ISSI
ON
OF
HIV
THR
OU
GH
B
REA
STFE
EDIN
G
In A
fric
a 3
to 4
out
of e
very
10
infa
nts
born
to H
IV in
fect
ed w
omen
acq
uire
HIV
infe
cshytio
n T
here
is t
here
fore
a 5
ndash 2
0 pe
rcen
t ri
sk o
f inf
ants
bor
n to
HIV
pos
itive
mot
hers
ac
quir
ing
infe
ctio
n th
roug
h br
east
-fe
edin
g if
ther
e ar
e no
inte
rven
tions
in
pla
ce
For
wom
en w
ho a
re i
nshyfe
cted
with
HIV
for
the
first
tim
e or
w
ho a
re r
e-in
fect
ed w
ith a
diff
eren
t st
rain
of H
IV d
urin
g th
e br
east
feed
shyin
g ph
ase
the
ris
k in
crea
ses
up t
o29
per
cen
t H
alf (
12)
of H
IV b
reas
t m
ilk t
rans
mis
sion
tak
es p
lace
by
6 w
eeks
and
thre
e qu
arte
rs (3
4) b
y 6
mon
ths
Mix
ed fe
edin
g in
crea
ses
the
risk
of
brea
st m
ilk t
rans
mis
sion
of
HIV
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
5
62
For
prop
hyla
xis
the
reco
mm
enda
tions
are
ran
ked
and
will
dep
end
on t
ime
of fi
rst
conshy
tact
with
the
wom
an H
IV-in
fect
ed p
regn
ant w
omen
who
are
not
elig
ible
for
AR
T or
in
72
3 C
OM
PREH
ENSI
VE
CA
RE
FOR H
IV-E
XPO
SED
CH
ILD
REN
w
hom
it is
not
pos
sibl
e to
sta
rt A
RT
imm
edia
tely
and
the
mot
her
is b
eing
see
n be
twee
n28
and
38
wee
ks o
f pr
egna
ncy
sho
uld
be s
tart
ed o
n re
com
men
ded
mor
e ef
ficac
ious
shor
t co
urse
pro
phyl
actic
AR
V r
egim
ens
as s
how
n in
Tab
le 4
3a
The
bab
y sh
ould
als
obe
giv
en A
RV
pro
phyl
axis
soo
n af
ter
birt
h as
sho
wn
in th
e sa
me
tabl
e T
he r
egim
ens
asou
tline
d be
low
are
for
prop
hyla
xis
and
not f
or tr
eatm
ent
MINI
STRY
OF H
EAL
TH
Tabl
e 4
3a R
ecom
men
ded
Firs
t Lin
e A
RV
prop
hyla
xis
ALGO
RITH
M FO
R EA
RLY
INFA
NTDI
AGNO
SISFO
R HI
VEX
POSE
DCH
ILDRE
N
to p
reve
nt H
IV in
fect
ion
in in
fant
s A
mon
g Pr
egna
nt W
omen
Pr
esen
ting
Bef
ore
38 W
eeks
Ran
king
Ti
me
of A
dmin
istr
atio
n
WEL
L CHI
LD
SICK
CHI
LD
(Man
age
pres
entin
g ill
ness
and
stab
ilize
)
STAR
T CO
TRIM
OXAZ
OLE
PROP
HYLA
XIS
FOR M
OR E
INFOR
MATIO
N C ON
TACT
THE N
ATI O
NAL A
IDS S
TD CO
NTRO
L PRO
GRAM
ME ( N
ASCO
P) PO
BOX
19 36
1-00
20 2 N
AIRO
BI TE
L 02
02 72
95 02
FAX 0
2 0 2 7
1 05 1
8
Exp
osur
e sta
tus s
houl
d be
det
erm
ined
for a
ll in
fants
of u
nkno
wn s
tatu
s at t
he
6 we
ek v
isit o
r firs
t con
t act
Coun
sel o
n inf
ant f
eedi
ng a
s per
nat
iona
l gui
delin
es
Conf
irma
tory
ABt
est
at 1
8 M
onth
s
Eval
uate
for
ART
star
t on
ARV
if el
igibl
e
If HI
V+ a
t 12
Mont
hs
Evalu
ate f
or A
RT
Start
on
ARV
if eli
gible
6 Wee
ks D
BS (P
CR)
HIV
+
If HI
V-sto
p CT
X if
not
BF
for a
t lea
st 2
Mont
hs
HI
V-
Antib
ody
test
ing
12 M
onth
s
Conf
irmat
ory
ABte
st at
18 M
onth
s
Conf
irmat
ory A
B te
st at
18 M
onth
s
Eval
uate
for A
RT
star
t on
ARV
if el
igible
If HIV
+ at
12
Mon
ths
Eval
uate
for A
RT
Star
t on
ARV
if el
igibl
e
If lt1
2 Mon
ths D
BS (P
CR)
If gt
12m
o An
tibod
y te
st
HIV
+
If HIV-
stop
CTX
if n
ot
BF
for a
t lea
st 2
Mont
hs
HI
V-
Antib
ody
testi
ng
12 M
onth
s
Conf
irma
tory
AB
test
at 1
8 Mo
nths
Exp
osur
e sta
tus s
hould
be de
term
ined
for a
ll in
fant
s of u
nkno
wn st
atus
at th
e 6w
eek
visit
or fi
rst c
onta
ct
Co
unse
l on
infa
nt fe
edin
g as
per n
atio
nal g
uideli
nes
Pre
gnan
cy
Labo
ur
Pos
tpar
tum
Mat
erna
l In
fant
Rec
omm
ende
d
AZT(
28-3
8 w
eeks
ge
stat
ion)
sd
NV
P
+ AZ
T+3T
C
AZT+
3TC
X
7 da
ys
sdN
VP
PL
US
3TC
X1
wee
k +
AZT
X
6 w
eeks
Tabl
e 4
3b b
elow
sho
ws
alte
rnat
ive
prop
hyla
ctic
regi
men
s fo
r w
omen
pre
sent
ing
befo
re 3
8 w
eeks
of p
regn
ancy
Ran
king
Ti
me
of A
dmin
istr
atio
n
Alte
rnat
ive
Min
imum
Pre
gnan
cy
AZT(
28-3
8 w
eeks
)
Labo
ur
sd N
VP
+
AZT(
600m
gs
stat
)
sdN
VP
+ A
ZT+3
TC
Pos
tpar
tum
AZT+
3TC
X
7 da
ys
Infa
nt
sdN
VP
+
3TC
X 7
da
ys +
AZT
X
6 w
eeks
sdN
VP
+
3TC
day
s +
AZT
X 6
wee
ks
HIV
-infe
cted
pre
gnan
t w
omen
who
are
see
n fo
r th
e fir
st t
ime
afte
r 38
wee
ks o
f pr
egshy
nanc
y or
in la
bour
sho
uld
be g
iven
AR
V p
roph
ylac
tic r
egim
ens
as s
how
n in
Tab
le 4
4
The
baby
sho
uld
also
be
give
n A
RV
pro
phyl
axis
soo
n af
ter
birt
h as
sho
wn
in t
he s
ame
Bot
h H
IV-in
fect
ed a
nd u
ninf
ecte
d ch
ildre
n re
quir
e co
mpr
ehen
sive
car
e (R
efer
to C
hap-
tabl
ete
r 8
and
9)
61
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
46
Tabl
e 4
4 A
RV
prop
hyla
xis
for P
MTC
T am
ong
preg
nant
wom
en w
ho
have
not
rece
ived
ant
enat
al A
RT
or p
roph
ylax
is
Ran
king
Ti
me
of A
dmin
istr
atio
n
La
bour
P
ostp
artu
m
Mat
erna
l In
fant
Rec
omm
ende
d
sdN
VP
AZ
T+3T
C
SdN
VP
+
X 7
days
P
LUS
3TC
X 1
wee
k +
AZT+
3TC
AZ
T X
6 w
eeks
Min
imum
sd
NV
P
-S
dNV
P
PLU
S 3
TC X
1 w
eek
+
AZT
X 6
wee
ks
Dos
ages
Mot
her
Bab
y
NV
P
200
mg
stat
2m
gkg
sta
t with
in 7
2 ho
urs
AZT
300
mg
BID
4m
gkg
BID
X 6
wee
ks
3TC
15
0 m
g BI
D
4mg
kg B
ID X
1 w
eek
Tabl
e 4
5 R
ecom
men
ded
HA
AR
T fo
r Pre
gnan
t Wom
en
base
d on
CD
4 C
ount
and
Sta
ge o
f Pre
gnan
cy
CD
4 C
ount
H
AA
RT
Trim
este
r C
ells
mm
3
72
2 H
IV P
OSI
TIV
EIN
FAN
TB
Y D
NA
PC
R
bull A
ll H
IV p
ositi
ve in
fant
s sh
ould
be
eval
uate
d fo
r el
igib
ility
for
antishy
retr
ovir
al tr
eatm
ent
and
linke
d to
car
e an
d tr
eatm
ent
as a
ppro
pria
te
bull W
HO
clin
ical
sta
ging
sho
uld
be d
one
for
all H
IV p
ositi
ve in
fant
s
Chi
ldre
n w
ho a
re a
t W
HO
Clin
ical
sta
ge 3
or
4 ar
e el
igib
le f
or
antir
etro
vira
l tre
atm
ent
bull A
ll H
IV p
ositi
ve in
fant
s sh
ould
be
asse
ssed
for
CD
4 co
unt
whe
re
poss
ible
and
ava
ilabl
e R
efer
to
AR
T g
uide
lines
for
CD
4 co
unts
tha
t de
term
ine
elig
ibili
ty f
or A
RT
for
chi
ldre
n of
diff
eren
t ag
e br
acke
ts
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
hav
e a
visi
ble
guar
dian
or
care
-tak
er
befo
re t
hey
can
be s
tart
ed o
n A
RT
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e fr
om 6
w
eeks
or
on f
irst
cont
act t
here
afte
r
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
be
star
ted
on A
RT
if el
igib
le
bull B
reas
tfeed
ing
shou
ld b
e en
cour
aged
for
all
HIV
-pos
itive
infa
nts
for
a
min
imum
of t
wo
year
s (
Ref
er t
o C
hapt
er 8
)
bull F
or a
ll H
IV-p
ositi
ve in
fant
s p
erfo
rm a
ntib
ody
test
ing
at 9
mon
ths
12
mon
ths
and
conf
irm
at
18 m
onth
s
1st T
rimes
ter
2nd T
rimes
ter
3rd T
rimes
ter
lt250
A
ZT+
3TC
+NV
P
AZ
T+3T
C+N
VP
AZT+
3TC
+NVP
250-
350
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
gt 35
0
A
ZT+3
TC+L
PVr
OR
A
BC
+3TC
+LPV
r
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
47
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
60
72
OPE
RA
TIO
NA
L G
UID
ELIN
ES
72
0 G
UID
ELIN
ESFO
R H
IV D
IAG
NO
SIS
INC
HIL
DR
EN
bull P
erfo
rm r
outin
e ra
pid
HIV
ant
ibod
y te
sts
for
all m
othe
rs o
f 6
wee
k ol
d in
fant
s pr
esen
ting
with
unk
now
n st
atus
bull P
erfo
rm r
outin
e dr
y bl
ood
spot
s (D
BS
) fo
r D
NA
PC
R f
or a
ll in
fant
s kn
own
to b
e H
IV-e
xpos
ed a
t 6
wee
ks
bull P
erfo
rm r
outin
e an
tibod
y te
stin
g fo
r al
l sic
k in
fant
s in
out
patie
nt a
nd
paed
iatr
ic w
ards
to
esta
blis
h H
IV e
xpos
ure
infe
ctio
n st
atus
bull P
erfo
rm D
BS
for
all
HIV
-exp
osed
sic
k in
fant
s un
der
12 m
onth
s
bull A
ll H
IV-e
xpos
ed in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e fr
om 6
w
eeks
of
age
or o
n fir
st c
onta
ct th
erea
fter
bull R
efer
to
chap
ter
on c
are
and
follo
w u
p of
the
HIV
-exp
osed
infe
cted
in
fant
72
1 H
IV N
EGA
TIV
EIN
FAN
TA
TA
GE
6 W
EEK
SO
RFI
RST
CO
NTA
CT
Perf
orm
ant
ibod
y te
stin
g at
9 m
onth
s an
d 12
mon
ths
of a
ge
bull I
f H
IV n
egat
ive
at 1
2 m
onth
s an
d st
ill b
reas
tfee
ding
co
ntin
ue
Cot
rim
oxaz
ole
bull I
f not
bre
astf
eedi
ng f
or a
t le
ast
2 m
onth
s s
top
Cot
rim
oxaz
ole
bull P
erfo
rm c
onfir
mat
ory
antib
ody
test
ing
at 1
8 m
onth
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Mat
erna
l dos
ages
AZT
30
0 m
g B
ID
3TC
15
0 m
g BI
D
NVP
200
mg
OD
for t
wo
wee
ks t
here
afte
r 200
mg
BID
AB
C
300m
g B
ID
LPV
r (4
001
00)
2 ta
blet
s B
ID
EFV
60
0mg
QID
Not
es I
mpo
rtan
t con
side
ratio
ns th
at m
odify
cho
ice
of A
RV
s du
ring
pre
gnan
cy in
clud
e C
D4
coun
t m
ater
nal a
naem
ia a
nd
stag
e of
pre
gnan
cy
bull 2
NR
TIs
(A
ZT
and
3TC
) ac
ting
as a
ldquotr
eatm
ent
back
bone
rdquo w
ith a
dditi
on o
f an
N
NR
TI (
NV
P)
rem
ains
the
pre
ferr
ed fi
rst-
line
AR
V t
hera
py in
res
ourc
e-po
or
sett
ings
bull P
rote
ase
inhi
bito
rs b
ased
reg
imen
s ar
e pr
efer
able
whe
n C
D4
coun
t is
high
er
than
250
bull R
epla
ce A
ZT
with
d4T
if H
blt 8
gm
dL
bull
EF
V m
ay b
e us
ed in
stea
d of
NV
P a
fter
first
trim
este
r
bull
Usu
ally
AR
V s
houl
d be
with
held
if C
D4
coun
t is
not
ava
ilabl
e or
not
don
e
AR
V is
how
ever
use
d fo
r P
MT
CT
and
or in
adv
ance
d H
IV d
isea
se (
WH
O
Sta
ge 3
or
4) ir
resp
ectiv
e of
CD
4 co
unt
Bab
ies
who
se
mot
hers
di
d no
t re
ceiv
e an
tepa
rtum
or
in
trap
artu
m
AR
Vpr
ophy
laxi
s sh
ould
be
give
n A
RV
pro
phyl
axis
as
show
n in
Tab
le 4
6
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
9
48
Tabl
e 4
6 A
RV
prop
hyla
ctic
regi
men
s fo
r inf
ants
bor
n to
H
IV-p
ositi
ve w
omen
who
hav
e no
t rec
eive
d an
tepa
rtum
or
intr
apar
tum
AR
T or
AR
V pr
ophy
laxi
s
Ran
king
T
ime
of a
dmin
istr
atio
n an
d In
fant
dos
age
sdN
VP (2
mg
kg s
tat)
PLU
S 3T
C (4
mg
kg B
ID) X
1 w
eek
+ AZ
T (4
mg
kg
BID
) X 6
wee
ks
Rec
omm
ende
d
sdN
VP (2
mg
kg s
tat)
Min
imum
sdN
VP
is g
iven
to th
e in
fant
with
in 7
2 ho
urs
of b
irth
Plea
se n
ote
A
t fir
st c
onta
ct a
ll H
IV i
nfec
ted
preg
nant
wom
en s
houl
d be
giv
en s
dNV
P ta
blet
s to
take
hom
e w
ith t
hem
The
y sh
ould
be
inst
ruct
ed t
o ta
ke t
he t
able
ts a
t th
e on
set
of la
shybo
ur i
f lab
our
occu
rs o
utsi
de h
ealth
faci
lity
sett
ings
The
y sh
ould
als
o be
giv
en N
VP
3T
C a
nd A
ZT s
yrup
for
thei
r ba
bies
to b
e ad
min
iste
red
soon
aft
er b
irth
Som
e w
omen
with
a C
D4
coun
t gr
eate
r th
an 2
50 c
ells
microl
on
Nev
irap
ine
(NV
P)-b
ased
AR
T m
ay d
evel
op N
VP
hype
rsen
sitiv
e re
actio
ns t
hat
can
be li
fe t
hrea
teni
ng I
n th
ese
guid
elin
es it
is r
ecom
men
ded
that
for
preg
nant
wom
en w
ith C
D4
mor
e th
an 2
50 N
VP-
base
d re
gim
en m
ay s
till
be u
sed
but
with
clo
se m
onito
ring
O
ther
wis
e th
e re
com
shym
ende
d re
gim
en to
use
with
CD
4 co
unt a
bove
250
is a
PI-
base
d H
AA
RT
regi
men
Whe
n si
ngle
dos
e N
VP
(sdN
VP)
is u
sed
in P
MTC
T s
ome
wom
en a
nd c
hild
ren
may
deshy
velo
p re
sist
ance
to
NV
P th
at m
ay l
imit
futu
re u
se o
f N
on-N
ucle
osid
e R
ever
se T
ranshy
scri
ptas
e In
hibi
tors
(NN
RTI
s) t
o tr
eat
them
Th
e ri
sk o
f NN
RTI
res
ista
nce
is p
artic
ushyla
rly
high
if
two
dose
s of
sdN
VP
are
give
n T
here
fore
SdN
VP
shou
ld n
ever
be
used
mor
e th
an o
nce
in a
ny o
ne p
regn
ancy
Whe
re p
ossi
ble
AZT
3TC
sho
uld
be g
iven
for
7 da
ys t
o co
ver
the
NV
P ta
il bo
th in
the
mot
her
and
the
baby
Th
e ba
by is
the
n co
ntin
shyue
d on
AZT
for
a to
tal o
f 6 w
eeks
for
prop
hyla
xis
agai
nst M
TCT
HIV
-infe
cted
pre
gnan
t w
omen
sta
rtin
g zi
dovu
dine
(A
ZT)
cont
aini
ng r
egim
ens
shou
ld
have
hae
mog
lobi
n (H
b) le
vels
abo
ve 8
gm
dl
The
Hb
leve
l sho
uld
be c
heck
ed m
onth
ly
for
the
first
thr
ee m
onth
s W
here
pos
sibl
e A
ZT s
houl
d be
use
d in
stea
d of
sta
vudi
ne(d
4T)
Clin
ical
judg
emen
t can
be
used
to e
stim
ate
Hb
leve
ls a
nd in
itiat
e AR
V pr
ophy
laxi
s if l
aboshy
rato
ry te
sts a
re u
nava
ilabl
e
Efa
vire
nz (
EFV
) m
ay b
e te
rato
geni
c if
used
in t
he f
irst
tri
mes
ter
If t
he p
atie
nt is
on
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Cha
pter
7
HIV
Dia
gnos
is in
Chi
ldre
n 7
1 IN
TRO
DU
CTI
ON
In g
ener
al
a ch
ild m
ay b
e te
sted
und
er a
num
ber
of c
ircu
mst
ance
s T
hese
inc
lude
sh
ortly
aft
er b
irth
for
earl
y di
agno
sis
of H
IV f
or th
e pu
rpos
es o
f ind
ivid
ual d
iagn
osis
in
a ch
ild w
ho is
ill (
eg
tho
se p
rese
ntin
g w
ith a
n H
IV r
elat
ed il
lnes
s) i
n ca
ses
whe
re a
child
has
eith
er b
een
expo
sed
or is
pot
entia
lly e
xpos
ed t
o H
IV e
g t
hrou
gh m
othe
r-to
shych
ild t
rans
mis
sion
se
xual
abu
se
sexu
al a
ctiv
ity
with
in a
hea
lthca
re s
ettin
g (e
g
thro
ugh
cont
amin
ated
nee
dles
or
rece
ipt
of p
oten
tially
infe
ctio
us b
lood
) th
roug
h ot
her
mea
ns a
nd in
orp
hans
Ear
ly i
nfan
t di
agno
sis
(EID
) re
fers
to
the
mak
ing
of H
IV d
iagn
osis
in
infa
nts
and
youn
g ch
ildre
n be
fore
18
mon
ths
of a
ge E
ID g
ives
an
oppo
rtun
ity fo
r ea
rly
iden
tific
ashytio
n of
HIV
infe
cted
infa
nts
(des
pite
PM
TCT)
and
ear
ly li
nkag
e to
car
e an
d tr
eatm
ent
Dis
ease
pro
gres
sion
in H
IV in
fect
ed in
fant
s is
fast
with
a h
igh
mor
talit
y ra
te (gt
50
)by
2 y
ears
of a
ge T
he m
edia
n ag
e of
dea
th in
the
first
two
year
s is
6 m
onth
s H
IV a
ntishy
body
tes
ting
amon
g ch
ildre
n ag
ed 1
8 m
onth
s or
mor
e is
abl
e to
det
erm
ine
whe
ther
a
child
is in
fect
ed o
r no
t
Dur
ing
preg
nanc
y m
othe
rs g
ive
thei
r ba
bies
ant
ibod
ies
to in
fect
ions
the
y ha
ve e
xper
ishyen
ced
and
thes
e an
tibod
ies
wan
e w
ith ti
me
Ant
ibod
y te
stin
g in
chi
ldre
n ag
ed le
ss th
an
18 m
onth
s id
entif
ies
child
ren
who
hav
e be
en e
xpos
ed to
thei
r m
othe
rsrsquo H
IV in
fect
ion
or
who
may
be
trul
y in
fect
ed a
nd a
re m
akin
g H
IV a
ntib
odie
s C
urre
ntly
the
re is
no
test
to
diff
eren
tiate
the
mot
herrsquos
ant
ibod
ies
from
tho
se p
rodu
ced
by t
he b
aby
In
orde
r to
id
entif
y th
e H
IV-in
fect
ed c
hild
age
d le
ss t
han
18 m
onth
s a
sec
ond
test
is r
equi
red
for
all b
abie
s te
stin
g po
sitiv
e on
ant
ibod
y te
stin
g or
kno
wn
to b
e H
IV-e
xpos
ed (m
othe
r is
H
IV-p
ositi
ve)
Infa
nt D
NA
(or
RN
A) P
CR
tes
ting
is t
he c
urre
nt r
ecom
men
ded
met
hod
for
EID
Sinc
e m
ost b
abie
s lo
se m
ater
nal a
ntib
odie
s (A
b) b
y 12
mon
ths
a n
egat
ive
antib
ody
test
will
ide
ntify
uni
nfec
ted
babi
es a
s lo
ng a
s th
ey a
re n
ot s
till
brea
stfe
edin
g A
pos
itive
antib
ody
test
at
12 m
onth
s a
lthou
gh h
ighl
y lik
ely
to b
e di
agno
stic
may
stil
l be
due
topa
ssiv
ely
carr
ied
mat
erna
l ant
ibod
ies
Suc
h te
sts
need
to
be c
onfir
med
by
PCR
tes
ting
or r
epea
t ant
ibod
y te
st a
t 18
mon
ths
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
9
58
CARE
SU
PPO
RTAN
DTR
EATM
ENT
FOR
HIV
PO
SITI
VEM
OTH
ERAN
DCH
ILD
HIV
-pos
itive
mot
hers
requ
ire c
are
and
supp
ort w
hich
incl
udes
bull
Cou
nsel
ing
bull P
roph
ylax
is a
nd tr
eatm
ent
bull L
ink
to s
uppo
rt g
roup
s an
d as
sess
men
t of
the
nee
d fo
r A
RT
bull E
arly
infa
nt d
iagn
osis
sho
uld
be p
rovi
ded
at s
ix w
eeks
usi
ng D
NA
shyP
CR
tes
ting
Cha
pter
ref
eren
ces
1
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
Pla
nnin
g
Guid
elin
es f
or
serv
ice
pro
vider
s
Rev
ised
in M
arch
2006
Foo
tnot
es
1
Pre
ble
and P
iwoz
2001
2
WH
O
Contr
ace
ptive
Elig
ibili
ty C
rite
ria
Guid
e
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
EFV
bef
ore
beco
min
g pr
egna
nt i
t sho
uld
be s
ubsi
tute
d w
ith N
VP
in th
e 1s
t tri
mes
ter
In c
ase
of s
ever
e hy
pere
mes
is g
ravi
daru
m A
RT
may
nee
d to
be
brie
fly in
terr
upte
d
On
aver
age
mot
her-
to-c
hild
tra
nsm
issi
on r
ates
are
15
for
sdN
VP
65
fo
r m
ore
effishy
caci
ous
dual
reg
imen
s an
d 2
4 fo
r 3-
drug
AR
V c
ombi
natio
n
Futu
re P
ersp
ectiv
es
Ext
ende
d pr
ophy
laxi
s w
ith 3
AR
V d
rug
com
bina
tions
sta
rtin
g du
ring
pre
gnan
cy a
nd
cont
inui
ng a
fter
del
iver
y fo
r a
peri
od o
f up
to
6 m
onth
s a
mon
g H
IV-in
fect
ed b
reas
t-fe
edin
g m
othe
rs h
as b
een
show
n in
a f
ew r
ecen
t an
d is
olat
ed s
tudi
es a
nd p
ilot
proshy
gram
me
to le
ad to
low
er b
reas
tfee
ding
-rel
ated
pos
tnat
al M
TCT
Thi
s ap
proa
ch m
ay b
e co
nsid
ered
whe
re th
is is
feas
ible
acc
epta
ble
saf
e an
d w
here
adh
eren
ce c
an b
e as
sure
d
Mor
e st
udie
s on
this
issu
e ar
e ex
pect
ed
Thre
e A
RV
dru
g co
mbi
natio
ns g
iven
to
HIV
pos
itive
pre
gnan
t w
omen
who
are
not
yet
el
igib
le fo
r in
itiat
ion
of A
RTs
for
thei
r ow
n he
alth
als
o le
ad to
low
er M
TCT
and
may
be
cons
ider
ed in
pro
gram
mes
with
the
capa
city
to in
itiat
e th
e re
gim
en a
nd fo
llow
up
such
wom
en S
uch
inte
rven
tion
is in
itiat
ed a
t ar
ound
28
wee
ks o
r so
on a
fter
and
sto
pped
af
ter
birt
h if
CD
4 co
unt i
s st
ill a
bove
350
cel
lsm
m3
App
endi
ces
Appen
dix
I
Appen
dix
II
Appen
dix
III
Appen
dix
IV
WH
O C
linic
al S
tagin
g o
f H
IVA
IDS f
or
Adults
and A
dole
scen
ts
w
ith c
onfirm
ed H
IV infe
ctio
n
Contr
acep
tive
Options
for
Peo
ple
Liv
ing w
ith H
IV
Sum
mar
y of
ARV D
rug U
se f
or
PMTCT o
f H
IV
In
tegra
ted M
onitori
ng a
nd E
valu
ation R
eport
Form
MO
H 7
26
Cha
pter
ref
eren
ces
1
Sum
mar
y of
ARV D
rugs
Adve
rse
Effec
ts a
nd M
anag
emen
t T
able
6-1
0
pages
101-1
12 o
f G
uid
elin
es f
or
Antire
trovi
ral D
rug T
her
apy
in K
enya
3rd
Editio
n
De-
cem
ber
2005
2
Dru
g I
nte
ract
ions
Tab
le 7
-10
pag
es 1
12-1
22 o
f G
uid
elin
es f
or
Antire
trovi
ral
Dru
g T
her
apy
in K
enya
3rd
editio
n
Dec
2005
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
7
50
Cha
pter
5
Imm
edia
te P
ostn
atal
and
Neo
nata
l Car
e 5
1 IN
TRO
DU
CTI
ON
Imm
edia
te p
ostn
atal
and
neo
nata
l car
e re
fers
to th
e pa
ckag
e of
ser
vice
s pr
ovid
ed to
the
mot
her
and
infa
nt b
efor
e th
ey le
ave
the
heal
th fa
cilit
y (u
p to
48
hour
s) a
fter
del
iver
yTh
e pe
riod
pro
vide
s an
opp
ortu
nity
to e
duca
te a
ll m
othe
rs a
bout
HIV
to
prov
ide
coun
shyse
lling
and
tes
ting
if it
was
not
don
e pr
evio
usly
and
to
rein
forc
e th
e ed
ucat
ion
proshy
vide
d du
ring
the
ant
enat
al p
erio
d B
oth
HIV
inf
ecte
d an
d H
IV u
ninf
ecte
d m
othe
rs
shou
ld r
ecei
ve th
is e
duca
tion
and
coun
selli
ng b
efor
e di
scha
rge
52
OPE
RA
TIO
NA
L G
UID
ELIN
ES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed fo
r all
wom
en a
nd
infa
nts
in th
e im
med
iate
pos
t par
tum
per
iod
a)
Opt
imal
pos
tpar
tum
car
e
bull R
outin
e ca
re in
clud
ing
brea
st e
xam
inat
ion
exa
min
atio
n of
the
ute
rus
ex
amin
atio
n of
the
per
ineu
m a
nd lo
chia
pa
ssag
e of
uri
ne r
egul
arly
pr
oper
hyg
iene
to
prev
ent
infe
ctio
n c
heck
ing
for
sign
s of
ana
emia
fe
ver
and
tach
ycar
dia
bull D
iscu
ss m
ater
nal n
utri
tion
bull E
stab
lish
the
HIV
sta
tus
of t
he m
othe
rs in
clud
ing
thos
e gi
ving
birt
h ou
tsid
e th
e he
alth
inst
itutio
n se
tting
bull P
rovi
de H
IV C
T f
or m
othe
rs w
ith u
nkno
wn
HIV
sta
tus
bull E
ncou
rage
HIV
res
ults
dis
clos
ure
and
part
ner
test
ing
bull F
ollo
w t
he s
tand
ard
guid
elin
es o
n th
e ca
re o
f a n
ewbo
rn (
IMP
AC
C
are
Man
ual)
bull A
ll ba
bies
sho
uld
rece
ive
thei
r ro
utin
e im
mun
izat
ion
(OP
V a
nd B
CG
) in
th
eir
first
hou
rs o
f lif
e1
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Con
trac
eptio
n A
ll m
othe
rs r
egar
dles
s of
the
ir H
IV s
tatu
s h
ave
a ri
ght
to r
ecei
ve a
dequ
ate
info
rmashy
tion
on a
vaila
ble
met
hods
of f
amily
pla
nnin
g an
d to
mak
e an
info
rmed
cho
ice
on w
hat
is b
est
for
them
H
IV-in
fect
ed w
omen
who
are
not
bre
astf
eedi
ng s
houl
d in
itiat
e a
relia
ble
cont
race
ptiv
e m
etho
d by
2-4
wee
ks p
ostp
artu
m
This
is
in a
dditi
on t
o th
epr
oper
and
con
sist
ent
use
of t
he c
ondo
m a
s a
form
of
dual
pro
tect
ion
All
met
hods
of
cont
race
ptio
n ca
n be
use
d by
HIV
pos
itive
wom
en b
ased
on
stan
dard
med
ical
elig
ibili
tycr
iteri
a in
clud
ing
taki
ng c
are
of d
rug
inte
ract
ions
as
outli
ned
belo
w2
bull L
acta
tiona
l Am
enor
rhoe
a M
etho
d (L
AM
) S
uita
ble
for
excl
usiv
ely
brea
stfe
edin
g H
IV in
fect
ed w
omen
who
hav
e no
t re
sum
ed m
ense
s
bull H
orm
onal
con
trac
eptio
n A
ll ho
rmon
al c
ontr
acep
tives
can
be
used
in
HIV
pos
itive
wom
en in
clud
ing
thos
e on
HA
AR
T
Com
bine
d or
al
cont
race
ptiv
es a
re c
ontr
aind
icat
ed f
or u
se w
ith d
rugs
that
indu
ce
hepa
tic m
icro
-enz
yme
that
may
red
uce
the
effe
ctiv
enes
s of
hor
mon
al
cont
race
ptiv
es
Som
e an
ti-T
Bs
ant
iret
rovi
rals
an
tifun
gals
and
ant
i-ep
ilept
ics
and
in c
ondi
tions
tha
t ca
use
mal
abso
rptio
n8
bull I
ntra
-ute
rine
con
trac
eptiv
e de
vice
s (I
UC
Ds)
IU
CD
s ar
e no
t co
ntra
indi
cate
d in
HIV
pos
itive
wom
en
In s
ever
ely
imm
uno
supp
rese
d w
omen
use
sho
uld
not
be d
isco
ntin
ued
but
new
inse
rtio
n is
dis
cour
aged
as
it m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f in
fect
ion
duri
ng t
he in
sert
ion
proc
ess
bull S
urgi
cal m
etho
ds S
urgi
cal c
ontr
acep
tion
shou
ld b
e of
fere
d to
HIV
po
sitiv
e w
omen
and
the
ir pa
rtne
rs
bull B
arri
er m
etho
ds
Fem
ale
and
mal
e co
ndom
s pr
ovid
e pr
otec
tion
agai
nst
ST
Ds
and
redu
ce t
he r
isk
of H
IV t
rans
mis
sion
and
sho
uld
be
enco
urag
ed a
lone
or
toge
ther
with
oth
er c
ontr
acep
tive
met
hods
bull S
perm
icid
es
Use
d in
con
junc
tion
with
bar
rier
met
hods
spe
rmic
ides
w
ill p
rovi
de a
dditi
onal
con
trac
eptiv
e pr
otec
tion
How
ever
sp
erm
icid
es s
houl
d no
t be
use
d al
one
as t
hey
can
incr
ease
the
ris
k of
HIV
acq
uisi
tion
bull E
mer
genc
y co
ntra
cept
ion
HIV
pos
itive
wom
en s
houl
d be
info
rmed
ab
out
emer
genc
y co
ntra
cept
ion
whe
re it
is a
vaila
ble
and
how
to
obta
in a
nd u
se it
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
1
56
Bre
ast c
are
in b
reas
tfeed
ing
mot
hers
bull E
ncou
rage
dai
ly c
lean
ing
of t
he b
reas
ts a
nd a
void
ing
the
appl
icat
ion
of lo
tions
bull T
reat
mat
erna
l vag
inal
can
didi
asis
and
infa
nt o
ral c
andi
dias
is
bull E
duca
te m
othe
r on
opt
imal
bre
astf
eedi
ng te
chni
que
incl
udin
g la
tchi
ng
on t
echn
ique
ex
lusi
ve b
reas
tfee
ding
and
rem
ovin
g ba
by f
rom
bre
ast
bull E
duca
te th
e m
othe
r on
bre
ast c
are
to p
reve
nt c
ompl
icat
ions
(cr
acki
ng
and
engo
rgem
ent)
bull E
xpre
ss a
nd h
eat
trea
t th
e m
ilk if
bre
ast
has
mas
titis
or
absc
ess
Opt
imal
pos
tpar
tum
car
e fo
r HIV
pos
itive
wom
en
Loch
ia
bull P
ut e
mph
asis
on
good
per
inea
l hyg
iene
and
pro
per
hand
ling
of b
ody
fluid
s
bull A
void
con
tam
inat
ing
the
baby
with
bod
y flu
ids
or w
ith b
eddi
ng s
oile
d w
ith lo
chia
bull S
hari
ng o
f be
ds b
y m
othe
rs in
the
hos
pita
l sho
uld
be d
isco
urag
ed
Cae
sare
an S
ectio
n
Bro
ad s
pect
rum
ant
ibio
tics
shou
ld b
e us
ed r
outin
ely
afte
r C
S
Esse
ntia
l mat
erna
l edu
catio
n an
d fo
llow
-up
bull M
onito
r fo
r br
east
and
pel
vic
infe
ctio
n at
all
post
nat
al c
linic
vis
its
bull E
duca
te o
n pr
ompt
hea
lth s
eeki
ng b
ehav
iour
bull H
ealth
edu
catio
n on
hyg
iene
lo
chia
and
bre
ast
care
bull A
void
sex
ual i
nter
cour
se f
or a
t lea
st 2
wee
ks a
fter
birt
h or
unt
il th
ere
is
no lo
nger
any
loch
ia r
ubra
or
sero
sa
bull D
o pa
p sm
ear
or V
IA a
t 4-
6 w
eeks
bull F
or e
very
sex
ual a
ctiv
ity
the
coup
le s
houl
d us
e co
ndom
s
bull D
iscu
ss f
amily
pla
nnin
g at
eve
ry o
ppor
tuni
ty a
nd p
rovi
de t
he
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Supp
ort
infa
nt fe
edin
g op
tions
For
all
HIV
neg
ativ
e w
omen
wom
en o
f unk
now
n H
IV
stat
us a
nd H
IV p
ositi
ve m
othe
rs o
ptin
g fo
r ex
clus
ive
brea
stfe
edin
g in
itiat
e br
east
feed
shyin
g w
ithin
hal
f hou
r of
bir
th a
nd fo
llow
oth
er g
uide
lines
as
per
Bab
y Fr
iend
ly H
ospi
tal
Initi
ativ
e2 (B
FHI)
bull G
ive
info
rmat
ion
on fa
mily
pla
nnin
g an
d du
al p
rote
ctio
n
bull C
ouns
el o
n H
IV r
isk
redu
ctio
n
bull S
ched
ule
post
nata
l clin
ic v
isits
at
2 w
eeks
and
at
4-6
wee
ks a
nd
com
plet
e m
othe
r-ch
ild b
ookl
et (
refe
r to
DR
H m
anua
l)
(b) S
peci
fic p
ostp
artu
m c
are
for H
IV p
ositi
ve w
omen
bull S
uppo
rt e
xclu
sive
bre
astf
eedi
ng u
nles
s m
othe
r ha
s ap
prop
riat
ely
opte
d fo
r an
d be
en c
ouns
elle
d on
rep
lace
men
t fe
edin
g an
tena
tally
bull I
nitia
te o
r co
ntin
ue c
o-tr
imox
azol
e pr
ophy
laxi
s -1
dou
ble
stre
ngth
tab
shyle
t da
ily
bull F
or H
IV p
ositi
ve m
othe
rs t
hat
rece
ived
sd
nevi
rapi
ne in
trap
artu
m
initi
shyat
e A
ZT
300m
g an
d 3T
C 1
50 m
g B
D f
or 1
wee
k
bull F
or n
ewly
dia
gnos
ed m
othe
rs
do H
IV s
tagi
ng
CD
4 co
unt
and
refe
r ap
prop
riat
ely
for
cont
inue
d ca
re
(c)
Spec
ific
care
for H
IV e
xpos
ed in
fant
s
bull F
or H
IV e
xpos
ed in
fant
s a
dmin
iste
r sd
NV
P 2
mg
kg s
tat
with
in 7
2 ho
urs
Giv
e A
ZT
4 m
gkg
BID
for
6 w
eeks
and
3T
C 4
mg
kg B
ID f
or 1
w
eek
Ref
er t
o C
hapt
er 4
bull R
efer
to C
hapt
er 8
for
deta
ils o
n in
fant
fee
ding
opt
ions
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
5
52
Cha
pter
ref
eren
ces
1
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
Nat
ional
Guid
elin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
ata
l Car
e (2
004)
2
2R
epublic
of
Ken
ya M
inis
try
of
Hea
lth
Ess
ential
Obst
etri
c C
are
Man
ual
for
Hea
lth
Ser
vice
Pro
vider
s in
Ken
ya 3
rd E
ditio
n (
Jan 2
006)
Foo
tnot
es
1
WH
O r
ecom
men
ds
that
all
vacc
ines
should
be
giv
en t
o H
IV-s
ero-n
egat
ive
child
ren
and t
o a
sym
pto
mat
ic s
ero-p
osi
tive
s
The
only
vac
cines
to b
e w
ithhel
d f
rom
child
ren w
ith s
ympto
mat
ic A
IDS a
re B
CG
and
Yel
low
fev
er v
acc
ines
2
The
ldquoTen
Ste
psrdquo
of
BFH
I R
ecom
men
ded
Pra
ctic
es f
or
Mat
ernity
Ser
vice
s ad
apte
d f
or
W
HO
UN
ICEF
1989
Cha
pter
6
Late
Pos
tnat
al C
are
and
Fam
ily P
lann
ing
61
INTR
OD
UC
TIO
N
Late
pos
tnat
al c
are
is p
rovi
ded
to t
he m
othe
r an
d th
e ch
ild 4
8 ho
urs
to 6
wee
ks a
fter
deliv
ery
Dur
ing
this
per
iod
the
heal
th o
f the
mot
her
and
child
is a
sses
sed
and
clos
ely
mon
itore
d
The
risk
of M
TCT
duri
ng th
e po
stpa
rtum
per
iod
can
be r
educ
ed b
y pr
ovid
ing
HIV
cou
nshyse
lling
and
test
ing
pos
t-ex
posu
re p
roph
ylax
is fo
r ex
pose
d ba
bies
cou
nsel
ling
on a
ppro
shypr
iate
infa
nt fe
edin
g op
tions
and
bre
ast c
are
Pos
tpar
tum
car
e fo
r H
IV p
ositi
ve w
omen
shou
ld in
clud
e cl
inic
al s
tagi
ng C
D4
coun
t and
AR
T fo
r th
ose
who
qua
lify
Fam
ily p
lann
ing
serv
ices
are
am
ong
the
core
inte
rven
tions
of P
MTC
T pr
ovid
ed to
hel
pw
omen
det
erm
ine
futu
re c
hild
bear
ing
patt
erns
inc
ludi
ng t
he p
reve
ntio
n of
HIV
-in
fect
ed b
irth
s
Rep
rodu
ctiv
e he
alth
cou
nsel
ling
can
help
a w
oman
pra
ctis
e sa
fer
sex
and
dete
rmin
e he
r fu
ture
ch
ildbe
arin
g pa
tter
ns
on
a m
ore
resp
onsi
ble
and
info
rmed
bas
is1
62
OPE
RA
TIO
NA
L G
UID
ELIN
ES
Opt
imal
pos
tpar
tum
car
e fo
r all
wom
en
This
ent
ails
rou
tine
care
inc
ludi
ng b
reas
t ex
amin
atio
n e
xam
inat
ion
of t
he u
teru
s
exam
inat
ion
of t
he p
erin
eum
and
loch
ia p
assa
ge o
f uri
ne r
egul
arly
pro
per
hygi
ene
topr
even
t in
fect
ion
che
ckin
g fo
r si
gns
of a
nem
ia
feve
r an
d ta
chyc
ardi
a an
d do
ing
peri
neal
exe
rcis
es
Add
ition
al c
are
incl
udes
bull C
ouns
ellin
g an
d te
stin
g fo
r m
othe
rs o
f un
know
n H
IV s
tatu
s bull
Pro
visi
on o
f co
ndom
s an
d ris
k re
duct
ion
coun
selli
ng
bull C
ouns
ellin
g on
con
trac
eptiv
e op
tions
in
clud
ing
dual
met
hod
use
bull D
iscu
ssin
g m
ater
nal n
utrit
ion
bull M
alar
ia p
reve
ntio
n bull
Scr
eeni
ng f
or S
TI a
nd c
ervi
cal c
ance
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
3
54
App
endi
x V
II
103
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Ms
Mw
anga
ngi
Alic
e Pr
ogra
m O
ffice
r D
RH
-MO
H
Ms
Mw
angi
Nan
cy
PMTC
T A
dmin
istr
ativ
e A
ssis
tant
CD
C K
enya
Mr
Ndw
iga
Fra
ncis
Pr
ogra
m O
ffice
r M
OH
-NA
SCO
P
Prof
Ndu
ati
Rut
h
Ass
ocia
te P
rofe
ssor
of P
aedi
atri
cs U
oN
Dr
Nju
guna
Cha
rles
Pr
ogra
m A
ssoc
iate
MSH
RPM
Plu
s
Mr
Nya
beri
Dav
id
Prog
ram
Offi
cer
MO
H-D
RH
Mr
Ode
ra J
W
Prog
ram
Coo
rdin
ator
GTZ
Ms
Olu
och
Pat
rici
a Te
chni
cal A
dvis
or C
DC
Ken
ya
Mr
Olu
och
Tom
Te
chni
cal A
dvis
or C
DC
Ken
ya
Dr
Onrsquo
gech
Joh
n
Prog
ram
Coo
rdin
ator
KN
H
Dr
Otie
no-N
yuny
a B
Se
nior
Lec
ture
rH
ead
of D
epar
tmen
t PM
TCT
Dir
ecto
rM
oi U
nive
rsity
AM
PATH
Dr
Oum
a C
hris
PM
TCT
Prog
ram
Offi
cer
UN
ICE
F
Dr
Saw
e F
redr
ick
K
Dep
uty
Dir
ecto
r W
RP
Mr
Soo
Leo
nard
Pr
ogra
m M
anag
er W
RP
Dr
Vak
il S
obha
N
Tech
nica
l Adv
isor
AR
T Pr
ogra
m N
ASC
OP
Ms
Way
ua R
uth
Prog
ram
Offi
cer
MO
H-D
RH
Dr
Yon
ga I
sabe
lla
PMTC
T Te
chni
cal A
dvis
or E
GPA
F
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
Tabl
e of
Con
tent
s Li
st o
f con
trib
utor
s 3
Tabl
e of
con
tent
s 5
Ack
now
ledg
emen
ts
10
Fore
wor
d 11
Abb
revi
atio
ns a
nd A
cron
yms
12
Exe
cutiv
e Su
mm
ary
16
Cha
pter
1
Bac
kgro
und
20
11T
he G
loba
l Pan
dem
ic
20
12
Mag
nitu
de o
f HIV
in P
regn
ancy
in
22
13
Ris
ks o
f Tra
nsm
issi
on o
f MTC
T at
Diff
eren
t Tim
e Pe
riod
s 23
14
Ris
k Fa
ctor
s of
MTC
T of
HIV
24
15
Ben
efits
of P
MTC
T of
HIV
25
16
Ben
efits
of H
IV C
ouns
ellin
g amp
Tes
ting
25
17
The
Four
-pro
nged
App
roac
h to
PM
TCT
26
18
Ove
rvie
w o
f the
New
PM
TCT
Gui
delin
es
28
19
Obj
ectiv
es amp
Org
anis
atio
n of
the
Gui
delin
es
28
110
U
sing
the
Gui
delin
es
29
Cha
pter
2 A
nten
atal
Car
e an
d Pr
even
tion
of M
TCT
of H
IV
32
21
Intr
oduc
tion
32
5
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4 B
acte
riolo
gica
l con
firm
atio
n
App
ropr
iate
clin
ical
sam
ples
incl
ude
sput
um
gast
ric
aspi
rate
s an
d ce
rtai
n ot
her
mat
eria
ls
Sin
ce m
ost
TB
in c
hild
ren
is in
infa
nts
and
youn
g ch
ildre
n s
putu
m
indu
ctio
n m
ay b
e do
ne fi
rst
or g
astr
ic a
spira
tions
and
exp
ecto
ratio
ns
a S
putu
m In
duct
ion
Spu
tum
indu
ctio
n is
saf
e an
d ef
fect
ive
in c
hild
ren
of a
ll ag
es a
nd t
he b
acte
rial
yi
elds
a]r
e as
goo
d or
bet
ter
that
for
gas
tric
asp
irate
s
b G
astr
ic a
spira
tion
Thi
s is
per
form
ed in
you
ng c
hild
ren
who
are
una
ble
or u
nwill
ing
to
expe
ctor
ate
sput
um
A g
astr
ic a
spir
ate
shou
ld b
e ob
tain
ed o
n ea
ch o
f th
e th
ree
cons
ecut
ive
mor
ning
s
c E
xpec
tora
tions
S
putu
m s
houl
d al
way
s be
obt
aine
d in
adu
lts a
nd o
lder
chi
ldre
n gt1
0 ye
ars
of
age
susp
ecte
d of
hav
ing
pulm
onar
y T
B
Bac
teri
al y
ield
s ar
e hi
gher
in o
lder
chi
ldre
n
Thr
ee s
putu
m s
peci
men
s sh
ould
be
obta
ined
an
on-
the
ndashspo
t sp
ecim
en (
at t
he
first
eva
luat
ion)
an
ear
ly m
orni
ng s
peci
men
and
a s
econ
d on
-the
-spo
t sp
ecim
en
Spu
tum
indu
ctio
n is
saf
e an
d ef
fect
ive
in c
hild
ren
of a
ll ag
es a
nd t
he b
acte
rial
yi
elds
are
as
good
or
bett
er t
han
for
gast
ric a
spira
tes
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
102
NO
TES
1 H
isto
ry
bull A
sk f
or s
ympt
oms
cons
iste
nt w
ith T
B in
clud
ing
chro
nic
coug
hgt 2
wee
ks
feve
r- b
ody
tem
pera
ture
of
38 o C
for
14 d
ays
afte
r co
mm
on c
ause
s su
ch a
s m
alar
ia a
nd p
neum
onia
hav
e be
en e
xclu
ded
wei
ght
loss
or
failu
re t
o th
rive
(
also
look
at
the
grow
th c
hart
) a
nd o
r ni
ght
swea
ts
Enq
uire
whe
ther
the
pat
ient
has
bee
n in
clo
se c
onta
ct w
ith s
mea
r-po
sitiv
e pu
lshym
onar
y T
B (
usua
lly a
par
ent
or o
ther
mem
ber
of th
e fa
mily
)
2 C
linic
al e
xam
inat
ion
a P
hysi
cal s
igns
hig
hly
sugg
estiv
e of
ext
ra p
ulm
onar
y T
B
bull O
ften
the
mai
n cl
inic
al f
indi
ng is
just
fai
lure
to
thriv
e
bull G
ibus
es
peci
ally
of
rece
nt o
nset
(re
sulti
ng f
rom
ver
tebr
al T
B)
bull N
on-p
ainf
ul e
nlar
ged
cerv
ical
lym
phad
enop
athy
with
fis
tula
for
mat
ion
b P
hysi
cal s
igns
req
uiri
ng in
vest
igat
ions
to
excl
ude
extr
a pu
lmon
ary
TB
bull M
enin
gitis
not
res
pond
ing
to a
ntib
iotic
s tr
eatm
ent
bull P
leur
al e
ffus
ion
bull P
eric
ardi
al e
ffus
ion
bull D
iste
nded
abd
omen
with
asc
itis
bull N
on-p
ainf
ul e
nlar
ged
lym
ph n
odes
with
out
fistu
la f
orm
atio
n
bull N
on-p
ainf
ul e
nlar
ged
join
t
Sig
ns o
f tu
berc
ulin
hyp
erse
nsiti
vity
3 M
anto
ux te
st
A m
anto
ux t
est
shou
ld b
e re
gard
ed p
ositi
ve a
s fo
llow
s
bull I
n hi
gh-r
isk
child
ren
(inc
lude
s H
IV-i
nfec
ted
child
ren
and
seve
rely
mal
shyno
uris
hed
child
ren
) gt
5mm
dia
met
er o
f in
dura
tion
bull I
n al
l oth
er c
hild
ren(
whe
ther
the
y ha
ve r
ecei
ved
BC
G o
r no
t)
gt10m
m d
ishyam
eter
of i
ndur
atio
n
101
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
22
Ope
ratio
nal G
uide
lines
32
23
Job
Aid
s 34
24
App
endi
ces
13
Cha
pter
3 I
ntra
part
um C
are
38
31
Intr
oduc
tion
38
32
Ope
ratio
nal G
uide
lines
38
Cha
pter
4
Use
of A
RVs
in P
regn
ancy
for T
reat
men
t amp P
MTC
T of
HIV
infe
ctio
n 42
41
Intr
oduc
tion
42
42
Ope
ratio
nal G
uide
lines
43
Cha
pter
5 I
mm
edia
te P
ostn
atal
and
Neo
nata
l Car
e
51
51
Intr
oduc
tion
51
52
Ope
ratio
nal G
uide
lines
51
Cha
pter
6 L
ate
Post
nata
l Car
e an
d Fa
mily
Pla
nnin
g
54
61
Intr
oduc
tion
54
62
Ope
ratio
nal G
uide
lines
54
Cha
pter
7 H
IV D
iagn
osis
in C
hild
ren
58
71
Intr
oduc
tion
58
72
Ope
ratio
nal G
uide
lines
59
72
0 G
uide
lines
for
HIV
Dia
gnos
is in
Chi
ldre
n
59
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
72
1 H
IV N
egat
ive
Infa
nt a
t 6 w
eeks
or
Firs
t Con
tact
59
72
2 H
IV P
ositi
ve In
fant
by
DN
A P
CR
60
72
3 C
ompr
ehen
sive
Car
e fo
r H
IV-e
xpos
ed In
fant
61
D
IAG
NO
STIC
ALG
OR
ITH
MFO
R P
ULM
ON
AR
Y T
B IN
CH
ILD
REN
Cha
pter
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
Bor
n to
HIV
infe
cted
mot
hers
62
81
Intr
oduc
tion
62
82
Ope
ratio
nal G
uide
lines
on
Infa
nt F
eedi
ng (0
-6 m
onth
s)
63
83
Ope
ratio
nal G
uide
lines
on
Feed
ing
Chi
ldre
n 6
mon
ths
and
olde
r 64
84
Nut
ritio
nal C
are
and
Supp
ort o
f HIV
infe
cted
Chi
ldre
n 64
85
Ext
ract
s fr
om R
esea
rch
on In
fant
Fee
ding
and
HIV
AID
S 65
Cha
pter
9
Car
e an
d Fo
llow
up
of C
hild
ren
of H
IV-in
fect
ed m
othe
rs 7
3
91
Intr
oduc
tion
73
92
Ope
ratio
nal G
uide
lines
74
Cha
pter
10
Mon
itorin
g an
d Ev
alua
tion
of P
MTC
T se
rvic
es
83
101
In
trod
uctio
n 83
102
O
pera
tiona
l Gui
delin
es
85
Bib
liogr
aphy
91
Job
Aid
sR
efer
ence
s
91
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
App
endi
x V
I
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
100
App
endi
x V
C
OM
MO
N A
DV
ERSE
EFF
ECTS
OF
AR
V U
SE D
UR
ING
PR
EGN
AN
CY
Cla
ss
Adv
erse
effe
cts
Nuc
leos
ide
Nuc
leot
ide
Rev
erse
Tra
nscr
ipta
se In
hibi
tors
( NR
TIs)
Zido
vudi
ne(A
ZT)
Nau
seau
La
miv
idin
e (3
TC)
Dia
rhoe
a
Stav
udin
e (d
4T)
Hyp
erse
nsiti
vity
(AB
C)
Aba
cavi
r(A
BC
) A
naem
ia(A
ZT)
Teno
fovi
r(TF
VTD
F)
Emitr
icita
bine
(FTC
)
Non
- Nuc
leos
ide
Rev
erse
Tra
nscr
ipta
se In
hibi
tors
(NN
RTI
s)
Nev
irapi
ne(N
VP)
Del
avird
in
Efav
irenz
(EFV
)
Pro
teas
e In
hibi
tors
(PIs
)
Saqu
inav
ir(SQ
V)
Indi
navi
r(ID
V)
Rito
navi
r(R
TV)
Nel
finav
ir(N
LF)
Lopi
navi
rrito
navi
r(LP
Vr)
A
taza
navi
r(A
TV)
Fose
mpr
enav
ir Ti
pana
vir(
TPV)
D
arun
avir(
DR
V)
Ras
h
Elev
ated
live
r enz
ymes
(c
omm
on w
ith N
VP in
hig
h C
D4
co
unt)
EFV
CN
S ef
fect
s(se
datio
n in
-so
mni
a v
ivid
dre
ams
diz
zine
ss
conf
usio
n fe
elin
g of
lsquod
isen
gage
men
trsquo
Tera
toge
nici
ty
GI i
ntol
eran
ce
Hep
atot
oxic
ity
Lipo
dyst
roph
y
Dys
lipid
emia
s
Insu
lin re
sist
ance
Hyp
ergl
ycae
mia
La
ctic
aci
dosi
s an
d he
patic
ste
a-to
sis
Cou
nsel
ing
and
Follo
w-u
p Ti
ps
May
not
be
wel
l-tol
erat
ed in
ear
l pr
egna
ncy
whe
n
mor
ning
sic
knes
s is
com
mon
M
ay in
crea
se ri
sk o
f non
-ad
here
nce
May
hav
e in
adeq
uate
blo
od le
vels
A
ll A
RVs
sho
uld
be d
isco
ntin
ued
and
rest
arte
d w
hen
Namp
V is
gon
e or
effe
ctiv
ely
trea
ted
Fo
llow
-up
labs
CB
C L
FTs
If ra
sh in
1st
2 w
ks d
o no
t inc
reas
e N
VP d
ose
and
cont
act c
linic
ian
Mild
rash
may
be
man
aged
with
an
tihis
tam
ines
A
void
cor
ticos
tero
ids
durin
g N
VP
dose
esc
alat
ion
EFV
shou
ld b
e ta
ken
initi
ally
at
bed
time
Avo
id E
FV in
wom
en o
f hig
h ch
ild-b
earin
g po
tent
ial
Do
not o
pera
te h
eavy
mac
hine
ry
Mon
itor g
luco
se le
vels
A
sk re
gula
rly fo
r sym
ptom
s of
hy
perg
lyca
emia
M
onito
r hep
atic
tran
sam
inas
es
(ALT
and
AST
) par
ticul
arly
dur
ing
the
first
18
wee
ks o
f the
rapy
w
hen
this
toxi
city
is m
ost l
ikel
y Ta
ke w
ith fo
od
Ant
iem
etic
s A
ntim
otili
ty
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
App
endi
ces
92
App
endi
x I
WH
O C
linic
al S
tagi
ng o
f HIV
AID
S fo
r A
dults
and
A
dole
scen
ts w
ith C
onfir
med
HIV
infe
ctio
n 92
App
endi
x II
C
ontr
acep
tive
Opt
ions
for
Peop
le L
ivin
g w
ith H
IV
95
App
endi
x II
I U
se o
f AR
Vs
for
Trea
tmen
t and
PM
TCT
of H
IV in
AN
C
97
App
endi
x IV
Use
Of A
RV
s fo
r PM
TCT
of H
IV in
Lab
our
And
Del
iver
y U
nit
98
App
endi
x V
Com
mon
Adv
erse
Effe
cts
of A
RV
Use
Dur
ing
Preg
nanc
y 99
App
endi
x V
I D
iagn
ostic
alg
orith
m fo
r pu
lmon
ary
TB in
Chi
ldre
n 10
0
App
endi
x V
II I
nteg
rate
d M
onito
ring
and
Eval
uatio
n Re
port
For
m M
OH
726
10
3
App
endi
x V
III
Rep
rodu
ctiv
e H
ealth
HIV
AID
S R
epor
t For
m M
OH
711
10
4
Lis
t of T
able
s
Tabl
e 1
1 A
dult
HIV
-pre
vale
nce
Est
imat
e by
Pro
vinc
e in
200
6 21
Tabl
e 1
2 E
stim
ated
Mag
nitu
de o
f MTC
T in
Ken
ya 2
007
22
Tabl
e 1
3 Tr
ansm
ission
Pat
tern
s in
Brea
stfee
ding
and
Non
bre
astfe
edin
g Pop
ulat
ions
23
Tabl
e 1
4 R
isk
Fact
ors
for
MTC
T of
HIV
24
Tabl
e 1
5 Th
e Fo
ur-p
rong
ed A
ppro
ach
App
lied
to th
e PM
TCT
Gui
delin
es
30
Tabl
e 2
1 E
ssen
tial P
acka
ge o
f Int
egra
ted
Ant
enat
al C
are
Serv
ices
33
Tabl
e 4
1 R
ecom
men
datio
ns fo
r In
itiat
ing
AR
V T
reat
men
t in
Preg
nant
Wom
en B
ased
on
Clin
ical
Sta
ge a
nd A
vaila
bilit
y of
CD
4 co
unt
44
Tabl
e 4
2 R
ecom
men
ded
Firs
t Lin
e A
RT
Reg
imen
for
Trea
ting
Preg
nant
Wom
en a
nd P
roph
ylac
tic R
egim
en fo
r In
fant
s 45
Tabl
e 4
3a R
ecom
men
ded
Firs
t Lin
e A
RV
Pro
phyl
axis
to P
reve
nt H
IV
46
Infe
ctio
n in
Infa
nts
Am
ong
preg
nant
Wom
en P
rese
ntin
gB
efor
e 38
Wee
ks
Tabl
e 4
3b A
ltern
ativ
e A
RV
Pro
phyl
axis
to P
reve
nt H
IV In
fect
ion
in In
fant
s 4
6 A
mon
g Pr
egna
nt W
omen
Pre
sent
ing
Bef
ore
38 W
eeks
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
9
9
47
IV
Wom
en w
ho h
ave
not r
ecei
ved
Intr
apar
tum
AR
T or
A
RV
Pro
phyl
axis
with
H
IV
Infe
ctio
n
Tabl
e 4
4 A
RV
Pro
phyl
axis
for
PMTC
T am
ong
Preg
nant
Wom
en w
ho h
ave
not r
ecei
ved
Ant
enat
al A
RT
or P
roph
ylax
is
App
endi
x Ta
ble
45
Cho
ice
of H
AA
RT
for
Preg
nant
Wom
en b
ased
on
CD
4 co
unt
47
Tabl
e 4
6 A
RV
Pro
phyl
actic
Reg
imen
s fo
r In
fant
s B
orn
to H
IV-p
ositi
ve
49
Tabl
e 9
1 D
ose
of C
o-tr
imox
azol
e fo
r PC
P pr
ophy
laxi
s 76
Tabl
e 9
2 W
HO
Rec
omm
enda
tions
for
Follo
w-u
p of
an
HIV
-exp
osed
Chi
ld
79
Tabl
e 10
1 C
ontr
acep
tive
Met
hods
for
Use
in C
oupl
es a
nd W
omen
Liv
ing
96
Figu
re 2
1 R
apid
HIV
Ser
ial T
estin
g A
lgor
ithm
35
Figu
re 8
1 G
uide
lines
for
Cou
nsel
ling
on H
IV a
nd In
fant
feed
ing
66
Job
Aid
s an
d IE
C M
ater
ials
on
Infa
nt a
nd Y
oung
Chi
ld F
eedi
ng
67
List
of F
igur
es
Figu
re 1
01
Mon
itori
ng a
nd E
valu
atio
n D
ata
Flow
in K
enya
84
September 0 8
USE OF ARVs FOR PMTCT OF HIV IN LABOUR AND DELIVERY UNITSALL MOTHERS
1 History 2 Examination3 Establish motherrsquos HIV status4 Offer HIV counseling and testing for mother with unknown HIV status5 Provide standard obstetrical management and care
HIV NEGATIVECounsel on risk reduction
HIV POSITIVE
Establish Motherrsquos use of ARVs in pregnancy and give appropriate ARVs as shown in boxesbelow
Regardless of Duration received HAART
Action
i Give mother ARV dose as per regimen
ii Post partu m Infant Give Infant sd Nevi rapine 2mgkg with in 72 hours of birthPL US 3T C 4mgkg BD for 1 w eek an d AZT syrup 4 m gkg BD for 6 w eeks
iii Post partum mother Continue w ith AR Vs as per regimen
MOTHE R RECEIVED HAART IN PREGNANCY
F OR MORE INFORMAT ION CONT ACT THE NATIONAL AIDSSTD CONTROL PROGRAMME (NASCOP)PO BO X 19361-00202 NAIROBI TEL 0202729502 FAX 020 2710518
MINISTRY OF HEALTH
bull G ive mo ther sd Nevirap ine 200m g AZT 600mg and 3TC 150 mg stat
bull Post partum Infant Give Infant sd Nevirapine 2mgkg within 72 ho urs of birth PL US
3TC syrup 4mg kg BD for 1 week and AZT syrup 4 mg kg BD fo r 6 w eeks
bull Post partum mother Give moth er AZT 300mg amp 3TC 150 mg BID for 7 d ays
MO THER RECEIVED AZT IN PREGNANCY OR NO ARVs TAKE N IN PREGNANCY
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
98
MINISTRY OF HEALTH
USE OF ARVs FOR TREATMENT AND PMTCT OF HIV IN ANC
App
endi
x II
I
Ack
now
ledg
emen
ts
ALL M O THERS1 History 2 Health Information3 Examination4 In vestigations (with informed consent for HIV test)
HIV NEGATIVE1 P rov id e pos t-te s t HIV pr ev e nti v e
i nter ve ntion s defi ned i n na tion alHT C gui de li nes
2 Re fe r for othe r p os t-te st HIVp re ve ntive inte rv e nti ons no tavai lable in the cli nic b ut avail ab le w ithi n the fa c ili ty
HIV PO SI TI VE1 C ounsel on risk reduction2 Per form WH O clinical staging for H IV disease3 D etermine CD 4 level (if testing facilities available)4 D etermine Gestation age and HB level5 Give ARVrsquos as shown below6 Provide or refer for other post-test HIV interventions defined in national HTC
guidelines
1 WHO clin ica l stage I o r II w ith CD4 cell co unt gt 350mm3 OR 2 WHO clin ica l stage I o r II no CD4 cell co unt do ne3 HB =8 gdl OR n o clinical feat ures of anaemia
bull Initiate AZT 30 0mg BD daily at 28 weeks gestation or any time periodimmediately there after
bull Monitor for clinical featur es of anemia and treatbull Dispense ANC Nev ir apine 200mg PLUS AZT 600mg + 3TC 1 50mg for
moth er to tak e at onset of labourbull Dispense NVP syrup to give infant at birth
bull At on set o f l abo uro Administer Nevirapine 20 0mg AZT 600mg 3TC 150 mg
stat to moth erbull Post p artum
o Give Infa nt sd Nevirapine 2mgk g within 72 hours ofbirth PLUS 3TC 4mg BD for 1 w eek and AZT syrup 4 mgkg BD for 6 w eeks
o Give mother AZT30 0 mg 3 TC 150 BID for 7 day s
1 WHO clinical stag e I or II with CD4 c ell count gt 35 0 mm3 OR 2 WHO clinical stag e I or II w ith no C D4 c ell c ount done
bull Dispense ANC Nevirapine 2 00mg PLUS AZ T 600 mg + 3TC 150mgfo r mo ther to take at onse t of labour
bull Dispense NVP sy rup to give infant at birthbull At Onset of lab our
o Administe r sd Nevirapine AZT 6 00 mg and 3TC1 50mg stat
bull Po st Par tu mo G iv e Infant sd Nev ir apine 2mg kg w ithin 72
h ours of bir th PLUS 3T C 4mgkg BD fo r 1 week a nd AZT syrup 4mgkg BD for 6 we eks
o G iv e mother AZ T300 mg 3TC 1 50 mg BID for 7d ays
1 Any gest ational age2 WHO clin ica l stage III or IV of HIV dis ease regardles s of CD4 cell count OR3 WHO clin ica l stages I or II of HIV d is ease with CD4 cell count =350mm3 ()
bull Refer to Clinician for Evaluation and initiation of NNRTI based ART as pernation al ART guidelines
bull At O nset of Lab ou ro G ive mo ther ARV dos e as per r egimen
bull Post par tumo G ive Infan t sd Nev ira pine 2mgkg within 72 hours of b irth PLUS
3TC 4mgkg and AZT syr up 4 mgkg BD for 6 weeks o G ive mo ther ARVs as per regimen
4 If no HAART av ailable man age the wo man as ind icated in box no2 a nd refer to ARTsite appro priately
F O R M OR E IN FOR M AT IO N CO N T AC T T H E N ATI ON A L A IDS STD C O NTR O L PR O G RAM ME ( N ASC O P)P O B OX 19361-00202 N AIR OBI TEL 0202729502 FAX 020 2710518
EL IGIBL E FO R T R EATMEN T
N O T E LIG IBLE FO R TR EA TM ET AN D PR ESE NTING B ELO W 3 8 W EE KSGESTA TIO N N OT ELIGIB LE FOR TREA TMEN T AN D PR ESE NTING gt 3 8 W EEK S
GE STATIO N
Plea se notebull Pregnan t w omen with WHO clinical stag e I or II plus CD4 cell co unt gt250 mm3 and = 350 mm3 can be initiated on ART wher e a PI based HAART re gimen is av ailable NVP hypersen sitivity h as been previously r eported amon g women in this gr oup initiated on N NRT I based
ART re gimens Where PI ba sed ART reg imen is not av ailab le r efer the patient to a site whe re th e regimen is availab le or c ontinue to ma nage th e w oman a s is indicated in box No 2bull The grading of ana emia in pregna ncy is gt 8-10 Milda nemia gt 6 -8 Moderate anem ia lt 6 Sever e anemiabull Treatment if common p ath ologies ruled out Mild anae mia haematinics irrespectiv e of gestatio n Moder ate a naemia tr ansfusion if close to term gt36 weeks otherwise give haema tinics Severe an aemia transfus ion irr espe ctive of ge statio n Do not stop AZT if Hb dr op s but
would manage it as above and only stop if continues to fall or fails to res pon d des pite transfusion
The
thir
d ed
ition
of
Gui
delin
es f
or P
reve
ntio
n of
Mot
her-
to-C
hild
Tra
nsm
issi
on o
f H
IV A
IDS
in K
enya
is a
res
ult o
f effo
rts
of m
any
indi
vidu
als
and
orga
niza
tions
in th
eco
untr
y T
he T
echn
ical
Wor
king
Gro
up o
n PM
TCT
led
thes
e ef
fort
s M
embe
rs o
f the
te
am r
evie
wed
all
the
mod
ules
rev
ised
and
in s
ome
case
s re
-wro
te th
e m
odul
es b
ased
on
the
seco
nd e
ditio
n to
mak
e th
em u
p to
dat
e an
d in
line
with
cur
rent
sci
entif
ic e
vishy
denc
e an
d ex
peri
ence
We
ackn
owle
dge
the
cont
ribu
tors
and
rev
iew
ers
of t
he c
urre
ntan
d pr
evio
us e
ditio
ns O
f sp
ecia
l m
entio
n ar
e th
e fo
llow
ing
Ken
ya O
bste
tric
al a
nd
Gyn
aeco
logi
cal S
ocie
ty (K
OG
S) t
he U
nive
rsity
of N
airo
bi a
nd M
oi U
nive
rsity
We
wou
ld l
ike
to t
hank
the
fol
low
ing
inst
itutio
ns f
or t
echn
ical
as
wel
l as
fin
anci
al
supp
ort
duri
ng t
he r
evis
ion
of t
he g
uide
lines
N
atio
nal A
IDS
and
STD
Con
trol
Pro
shygr
amm
e (N
ASC
OP)
the
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
Cen
ters
for
Dis
ease
Con
trol
and
Prev
entio
n (C
DC
) It
is n
ot p
ossi
ble
to m
entio
n al
l ind
ivid
uals
and
org
aniz
atio
ns
that
par
ticip
ated
in th
is im
port
ant e
xerc
ise
To
all o
f you
Asa
nte
Sana
Min
istr
y of
Hea
lth
September 2008
97
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
10
Fore
wor
d
The
Min
istr
y of
Hea
lth (
MoH
) is
com
mitt
ed t
o de
velo
pmen
t of
effe
ctiv
e PM
TCT
proshy
gram
mes
Gui
delin
es a
re a
n im
port
ant
part
of t
he G
over
nmen
t st
rate
gy t
o re
duce
MTC
Tan
d is
in
line
with
the
Nat
iona
l H
ealth
Sec
tor
Stra
tegi
c Pl
an I
I (N
HSS
PII)
and
Ken
yaN
atio
nal A
IDS
Stra
tegi
c Pl
an (K
NA
SP) 2
000-
2010
whi
ch fo
cuse
s on
pri
ority
are
as o
f pre
shyve
ntio
n of
new
infe
ctio
ns i
mpr
ovin
g qu
ality
of l
ife o
f tho
se in
fect
ed a
nd a
ffect
ed a
nd m
itishy
gatio
n of
soc
ial a
nd e
cono
mic
impa
ct o
f the
infe
ctio
n
MTC
T is
the
pre
dom
inan
t m
ode
of t
rans
mis
sion
of
HIV
in
infa
nts
and
youn
g ch
ildre
n
This
tra
nsm
issi
on o
ccur
s du
ring
pre
gnan
cy
labo
ur a
nd d
eliv
ery
and
am
ong
brea
stfe
d ba
bies
in
the
post
-par
tum
per
iod
Mem
bers
of t
he T
echn
ical
Wor
king
Gro
up (T
WG
) on
PMTC
T re
view
ed t
he m
odul
es o
f the
se
cond
edi
tion
rev
ised
and
in s
ome
case
s re
-wro
te th
e m
odul
es b
ased
on
up to
dat
e kn
owlshy
edge
and
in
line
with
cur
rent
sci
entif
ic e
vide
nce
and
expe
rien
ce T
he T
WG
con
sist
s of
agr
oup
of p
rofe
ssio
nals
dra
wn
from
var
ious
dis
cipl
ines
tha
t ar
e im
plem
entin
g an
dor
man
shyag
ing
PMTC
T T
he g
roup
ado
pted
and
ada
pted
the
late
st r
ecom
men
datio
ns o
f the
WH
O o
nPM
TCT
as w
ell a
s va
riou
s na
tiona
l gui
delin
es o
n H
IV p
reve
ntio
n tr
eatm
ent a
nd c
are
A f
our-
pron
ged
appr
oach
thr
ough
the
var
ious
rep
rodu
ctiv
e lif
e cy
cles
as
prop
osed
by
the
Inte
r-A
genc
y Ta
sk T
eam
(IA
TT)
on c
hild
ren
and
HIV
and
AID
S w
as a
dopt
ed i
n th
ese
guid
elin
es w
ith e
mph
asis
bei
ng p
lace
on
all t
he fo
ur p
rong
s
For
any
of t
he P
MTC
T in
terv
entio
ns t
o be
suc
cess
fully
impl
emen
ted
coun
selin
g an
d te
stshy
ing
(CT)
mus
t fir
st b
e do
ne R
outin
e H
IV te
stin
g w
ith o
pt-o
ut o
ptio
n is
rec
omm
ende
d T
his
is fo
llow
ed b
y ap
prop
riat
e m
edic
al s
urgi
cal i
nter
vent
ions
incl
udin
g an
tiret
rovi
ral p
roph
yshyla
xis
saf
er o
bste
tric
pra
ctic
es a
s w
ell a
s in
fant
feed
ing
coun
selin
g an
d pr
ovis
ion
of a
ppro
shypr
iate
infa
nt fe
edin
g H
IV-p
ositi
ve w
omen
are
ass
esse
d cl
inic
ally
usi
ng W
HO
sta
ging
and
whe
re f
easi
ble
imm
unol
ogic
al a
sses
smen
t us
ing
CD
4 ce
ll co
unt
HIV
exp
osed
infa
nts
are
test
ed th
roug
h ea
rly
infa
nt d
iagn
osis
(EID
)
In th
ese
guid
elin
es m
ore
effic
acio
us r
egim
ens
are
intr
oduc
ed fo
r th
e fir
st ti
me
whi
le in
forshy
mat
ion
and
coun
selin
g on
inf
ant
feed
ing
follo
ws
the
AFA
SS (
Ava
ilabl
e f
easi
ble
acc
eptshy
able
saf
e an
d su
stai
nabl
e) c
rite
ria
The
mod
ule
on m
onito
ring
and
eva
luat
ion
addr
esse
s is
sues
of d
ata
colle
ctio
n c
olla
tion
and
repo
rtin
g as
wel
l as
use
of d
ata
for
deci
sion
-mak
ing
at th
e fa
cilit
y-le
vel
We
hope
that
app
ropr
iate
impl
emen
tatio
n in
stru
men
ts w
ill b
e us
ed to
ope
ratio
naliz
e th
ese
guid
elin
es
Tabl
e 11
1
Con
trac
eptiv
e M
etho
ds fo
r Use
in
Cou
ples
and
Wom
en L
ivin
g w
ith H
IV In
fect
ion
MET
HO
D
CO
MM
ENTS
Con
dom
s bull
M
ale
amp f
emal
e co
ndom
s av
aila
ble
bull
P
rovi
de d
ual p
rote
ctio
n ag
ains
t STI
sH
IV
amp p
regn
ancy
bull
R
equi
re a
ttent
ion
amp ca
re
for c
orre
ct u
se e
ach
time
bull
M
ay re
quire
co-
oper
atio
n of
par
tner
Hor
mon
al
bull V
ery
effe
ctiv
e an
d ea
sy to
use
M
etho
ds
bull S
uita
ble
for s
hort-
or lo
ng-
term
use
bull
Rev
ersi
ble
bull A
ssoc
iate
d w
ith n
on-
cont
race
ptiv
e he
alth
ben
efits
bull
Ser
ious
com
plic
atio
ns
extre
mel
y ra
re
Intra
uter
ine
bull
H
ighl
y ef
fect
ive
long
-term
C
ontra
cept
ive
reve
rsib
le m
etho
d
Dev
ice
bull
Rem
ains
in p
lace
up
to 1
2 ye
ars
bull
A
lmos
t 100
per
cent
ef
fect
ive
bull
H
as n
o ef
fect
on
ferti
lity
whe
n us
ed b
y nu
llipar
ous
wom
en
bull
Sho
uld
not b
e pr
ovid
ed to
w
omen
with
hig
h ris
k se
xual
life
styl
e bull
B
acte
rial S
TIs
shou
ld b
e sc
reen
ed fo
r and
or
treat
ed a
s a
prec
autio
n pr
ior t
o in
serti
on o
f IU
CD
Ste
riliz
atio
n bull
Goo
d v
ery
effe
ctiv
e fo
r co
uple
s or
indi
vidu
als
who
w
ant n
o m
ore
child
ren
bull S
afe
sim
ple
surg
ical
pr
oced
ure
Con
side
red
perm
anen
t
US
E IN
HIV
PO
SITI
VE
PA
TIE
NTS
bull
Can
and
sho
uld
be u
sed
at a
ll st
ages
of H
IV
infe
ctio
n bull
C
an a
nd s
houl
d be
use
d by
pat
ient
s on
AR
T
bull
Cor
rect
and
con
sist
ent u
se b
y H
IV in
fect
ed p
atie
nts
is
reco
mm
ende
d re
gard
less
of t
he u
se o
f oth
er m
etho
ds
of c
ontra
cept
ion
(dua
l con
trace
ptio
n)
bull C
an b
e us
ed w
ithou
t res
trict
ion
in H
IV+
wom
en n
ot o
n AR
T bull
Can
be
used
with
out r
estri
ctio
n in
all
HIV
+ w
omen
for
emer
genc
y co
ntra
cept
ion
bull S
ome
AR
V dr
ugs
may
redu
ce m
etho
d ef
fect
iven
ess
bull
DM
PA
Im
plan
ts c
an h
owev
er b
e us
ed w
ith A
RT
reshy
inje
ctio
n of
DM
PA
sho
uld
be d
one
at 1
0-12
wee
ks
bull If
horm
onal
met
hod
is c
hose
n c
ondo
ms
shou
ld s
till b
e us
ed c
orre
ctly
and
con
sist
ently
bull
Attr
activ
e m
etho
d fo
r wom
en w
ith H
IV w
ho d
esire
ver
y re
liabl
e pr
egna
ncy
prot
ectio
n bull
C
an b
e in
serte
d in
HIV
+ w
omen
who
do
not h
ave
WH
O
Sta
ge 4
dis
ease
AID
S d
efin
ing
illne
ss
bull
For w
omen
with
sta
ge 4
dis
ease
IUD
can
be
inse
rted
once
they
are
on
ART
and
have
con
trolle
d sy
mpt
oms
of s
ever
e ill
ness
bull N
o m
edic
al re
ason
s to
den
y st
eriliz
atio
n to
clie
nts
w
ith H
IV
bull P
roce
dure
may
be
dela
yed
in e
vent
of a
cute
HIV
-rel
ated
in
fect
ion
or s
tage
4 d
isea
se p
endi
ng im
mun
e re
cons
titut
ion
bull E
ncou
rage
con
dom
use
as
wel
l
DM
PA =
Dep
ot M
edro
xypr
oges
tero
ne A
ceta
te (D
epo-
Prov
era)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
1
96
App
endi
x II
CO
NTR
AC
EPTI
VE
OPT
ION
SFO
R P
EOPL
E L I
VIN
G W
ITH
HIV
It
has
bee
n sh
own
in a
num
ber
of s
tudi
es o
f coh
orts
of H
IV p
ositi
ve w
omen
tha
t so
me
choo
se t
o co
ntin
ue s
exua
l act
ivity
des
pite
kno
wle
dge
of t
heir
sta
tus
Evi
denc
e of
con
shyce
ptio
n ha
s de
mon
stra
ted
that
fert
ility
in H
IV p
ositi
ve w
omen
for
the
mos
t pa
rt is
unshy
affe
cted
H
owev
er c
erta
in c
ondi
tions
may
affe
ct fe
rtili
ty s
uch
as lo
w b
ody
mas
s in
dex
A
IDS
and
inte
rcur
rent
illn
ess
esp
ecia
lly t
uber
culo
sis
Put
ting
wom
en w
ho a
re H
IV
infe
cted
on
cont
race
ptiv
es is
one
of t
he m
eans
of p
reve
ntin
g m
othe
r to
chi
ld t
rans
mis
shysi
on o
f HIV
(PM
TCT)
It is
the
rig
ht o
f HIV
infe
cted
wom
en t
o m
ake
thei
r ow
n de
cisi
ons
rega
rdin
g re
prod
ucshy
tion
The
y m
ay w
ish
to h
ave
mor
e ba
bies
lim
it th
eir
fam
ilies
or
avoi
d pr
egna
ncy
alto
shyge
ther
The
hea
lth c
are
prov
ider
s th
ey c
onsu
lt sh
ould
ena
ble
them
to
mak
e in
form
edch
oice
s by
them
selv
es
The
follo
win
g co
ntra
cept
ive
met
hods
are
ava
ilabl
e in
Ken
ya -
pro
gest
eron
e on
ly p
ills
lo
w d
ose
com
bine
d or
al c
ontr
acep
tives
de
pot
med
roxy
prog
este
rone
ace
tate
(D
MPA
shyde
po)
levo
norg
estr
el a
nd e
tono
gest
rel i
mpl
ants
Em
erge
ncy
cont
race
ptiv
e pi
lls c
oppe
rin
trau
teri
ne c
ontr
acep
tive
devi
ces
bar
rier
met
hods
fem
ale
and
mal
e st
erili
satio
n ar
e al
so a
vaila
ble
Som
e dr
ugs
inte
ract
with
hor
mon
al c
ontr
acep
tives
A
nd c
oncu
rren
t us
e sh
ould
be
avoi
ded
The
se d
rugs
incl
ude
bull P
rote
ase
inhi
bito
rs ndash
Rito
navi
r N
elfin
avir
Lop
inav
ir w
ith R
itona
vir
bull N
on-n
ucle
otid
e re
vers
e tr
ansc
ript
ase
inhi
bito
rs (
NN
RT
Is)
ndash N
evir
apin
e
bull E
favi
renz
bull A
nti-T
B d
rugs
ndash R
ifam
pici
n an
d R
ifabu
tin
bull O
ther
dru
gs ndash
Gris
eofu
lvin
P
heno
barb
itone
C
arba
maz
epin
e P
heny
toin
All
the
abov
e do
not
app
ly i
n th
e fa
ce o
f ot
her
med
ical
con
ditio
ns t
hat
are
cont
ra-
indi
catio
ns f
or t
he v
ario
us m
etho
ds e
g k
now
n ca
rdio
vasc
ular
dis
ease
hep
atic
con
dishy
tions
sm
okin
g h
igh
bloo
d pr
essu
re a
nd th
rom
boem
bolic
dis
orde
rs
The
follo
win
g ta
ble
sum
mar
ises
maj
or is
sues
reg
ardi
ng u
se o
f diff
eren
t co
ntra
cept
ives
by H
IV-p
ositi
ve w
omen
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Abb
revi
atio
ns a
nd A
cron
yms
AFA
SS
Acc
epta
ble
Fea
sibl
e A
fford
able
Sus
tain
able
and
Saf
e
Ab
Ant
i-bod
y
AID
S A
cqui
red
Imm
une
Def
icie
ncy
Synd
rom
e
ALT
Ala
nine
Tra
nsfe
rase
AN
C
Ant
enat
al C
are
AR
M
Art
ifici
al R
uptu
re o
f Mem
bran
es
AR
T
Ant
iret
rovi
ral T
hera
py
A
RV
A
ntir
etro
vira
l
AZT
A
zido
thym
idin
e (Z
idov
udin
e or
ZD
V)
AZT
3TC
Com
bivi
r
3TC
Lam
ivud
ine
BC
C
Beh
avio
ur C
hang
e C
omm
unic
atio
n
BC
G
Bac
ille
Cal
met
te G
ueri
ne v
acci
ne
BFH
I B
aby
Frie
ndly
Hos
pita
l Ini
tiativ
e
BID
BD
ldquoT
wic
e a
dayrdquo
CD
C (K
) C
entr
es fo
r D
isea
se C
ontr
ol a
nd P
reve
ntio
n K
enya
CN
S C
entr
al N
ervo
us S
yste
m
CS
Cae
sare
an S
ectio
n
CT
Cou
nsel
ling
and
Test
ing
CTX
CTZ
Cot
rim
oxaz
ole
d4T
Stav
udin
e
D
ASC
O
Dis
tric
t AID
SST
I Coo
rdin
ator
G
uid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
5
12
DB
S D
ried
Blo
od S
pot s
peci
men
DN
A
Deo
xyri
bonu
clei
c A
cid
DR
H
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
EC
V
Ext
erna
l Cep
halic
Ver
sion
EFV
Efa
vire
nz
EID
E
arly
Infa
nt D
iagn
osis
ELI
SA
Enz
yme
Link
ed Im
mun
osor
bent
Ass
ay
FBC
Fu
ll B
lood
Cou
nt
GTZ
G
erm
an T
echn
ical
Coo
pera
tion
HA
AR
T
Hig
hly
Act
ive
Ant
iret
rovi
ral T
hera
py
Hb
Hae
mog
lobi
n
HIV
H
uman
Imm
unod
efic
ienc
y Vi
rus
IATT
Inte
r-A
genc
y Ta
sk T
eam
IMC
I In
tegr
ated
Man
agem
ent o
f Chi
ldho
od Il
lnes
s
IPPT
Inte
rmitt
ent P
resu
mpt
ive
Trea
tmen
t for
Mal
aria
ITN
s In
sect
icid
es T
reat
ed N
ets
IUC
D
Intr
a U
teri
ne C
ontr
acep
tive
Dev
ice
KD
HS
Ken
ya D
emog
raph
ic a
nd H
ealth
Sur
vey
KE
PI
Ken
ya E
xpan
ded
Prog
ram
me
on Im
mun
izat
ion
KO
GS
Ken
ya O
bste
tric
al a
nd G
ynae
colo
gica
l Soc
iety
KN
H
Ken
yatt
a N
atio
nal H
ospi
tal
LAM
Lact
atio
nal A
men
orrh
oea
Met
hod
Mamp
E
Mon
itori
ng a
nd E
valu
atio
n
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
Cyt
omeg
alov
irus
infe
ctio
n (r
etin
itis
or in
fect
ion
of o
ther
org
ans)
9
Cen
tral
ner
vous
sys
tem
tox
opla
smos
is
10
HIV
enc
epha
lopa
thy
11
Ext
rapu
lmon
ary
cryp
toco
ccos
is in
clud
ing
men
ingi
tis
12
Dis
sem
inat
ed n
on-t
uber
culo
us m
ycob
acte
rial
infe
ctio
n
13
Pro
gres
sive
mul
tifoc
al le
ukoe
ncep
halo
path
y
14
Chr
onic
cry
ptos
pori
dios
is
15
Chr
onic
isos
poria
sis
16
Dis
sem
inat
ed m
ycos
is (
extr
apul
mon
ary
hist
opla
smos
is
or c
occi
diom
ycos
is)
17
Rec
urre
nt s
eptic
aem
ia (
incl
udin
g no
n-ty
phoi
dal S
alm
onel
la)
18
Lym
phom
a (c
ereb
ral o
r B
-cel
l non
-Hod
gkin
s)
19
Inv
asiv
e ce
rvic
al c
arci
nom
a
20
Aty
pica
l dis
sem
inat
ed le
ishm
ania
sis
21
Sym
ptom
atic
HIV
-ass
ocia
ted
neph
ropa
thy
or s
ympt
omat
ic H
IV-
asso
ciat
ed
22
Car
diom
yopa
thy
Ple
ase
note
S
igns
and s
ympto
ms
of
HIV
was
ting s
yndro
me
incl
ude
Unex
pla
ined
invo
lunta
ry w
eight
loss
(gt
10
base
line
body
wei
ght)
with o
bvi
ous
was
ting o
f body
mas
s in
dex
lt185
PLU
S
unex
pla
ined
chro
nic
dia
rrhoea
(lo
ose
or
wat
ery
stools
thre
e or
more
tim
es d
aily
) re
port
ed
for
longer
than
one
month
OR r
eport
s of
feve
r or
nig
ht
swea
ts f
or
more
than
one
month
w
ithout
oth
er c
ause
and lack
of
resp
onse
to a
ntibio
tics
or
antim
ala
rial ag
ents
M
ala
ria
must
be
excl
uded
in m
ala
ria
pro
ne
area
s
Fo
r th
e purp
ose
of
the
WH
O s
tagin
g s
yste
m
adole
sents
and a
dults
are
def
ined
as
adults
aged
ge15 y
ears
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
3
94
CLI
NIC
AL
STA
GE
3 1
Une
xpla
ined
sev
ere
wei
ght
loss
(gt1
0 o
f pr
esum
ed o
r m
easu
red
bo
dy w
eigh
t)
2
Une
xpla
ined
chr
onic
dia
rrho
ea fo
r lo
nger
tha
n on
e m
onth
3
Une
xpla
ined
per
sist
ent
feve
r (a
bove
37
5degC
inte
rmitt
ent
or c
onst
ant
for
long
er t
han
one
mon
th)
4
Per
sist
ent
oral
can
didi
asis
5
Ora
l hai
ry le
ukop
laki
a
6
Pul
mon
ary
tube
rcul
osis
7
Tub
ercu
lous
Lym
phad
enop
athy
8
Sev
ere
bact
eria
l inf
ectio
ns (
such
as
pneu
mon
ia
empy
ema
pyo
myo
sitis
bo
ne o
r jo
int
infe
ctio
n m
enin
gitis
or
bact
erae
mia
)
9
Acu
te n
ecro
tizin
g ul
cera
tive
stom
atiti
s g
ingi
vitis
or
perio
dont
itis
10
Une
xpla
ined
ana
emia
(lt8
gdl
) n
eutr
opae
nia
(lt0
5 times1
09 pe
rlitr
e) a
ndo
r ch
roni
c th
rom
bocy
topa
enia
(lt5
0times10
9 per
litr
e)
CLI
NIC
AL
STA
GE
4 1
HIV
was
ting
synd
rom
e
2
Pne
umoc
ystis
pne
umon
ia
3
Rec
urre
nt s
ever
e ba
cter
ial p
neum
onia
4
Chr
onic
her
pes
sim
plex
infe
ctio
n (o
rola
bial
ge
nita
l or
anor
ecta
l of
mor
e th
an o
ne
mon
thrsquos
dur
atio
n or
vis
cera
l at
any
site
)
5
Oes
opha
geal
can
didi
asis
(or
can
didi
asis
of
trac
hea
bro
nchi
or
lung
s)
6
Ext
rapu
lmon
ary
tube
rcul
osis
exc
ept
Tub
ercu
lous
Lym
ph a
deno
path
y
7
Kap
osirsquos
sar
com
a
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
MC
H
Mat
erna
l and
Chi
ld H
ealth
MoH
M
inis
try
of H
ealth
MSF
M
edic
ins
Sans
Fro
ntie
rs
M
TCT
Mot
her-
To-C
hild
Tra
nsm
issi
on
NA
SCO
P N
atio
nal A
IDS
and
STD
Con
trol
Pro
gram
me
NV
P
Nev
irap
ine
OD
ldquoO
nce
a D
ayrdquo
OI
Opp
ortu
nist
ic In
fect
ion
OPV
O
ral P
olio
Vac
cine
PASC
O
Prov
inci
al A
IDS
STI C
oord
inat
or
PCP
Pneu
moc
ystis
jiro
veci
i pne
umon
ia
PCR
Po
lym
eras
e C
hain
Rea
ctio
n
PI
Prot
ease
Inhi
bito
r
PLW
HA
Pe
rson
sPe
ople
Liv
ing
With
HIV
AID
S
PMTC
T
Prev
entio
n of
Mot
her
To C
hild
Tra
nsm
issi
on
RD
A
Rec
omm
ende
d D
aily
Allo
wan
ce
RH
Rep
rodu
ctiv
e H
ealth
RN
A
Rib
onuc
leic
Aci
d
SdN
VP
Si
ngle
dos
e N
evir
apin
e
SRH
Se
xual
and
Rep
rodu
ctiv
e H
ealth
STD
Se
xual
ly T
rans
mitt
ed D
isea
se
STI
Sexu
ally
Tra
nsm
itted
Infe
ctio
n
TB
Tube
rcul
osis
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
3
14
TBA
s Tr
aditi
onal
Bir
th A
tten
dant
s
TLC
To
tal L
ymph
ocyt
e C
ount
TT
Teta
nus
Toxo
id v
acci
ne
UN
ICE
F U
nite
d N
atio
ns C
hild
renrsquo
s Fu
nd
UN
GA
SS
Uni
ted
Nat
ions
Gen
eral
Ass
embl
y Sp
ecia
l Ses
sion
on
HIV
AID
S
UoN
Uni
vers
ity o
f Nai
robi
VC
T V
olun
tary
Cou
nsel
ling
and
Test
ing
VIA
V
isua
l Ins
pect
ion
usin
g A
ceto
ne
VD
RL
Ven
erea
l Dis
ease
Res
earc
h La
bora
tory
(tes
t for
syp
hilis
)
WH
O
Wor
ld H
ealth
Org
anis
atio
n
WR
P W
alte
r R
eed
Prog
ram
App
endi
x I
WH
O C
LIN
ICA
L S T
AG
ING
OF
HIV
AID
S FO
R A
DU
LTS
AN
D A
DO
LES-
CEN
TSW
ITH
CO
NFI
RM
ED H
IV IN
FEC
TIO
N
CLI
NIC
AL
STA
GE
1
bull
Asy
mpt
omat
ic
bull
Per
sist
ent
gene
raliz
ed ly
mph
aden
opat
hy
CLI
NIC
AL
STA
GE
2 1
Une
xpla
ined
mod
erat
e w
eigh
t lo
ss (
lt10
of
pres
umed
or
mea
sure
d bo
dy w
eigh
t)
2
Rec
urre
nt u
pper
res
pira
tory
tra
ct in
fect
ions
(si
nusi
tis
tons
illiti
s
otiti
s m
edia
and
pha
ryng
itis)
3
Her
pes
Zos
ter
4
Ang
ular
Che
ilitis
5
Rec
urre
nt o
ral u
lcer
atio
n
6
Pap
ular
pru
ritic
eru
ptio
ns
7
Seb
orrh
oeic
der
mat
itis
8
Fun
gal n
ail i
nfec
tions
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
5
92
Bib
liog
raph
y 1
Offic
e of
the
Pres
iden
t N
ational
AID
S C
ontr
ol Counci
l K
enya
Nat
ional H
IVA
IDS
Str
ate
gic
pla
n 2
0056
-20091
0
2
Rep
ublic
of
Ken
ya
Nat
ional AID
S C
ontr
ol C
ounci
l N
atio
nal H
IVA
IDS M
onitori
ng
and E
valu
atio
n F
ram
ework
3
Rep
ublic
of
Ken
ya
Nat
ional AID
S C
ontr
ol C
ounci
l N
atio
nal H
IVA
IDS M
onitori
ng
and E
valu
atio
n I
mple
men
tation M
anual
Job
Aid
sR
efer
ence
s 1
MoH
AN
C R
egis
ters
2
MoH
Mat
ernity
Reg
iste
rs
3
MoH
Post
-nata
l Reg
iste
rs
4
Mat
ernal
and C
hild
Wel
fare
Han
dbook
5
Rep
roduct
ive
Hea
lth S
ervi
ces
month
ly r
eport
6
MoH
Form
726
(Appen
dix
IV)
7
MoH
Form
727
8
MO
H F
orm
711
Exec
utiv
e Su
mm
ary
The
Rev
ised
Gui
delin
es (3
rd
editi
on) f
or P
reve
ntio
n of
Mot
her
to C
hild
Tra
nsm
issi
on(P
MTC
T) o
f H
IV a
nd A
IDS
addr
esse
s th
e ri
sks
of m
othe
r-to
-chi
ld t
rans
mis
sion
(MTC
T) o
f H
IV a
nd A
IDS
usin
g m
ore
effic
acio
us in
terv
entio
ns t
han
in t
he p
revi
ous
editi
ons
The
Gui
delin
es a
re i
n lin
e w
ith K
enya
rsquos N
atio
nal
Hea
lth S
ecto
r St
rate
gic
Plan
II
(NH
SSP
II)
and
are
anch
ored
on
the
Ken
ya N
atio
nal
AID
S St
rate
gic
Plan
(KN
ASP
) 20
00-2
010
whi
ch f
ocus
es o
n th
e pr
iori
ty a
reas
of
prev
entio
n of
new
inf
ecshy
tions
im
prov
ing
the
qual
ity o
f life
of p
eopl
e in
fect
ed a
nd a
ffect
ed b
y H
IV a
nd A
IDS
and
miti
gatio
n of
the
soc
ial a
nd e
cono
mic
impa
ct o
f the
infe
ctio
n O
ne o
f the
pri
ority
ar
eas
of N
HSS
P II
is
adhe
renc
e to
set
clin
ical
and
pub
lic h
ealth
sta
ndar
ds
The
Gui
delin
es w
ere
deve
lope
d th
roug
h a
part
icip
ator
y an
d co
nsul
tativ
e pr
oces
s th
at
drew
par
ticip
ants
fro
m p
ublic
hea
lth i
nstit
utio
ns
NG
Os
FB
Os
aca
dem
ic a
nd r
eshyse
arch
ins
titut
ions
and
dev
elop
men
t pa
rtne
rs
The
proc
ess
was
co-
ordi
nate
d by
N
ASC
OP
with
tech
nica
l and
fina
ncia
l sup
port
from
CD
C (K
)
HIV
infe
ctio
n ha
s re
vers
ed g
ains
rea
lised
in c
hild
hea
lth a
nd s
urvi
val i
n th
e la
st d
ecshy
ade
in K
enya
The
infe
ctio
n ha
s al
so c
ontr
ibut
ed s
igni
fican
tly t
o th
e co
mm
on c
ompl
ishyca
tions
of
preg
nanc
y in
man
y co
untr
ies
Glo
bally
mor
e th
an 6
300
00 c
hild
ren
wer
ein
fect
ed w
ith H
IV t
hrou
gh M
TCT
in 2
003
In
2007
K
enya
had
a p
opul
atio
n es
tishym
ated
at
34 m
illio
n t
he n
umbe
r of
bir
ths
per
annu
m w
as 1
73
mill
ion
the
HIV
prev
alen
ce a
mon
g pr
egna
nt m
othe
rs w
as 6
7 p
er c
ent
and
the
tota
l num
ber
of b
irth
s to
HIV
-infe
cted
mot
hers
exp
osed
to
MTC
T w
as 1
638
00
Ass
umin
g a
tran
smis
sion
rate
of 4
0 pe
r ce
nt a
nd in
the
abs
ence
of a
ny in
terv
entio
n t
he n
umbe
r of
HIV
pos
ishytiv
e in
fant
s pe
r an
num
wou
ld b
e 65
520
Ken
ya A
IDS
Indi
cato
r su
rvey
(KA
IS) 2
007
HIV
ser
opre
vale
nce
amon
g ad
ults
age
d 15
-49
year
s is
78
Var
ious
inte
rven
tions
hav
e be
en p
ut in
pla
ce t
o re
spon
d to
the
em
ergi
ng c
halle
nges
an
d co
nstr
aint
s to
MTC
T ac
ross
the
cou
ntry
Ana
lysi
s of
effe
ctiv
enes
s of
the
var
ious
ap
proa
ches
nee
ded
to m
anag
e ri
sks
of M
TCT
prov
ides
val
uabl
e in
sigh
ts th
at n
eces
sishy
tate
the
ado
ptio
n of
mor
e ef
ficac
ious
car
e an
d tr
eatm
ent
regi
men
s T
hese
ins
ight
s ha
ve in
form
ed t
he d
evel
opm
ent
of n
ew G
uide
lines
The
Gui
delin
es in
corp
orat
e th
ese
chan
ges
and
are
reco
mm
ende
d fo
r us
e by
hea
lth p
rofe
ssio
nals
and
hea
lth in
stitu
tions
at a
ll le
vels
of c
are
The
Gui
delin
es w
ill e
nhan
ce th
e ca
paci
ty o
f hea
lth c
are
prov
ider
sto
giv
e m
ore
effic
ient
and
effe
ctiv
e se
rvic
es t
o H
IV p
ositi
ve e
xpec
tant
mot
hers
and
ne
wbo
rns
The
Gui
delin
es h
ave
ten
chap
ters
and
cov
er th
e fo
llow
ing
just
ifyin
g th
e ne
ed fo
r sp
eshyci
fic m
anag
emen
t of
HIV
pos
itive
wom
en c
are
befo
re d
urin
g an
d af
ter
preg
nanc
yus
e of
ant
iret
rovi
ral t
hera
py in
pre
gnan
cy p
ostn
atal
car
e fa
mily
pla
nnin
g e
arly
inshy
fant
dia
gnos
is
feed
ing
car
e an
d fo
llow
-up
of H
IV-in
fect
ed i
nfan
ts
and
mon
itori
ng
and
eval
uatio
n A
dditi
onal
inf
orm
atio
n on
WH
O s
tagi
ng
cont
race
ptiv
e op
tions
for
PLW
As
and
a su
mm
ary
of A
RV
use
in P
MTC
T is
giv
en in
the
appe
ndic
es
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
9
1
16
The
Gui
delin
es h
ave
also
inc
orpo
rate
d ba
sic
info
rmat
ion
that
pro
gram
man
ager
sne
ed in
ord
er to
mak
e th
eir
inst
itutio
ns P
MTC
T-fr
iend
ly T
his
info
rmat
ion
is fo
und
in
the
boxe
s an
d ap
pend
ices
Sum
mar
ies
of t
he i
nfor
mat
ion
cont
aine
d in
the
tex
t ar
e fo
und
in th
e ta
bles
The
Gui
delin
es p
rovi
de a
bac
kgro
und
to t
he P
MTC
T pr
oble
m in
the
wor
ld i
n A
fric
a an
d in
Ken
ya T
hey
also
giv
e de
tails
on
HIV
in p
regn
ancy
the
tran
smis
sion
pat
tern
sof
MTC
T an
d de
scri
be t
he b
enef
its o
f pr
even
ting
mot
her-
to-c
hild
tra
nsm
issi
on(P
MTC
T) T
hey
also
pro
vide
info
rmat
ion
on in
terv
entio
ns n
eces
sary
to
redu
ce M
TCT
that
incl
ude
coun
selli
ng a
nd te
stin
g la
bora
tory
inve
stig
atio
ns o
bste
tric
inte
rven
tions
and
trea
tmen
tpro
phyl
axis
The
ante
nata
l man
agem
ent
for
HIV
pos
itive
wom
en i
nclu
ding
pol
icy
guid
e jo
b ai
dsw
ith s
umm
aris
ed e
ssen
tial p
acka
ge o
f int
egra
ted
ante
nata
l car
e se
rvic
es a
re d
etai
led
in C
hapt
er 2
Cha
pter
3 p
rovi
des
info
rmat
ion
on i
ntra
part
um c
are
Thi
s is
the
man
agem
ent
ofw
omen
from
the
onse
t of l
abou
r to
del
iver
y A
t thi
s st
age
it is
impo
rtan
t to
esta
blis
hth
e H
IV s
tatu
s of
wom
en p
rior
to d
eliv
ery
or d
urin
g la
bour
Gui
delin
es s
houl
d be
folshy
low
ed fo
r al
l wom
en a
dmitt
ed to
labo
ur a
nd d
eliv
ery
To
cond
uct v
agin
al d
eliv
erie
s fo
r H
IV p
ositi
ve w
omen
m
odifi
ed r
outin
e ca
re i
s gi
ven
The
gui
delin
es p
rovi
de a
reshy
min
der
on th
e ac
tiviti
es e
ssen
tial t
o ca
rry
out f
or s
afe
vagi
nal d
eliv
ery
for
all w
omen
no
t ju
st fo
r th
ose
infe
cted
with
HIV
It
is r
ecom
men
ded
that
the
re s
houl
d be
no
disshy
crim
inat
ion
or is
olat
ion
of H
IV p
ositi
ve w
omen
dur
ing
labo
ur a
nd d
eliv
ery
Del
iver
y th
roug
h el
ectiv
e ca
esar
ean
sect
ion
redu
ces
the
risk
of
HIV
MTC
T as
com
pare
d to
vagi
nal d
eliv
ery
amon
g H
IV p
ositi
ve w
omen
Whe
re C
S is
per
form
ed a
s an
em
erge
ncy
or e
lect
ivel
y a
ntib
iotic
s sh
ould
be
give
n
Ant
iret
rovi
ral (
AR
V) t
hera
py is
dis
cuss
ed in
det
ail i
n C
hapt
er 4
Thi
s in
clud
es t
hershy
apy
for
the
mot
her
befo
re la
bour
dur
ing
labo
ur a
nd a
fter
del
iver
y a
nd fo
r th
e in
fant
afte
r de
liver
y C
urre
ntly
N
evir
apin
e is
the
rec
omm
ende
d re
gim
en H
owev
er
shor
tco
urse
effi
caci
ous
AR
V d
rug
regi
men
s ca
n be
im
plem
ente
d in
res
ourc
e lim
ited
setshy
tings
AR
Vs
are
used
bot
h fo
r tr
eatm
ent
and
for
PMTC
T in
HIV
inf
ecte
d pr
egna
ntw
omen
and
thei
r ne
onat
es
Gui
delin
es f
or t
he p
ostp
artu
m c
are
of t
he m
othe
r an
d ca
re f
or H
IV e
xpos
ed in
fant
s ar
e de
taile
d in
Cha
pter
5 I
n C
hapt
er 6
the
Gui
de p
rovi
des
deta
iled
info
rmat
ion
on
late
pos
tnat
al c
are
and
fam
ily p
lann
ing
HIV
pos
itive
wom
en c
an u
se a
ll ty
pes
of fa
mshy
ily p
lann
ing
base
d on
sta
ndar
d el
igib
ility
cri
teri
a as
exp
licitl
y ou
tline
d in
the
text
Gui
delin
es fo
r in
fant
dia
gnos
is c
are
and
trea
tmen
t ar
e di
scus
sed
in C
hapt
er 7
Cur
shyre
ntly
the
re is
no
test
to
diffe
rent
iate
bet
wee
n an
tibod
ies
from
the
mot
her
and
thos
e pr
oduc
ed b
y th
e ba
by T
o id
entif
y H
IV in
fect
ed in
fant
s le
ss t
han
18 m
onth
s D
NA
or
RN
A ndash
PC
R te
st is
cur
rent
ly r
ecom
men
ded
HIV
exp
osed
infa
nts
at 6
wee
ks a
nd s
ick
infa
nts
at 1
2 m
onth
s sh
ould
hav
e ac
cess
to
DB
S fo
r D
NA
PC
R H
IV e
xpos
ed in
fant
ssh
ould
be
star
ted
on c
otri
mox
azol
e fr
om 6
wee
ks A
ll m
othe
rs w
ith 6
wee
k ol
d in
fant
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
E
Upt
ake
of c
ouns
ellin
g an
d te
stin
g in
Mat
erni
ty c
linic
Rat
io o
f m
ater
nity
clie
nts
with
unk
now
n H
IV s
tatu
s w
ho a
re c
ouns
elle
d an
d te
sted
for H
IV in
mat
erni
ty
Num
erat
or
Num
ber o
f pre
gnan
t wom
en a
dmitt
ed in
to m
ater
nity
with
un
know
n H
IV s
tatu
s th
at a
re c
ouns
elle
d an
d te
sted
for H
IV
durin
g la
bour
or a
fter d
eliv
ery
Den
omin
ator
N
umbe
r of p
regn
ant w
omen
adm
itted
into
mat
erni
ty
with
unk
now
n H
IV s
tatu
s
F
Mat
erni
ty m
othe
r AR
V pr
ophy
laxi
s up
take
R
atio
of H
IV in
fect
ed m
othe
rs in
mat
erni
ty c
linic
rece
ivin
g pr
even
tive
A
RV
pro
phyl
axis
Num
erat
or
Num
ber o
f HIV
-infe
cted
mot
hers
adm
itted
in m
ater
nity
takshy
ing
or re
porte
d to
hav
e ta
ken
the
mot
her d
ose(
s) o
f pre
venshy
tive
AR
V p
roph
ylax
is
Den
omin
ator
N
umbe
r of p
regn
ant w
omen
adm
itted
into
mat
erni
ty w
ho
are
HIV
-infe
cted
G
Infa
nt A
RV
prop
hyla
xis
upta
ke
Rat
io o
f inf
ants
bor
n to
HIV
-infe
cted
mot
hers
in m
ater
nity
clin
ic
rece
ivin
g pr
even
tive
AR
V p
roph
ylax
is
Num
erat
or
Num
ber o
f inf
ants
bor
n to
HIV
-infe
cted
mot
hers
who
rece
ive
prev
entiv
e
Den
omin
ator
N
umbe
r of i
nfan
ts b
orn
to H
IV-in
fect
ed m
othe
rs
Num
ber o
f pre
gnan
t wom
en a
dmitt
ed in
to m
ater
nity
who
are
H
IV-in
fect
ed is
use
d to
app
roxi
mat
e th
is n
umbe
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
7
90
With
the
mea
sure
men
ts li
sted
abo
ve t
he fo
llow
ing
perf
orm
ance
indi
cato
rs
for m
onito
ring
PMTC
T ac
tiviti
es a
re c
alcu
late
d
A
Upt
ake
of c
ouns
ellin
g an
d te
stin
g in
Ant
enat
al c
linic
R
atio
of a
nten
atal
clie
nts
who
wer
e co
unse
lled
and
test
ed fo
r HIV
Num
erat
or
This
is n
umbe
r of p
regn
ant w
omen
atte
ndin
g th
eir f
irst
ante
nata
l clin
ic v
isit
who
are
test
ed fo
r HIV
Den
omin
ator
N
umbe
r of n
ew v
isits
to th
e an
tena
tal c
linic
B
Ant
enat
al H
IV s
erop
reva
lenc
e
Rat
io o
f Ant
enat
al p
regn
ant w
omen
test
ed fo
r HIV
that
are
HIV
infe
cted
Num
erat
or
Num
ber o
f clie
nts
who
test
HIV
pos
itive
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
test
ed fo
r HIV
in a
nten
ashyta
l clin
ic
C
Ant
enat
al m
othe
r AR
V pr
ophy
laxi
s up
take
R
atio
of k
now
n H
IV in
fect
ed p
regn
ant w
omen
in a
nten
atal
clin
ic
rece
ivin
g A
RV
pre
vent
ive
prop
hyla
xis
Num
erat
or
Tota
l num
ber o
f HIV
-infe
cted
pre
gnan
t wom
en in
ant
enat
al
clin
ic re
ceiv
ing
mot
her p
reve
ntiv
e A
RV
pro
phyl
axis
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
who
are
HIV
-infe
cted
in
the
ante
nata
l clin
ic
D
Ant
enat
al in
fant
AR
V pr
ophy
laxi
s up
take
R
atio
of k
now
n H
IV-in
fect
ed p
regn
ant w
omen
in a
nten
atal
clin
ic w
ho
rece
ive
infa
nt d
ose(
s) o
f pre
vent
ive
AR
V p
roph
ylax
is
Num
erat
or
Tota
l num
ber o
f HIV
infe
cted
pre
gnan
t wom
en in
an
tena
tal c
linic
rece
ivin
g in
fant
dos
e(s)
pre
vent
ive
A
RV
pro
phyl
axis
Den
omin
ator
To
tal n
umbe
r of p
regn
ant w
omen
who
are
HIV
-infe
cted
in
the
ante
nata
l clin
ic
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
shou
ld h
ave
rout
ine
HIV
ant
ibod
y te
st
Gui
delin
es f
or f
eedi
ng in
fant
s an
d yo
ung
child
ren
born
to
HIV
infe
cted
mot
hers
are
di
scus
sed
in C
hapt
er 8
The
Min
istr
y of
Hea
lth r
ecom
men
ds p
rom
otio
n of
exc
lusi
vebr
east
feed
ing
for
the
first
6 m
onth
s of
life
Whe
re r
epla
cem
ent f
eedi
ng is
acc
epta
ble
feas
ible
af
ford
able
su
stai
nabl
e an
d sa
fe (
AFA
SS)
avoi
danc
e of
bre
astf
eedi
ng b
yH
IV-in
fect
ed w
omen
is
reco
mm
ende
d (W
HO
200
6) D
iscu
ssio
n on
diff
eren
t ty
pes
offe
edin
g al
tern
ativ
es t
o br
east
feed
ing
is c
aptu
red
in t
he t
ext
Thes
e op
tions
exi
st f
orth
e m
othe
r to
cho
ose
with
the
aid
of
coun
selli
ng I
deal
ly c
oupl
e de
cisi
on-m
akin
g is
enco
urag
ed f
or t
he H
IV p
ositi
ve m
othe
r F
or t
he H
IV n
egat
ive
mot
her
exc
lusi
ve
brea
stfe
edin
g is
rec
omm
ende
d fo
r 6
mon
ths
or le
ss fo
llow
ed b
y w
eani
ng
Car
e an
d fo
llow
-up
of c
hild
ren
of H
IV-in
fect
ed m
othe
rs is
dis
cuss
ed in
det
ail i
n C
hapshy
ter
9 A
ll ch
ildre
n bo
rn t
o H
IV i
nfec
ted
mot
hers
sho
uld
be f
ollo
wed
up
clos
ely
from
birt
h th
roug
h 2
year
s T
able
92
pro
vide
s th
e W
HO
rec
omm
ende
d fo
llow
up
deta
ils
Sim
ilarl
y t
he m
othe
rs s
houl
d be
sup
port
ed t
o pr
ovid
e op
timal
infa
nt fe
edin
g an
d to
av
oid
mix
ed fe
edin
g w
ithin
6 m
onth
s
In C
hapt
er 1
0 t
he G
uide
lines
exp
lain
the
ben
efits
of
mon
itori
ng a
nd e
valu
atio
n of
PMTC
T pr
ogra
ms
Mamp
E p
rovi
des
an o
ppor
tuni
ty t
o m
easu
re a
nd a
ppra
ise
perf
orm
shyan
ce w
ithin
def
ined
tim
e fr
ame
to e
nsur
e ac
com
plis
hmen
t of s
et g
oals
and
obj
ectiv
es
PMTC
T se
rvic
es m
ust
be g
uide
d by
tim
ely
and
accu
rate
dat
a re
port
ed f
rom
the
heal
th f
acili
ties
thr
ough
the
dis
tric
t an
d pr
ovin
cial
lev
els
to
the
natio
nal
leve
l at
NA
SCO
P
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
9
18
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
(xiii
) H
IV in
fect
ed in
mat
erni
ty w
ard
Num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to
mat
erni
ty c
linic
who
are
HIV
infe
cted
In
clud
es b
oth
thos
e w
ho w
ere
adm
itted
al
read
y kn
owin
g th
ey a
re H
IV-i
nfec
ted
and
thos
e w
ho w
ere
test
ed a
nd r
ecei
ved
thei
r re
sults
in m
ater
nity
clin
ic T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(xiv
) P
reve
ntiv
e A
RV
pro
phyl
axis
in m
ater
nity
war
d (m
othe
r do
se)
Num
ber
of
preg
nant
wom
en a
dmitt
ed in
mat
erni
ty t
akin
g or
rep
orte
d to
hav
e ta
ken
the
mot
her
dose
(s)
of p
reve
ntiv
e A
RV
pro
phyl
axis
T
his
is o
btai
ned
from
the
m
ater
nity
reg
iste
r
(xv)
Inf
ant
prev
entiv
e A
RV
pro
phyl
axis
in m
ater
nity
clin
ic
war
d N
umbe
r of
inshy
fant
s bo
rn in
mat
erni
ty r
ecei
ving
the
infa
nt p
reve
ntiv
e A
RV
pro
phyl
axis
in t
he
mat
erni
ty c
linic
T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(xvi
) D
eliv
erie
s T
otal
num
ber
of p
regn
ant
wom
en d
eliv
erin
g at
the
hea
lth fa
cilit
y
(xvi
i) C
ouns
ellin
g on
infa
nt f
eedi
ng o
ptio
ns
Num
ber
of m
othe
rs d
eliv
erin
g at
the
he
alth
fac
ility
cou
nsel
led
on in
fant
fee
ding
opt
ions
T
his
is o
btai
ned
from
the
m
ater
nity
reg
iste
r
(xvi
ii) I
nfan
t te
stin
g at
6 w
eeks
bull N
umbe
r of
infa
nts
test
ed f
or H
IV a
t 6
wee
ks o
ld
bull N
umbe
r of
infa
nts
test
ing
HIV
-pos
itive
T
his
is o
btai
ned
from
labo
rato
ry
regi
ster
(xix
) R
efer
red
for
care
and
tre
atm
ent
bull N
umbe
r of
HIV
infe
cted
wom
en a
ttend
ing
ante
nata
l clin
ic t
hat
is r
efer
red
for
HIV
car
e an
d tr
eatm
ent
bull N
umbe
r of
HIV
infe
cted
wom
en in
mat
erni
ty t
hat
is r
efer
red
for
HIV
car
e an
d tr
eatm
ent
bull N
umbe
r H
IV in
fect
ed in
fant
s re
ferr
ed f
or H
IV c
are
and
trea
tmen
t T
his
is
ob
tain
ed f
rom
ant
enat
al a
nd m
ater
nity
reg
iste
rs
(xx)
Ini
tiate
d on
Cot
rim
oxaz
ole
Num
ber
of H
IV in
fect
ed p
regn
ant
wom
en a
ttend
ing
ante
nata
l clin
ic th
at h
as
been
initi
ated
on
Cot
rimox
azol
e T
his
is o
btai
ned
from
the
ant
enat
al r
egis
ter
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
1
9
88
Th
e da
ta is
pre
sent
ed u
sing
def
ined
per
form
ance
indi
cato
rs th
at in
clud
e th
e fo
llow
ing
(i)
New
clie
nts
first
ant
enat
al c
linic
vis
its
Num
ber
of p
regn
ant
wom
en a
ttend
ing
thei
r fir
st a
nten
atal
vis
it fo
r th
e cu
rren
t pr
egna
ncy
at t
he h
ealth
fac
ility
T
his
is
obta
ined
fro
m t
he a
nten
atal
reg
iste
r
(ii)
Ret
urn
visi
tsr
evis
its
Num
ber
of r
etur
n an
tena
tal c
linic
vis
itsr
evis
its
atte
nded
by
the
preg
nant
wom
en a
t th
e fa
cilit
y T
his
is o
btai
ned
from
the
an
tena
tal r
egis
ter
(iii)
C
ouns
ellin
g an
d te
stin
g fo
r H
IV in
ant
enat
al c
linic
Tot
al n
umbe
r of
pre
gnan
t w
omen
cou
nsel
led
and
test
ed f
or H
IV a
t th
e an
tena
tal c
linic
w
heth
er t
his
is d
one
on th
e fir
st a
nten
atal
vis
it or
a la
ter
visi
t T
his
is o
btai
ned
from
the
an
tena
tal r
egis
ter
(iv)
H
IV c
ouns
ellin
g an
d te
stin
g at
fir
st a
nten
atal
clin
ic v
isit
Num
ber
of p
regn
ant
wom
en a
tten
ding
the
ir fir
st a
nten
atal
clin
ic v
isit
for
curr
ent
preg
nanc
y w
ho a
re
test
ed f
or H
IV
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(v)
Lear
ning
HIV
sta
tus
in a
nten
atal
clin
ic
Num
ber
of a
nten
atal
clin
ic p
regn
ant
wom
en t
este
d fo
r H
IV w
ho r
ecei
ve t
heir
HIV
res
ults
w
heth
er t
his
is d
one
on t
he
first
ant
enat
al c
linic
vis
it or
at
a la
ter
visi
t T
his
is o
btai
ned
from
the
ant
enat
al
regi
ster
(vi)
HIV
infe
cted
in a
nten
atal
clin
ic
Num
ber
of a
nten
atal
clin
ic p
regn
ant
wom
en
who
are
HIV
-inf
ecte
d on
the
late
st t
est
durin
g th
e pr
egna
ncy
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(vii)
Pre
vent
ive
AR
V p
roph
ylax
is in
ant
enat
al c
linic
(m
othe
r do
se)
Num
ber
of
preg
nant
wom
en in
the
ant
enat
al c
linic
rec
eivi
ng t
he m
othe
r do
se(s
) of
pre
venshy
tive
AR
V p
roph
ylax
is
Thi
s is
obt
aine
d fr
om t
he a
nten
atal
reg
iste
r
(viii
) P
reve
ntiv
e A
RV
pro
phyl
axis
in a
nten
atal
clin
ic (
infa
nt d
ose)
N
umbe
r of
pr
egna
nt w
omen
in t
he A
nten
atal
clin
ic is
sued
with
the
infa
nt d
ose(
s) o
f pr
even
shytiv
e A
RV
pro
phyl
axis
T
his
is o
btai
ned
from
the
ant
enat
al r
egis
ter
(ix)
New
clie
nts
in m
ater
nity
clin
ic
Num
ber
of p
regn
ant
wom
en a
tten
ding
the
Mashy
tern
ity c
linic
for
the
firs
t tim
e T
his
is o
btai
ned
from
the
mat
erni
ty r
egis
ter
(x)
Unk
now
n H
IV s
tatu
s at
mat
erni
ty
Num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to
the
mat
erni
ty w
ith u
nkno
wn
HIV
sta
tus
Thi
s is
obt
aine
d fr
om t
he m
ater
nity
reg
isshy
ter
(xi)
Cou
nsel
ling
and
test
ing
for
HIV
in m
ater
nity
war
dT
otal
num
ber
of p
regn
ant
wom
en a
dmitt
ed in
to m
ater
nity
with
unk
now
n st
atus
tha
t ar
e co
unse
lled
and
test
ed fo
r H
IV d
urin
g la
bour
or
afte
r de
liver
y T
his
is o
btai
ned
from
the
mat
erni
ty
regi
ster
(xii)
Lea
rnin
g H
IV s
tatu
s in
mat
erni
ty w
ard
Num
ber
of p
regn
ant
wom
en a
dmitt
ed
into
mat
erni
ty a
nd t
este
d fo
r H
IV w
ho r
ecei
ved
thei
r H
IV r
esul
ts
Thi
s is
obt
aine
d fr
om t
he m
ater
nity
reg
iste
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Cha
pter
1
Bac
kgro
und
11
THE
GLO
BA
L P A
ND
EMIC
Ove
r 38
mill
ion
peop
le a
re li
ving
with
HIV
AID
S w
orld
wid
e a
nd a
bout
two-
thir
ds o
r 25
m
illio
n of
PLW
HA
liv
e in
sub
-Sah
aran
Afr
ica1
H
IVA
IDS
mai
nly
affe
cts
peop
le o
fre
prod
uctiv
e ag
e an
d in
crea
sing
ly a
ffect
s w
omen
w
ho n
ow a
ccou
nt f
or 5
7 o
f ne
win
fect
ions
in s
ub-S
ahar
an A
fric
a w
here
wom
en a
re 3
0 m
ore
likel
y to
be
livin
g w
ith
HIV
AID
S th
an m
en a
nd y
oung
wom
en a
ged
15-2
4 ar
e ne
arly
four
tim
es m
ore
likel
y to
be
inf
ecte
d th
an t
heir
mal
e co
unte
rpar
ts2
Youn
g m
arri
ed w
omen
w
ho a
re o
ften
m
onog
amou
s h
ave
beco
me
one
of t
he g
roup
s m
ost
vuln
erab
le t
o H
IV i
n th
e re
gion
Th
is r
equi
res
new
and
rap
id r
espo
nses
that
bro
aden
the
focu
s be
yond
trad
ition
al ldquoh
igh
risk
rdquo gro
ups
like
com
mer
cial
sex
wor
kers
tru
ck d
rive
rs a
nd d
rug
user
s
To r
each
you
ng m
arri
ed w
omen
w
ho m
ay n
ot b
e aw
are
of t
heir
vul
nera
bilit
y H
IV
AID
S pr
even
tion
ca
re
and
supp
ort
activ
ities
m
ust
be
inte
grat
ed
into
al
read
yes
tabl
ishe
d he
alth
ser
vice
s th
at a
re u
sed
by t
he g
ener
al p
opul
atio
n A
n es
timat
ed
630
000
child
ren
wor
ld-w
ide
beca
me
infe
cted
with
HIV
in
2003
mdash m
ost
thro
ugh
MTC
T3
The
risk
of
an H
IV-in
fect
ed m
othe
r pa
ssin
g th
e vi
rus
to h
er i
nfan
t du
ring
pr
egna
ncy
labo
ur a
nd d
eliv
ery
or in
the
post
nata
l per
iod
is 1
in 3
if n
othi
ng is
don
e to
re
duce
this
ris
k I
n ot
her
wor
ds o
ut o
f 100
infa
nts
born
to w
omen
with
HIV
AID
S an
d w
ithou
t in
terv
entio
n 6
0-75
of t
hem
will
not
be
infe
cted
Of t
he o
ne-t
hird
who
bec
ome
infe
cted
abo
ut 5
-10
babi
es w
ill b
e in
fect
ed d
urin
g pr
egna
ncy
15
will
be
infe
cted
dur
ing
labo
ur a
nd d
eliv
ery
whi
le 5
-15
will
be
infe
cted
dur
ing
brea
stfe
edin
g l
arge
ly b
eing
de
pend
ent
on b
reas
tfee
ding
pra
ctic
es a
nd o
n th
e du
ratio
n of
bre
astfe
edin
g4 I
n 20
03
near
ly 5
000
00 c
hild
ren
died
of A
IDS-
rela
ted
caus
es M
ost
child
ren
born
with
HIV
die
befo
re th
ey r
each
thei
r fif
th b
irth
day
with
mos
t not
sur
vivi
ng b
eyon
d tw
o ye
ars5
The
high
rat
es o
f M
TCT
in d
evel
opin
g co
untr
ies
com
pare
d to
muc
h lo
wer
rat
es i
nri
cher
cou
ntri
es
illus
trat
e gr
owin
g in
equa
litie
s in
glo
bal
heal
th
In t
he w
ealth
y co
untr
ies
the
rat
e of
MTC
T is
les
s th
an 2
b
ecau
se o
f w
ides
prea
d ac
cess
to
antishy
retr
ovir
al th
erap
y (A
RT)
pla
nned
cae
sare
an s
ectio
ns (C
S) t
he m
eans
to s
afel
y fo
rmul
afe
ed a
nd a
cces
s to
qua
lity
med
ical
ser
vice
s I
n po
orer
cou
ntri
es li
ke K
enya
the
re is
a
30-4
0 c
hanc
e th
at a
n H
IV-p
ositi
ve b
reas
tfee
ding
mot
her
will
pas
s H
IV to
her
chi
ld in
th
e ab
senc
e of
the
se s
ervi
ces
In
such
set
tings
it
is c
ritic
al t
hat
prev
entio
n pr
oced
ures
be i
nteg
rate
d in
to e
xist
ing
sexu
al a
nd r
epro
duct
ive
heal
th (
SRH
) an
d m
ater
nal
and
child
hea
lth (
MC
H)
serv
ices
re
achi
ng a
s m
any
wom
en a
s po
ssib
le a
nd l
ower
ing
tran
smis
sion
rat
es A
lthou
gh p
harm
aceu
tical
com
pany
don
atio
ns d
onor
sup
port
and
othe
r go
vern
men
t in
itiat
ives
hav
e he
lped
exp
and
acce
ss t
o H
IV t
estin
g fo
r pr
egna
ntw
omen
and
use
of a
ntir
etro
vira
l dru
gs li
ke N
evir
apin
e w
hich
red
uce
the
chan
ce o
f HIV
tr
ansm
issi
on s
till o
nly
10
of p
regn
ant w
omen
glo
bally
hav
e ac
cess
to th
ese
drug
s6
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
7
20
HIV
AID
S tr
ansm
issi
on fr
om m
othe
r to
chi
ld in
Ken
ya is
one
of t
he b
igge
st h
ealth
and
de
velo
pmen
t cha
lleng
es in
Ken
ya A
ccor
ding
to th
e 20
03 D
emog
raph
ic a
nd H
ealth
Sur
shyve
y7 6
7
or
over
12
mill
ion
Ken
yan
adul
ts w
ere
livin
g w
ith H
IVA
IDS
in 2
003
The
re
has
been
a s
tead
y de
clin
e in
HIV
ser
opre
vale
nce
in K
enya
In
2005
the
pre
vale
nce
rate
w
as e
stim
ated
at 5
9
and
as
per
the
2006
sta
tistic
s th
e pr
eval
ence
rat
e am
ong
adul
tsha
d dr
oppe
d to
51
8
Acc
ordi
ng t
o 20
07 K
enya
AID
S In
dica
tor
Surv
ey (
KA
IS)8a
the
H
IV s
erop
reva
lenc
e in
Ken
ya is
cur
rent
ly 7
8
am
ong
adul
ts a
ged
15-4
9 ye
ars
bei
nghi
gher
in
wom
en (
87
) th
an i
n m
en (
56
) Y
oung
wom
en a
re m
ore
vuln
erab
le i
n K
enya
tha
n m
en a
s ev
iden
ced
by a
nea
rly
9 p
reva
lenc
e ra
te a
mon
g w
omen
and
unshy
der
5 a
mon
g m
en9
Ther
e ar
e w
ide
vari
atio
ns b
etw
een
urba
n an
d ru
ral
area
s b
etw
een
regi
ons
bet
wee
n ad
ults
and
you
ng p
eopl
e an
d be
twee
n m
en a
nd w
omen
The
re h
as b
een
a no
tabl
e dr
op
in t
he n
umbe
r of
new
inf
ectio
ns
with
an
estim
ated
60
000
new
inf
ectio
ns i
n 20
05
drop
ping
to 5
500
0 in
200
6 In
fant
s an
d yo
ung
child
ren
unde
r 15
yea
rs a
ccou
nt fo
r 16
of
all
new
HIV
infe
ctio
ns m
ainl
y as
a r
esul
t of M
TCT
Mos
t of t
he n
ew in
fect
ions
occ
ur
amon
g yo
ung
peop
le i
n w
hom
the
mai
n m
ode
of t
rans
mis
sion
is t
hrou
gh s
exua
l int
ershy
cour
se
Tabl
e 1
1 A
dult
HIV
-Pre
vale
nce
Estim
ate
by P
rovi
nce
in 2
006
Prov
ince
N
umbe
r of H
IV +
Pre
vale
nce
()
Nai
robi
Cen
tral
Coa
st
Eas
tern
N E
aste
rn
Nya
nza
Rift
Val
ley
Wes
tern
Tota
l
197
000
960
00
930
00
720
00
900
0 18
300
0
171
000
112
000
11
milli
on
Tota
l
101
41
59
28
14
78
38
53
51
Mal
e
80
17
50
11
09
61
26
42
35
Fem
ale
123
65
69
44
18
96
49
64
67
Mal
eFe
mal
e R
atio
15
38
14
40
20
16
19
15
19
all t
he d
ata
from
the
prov
ince
s (a
nd r
efer
ral h
ospi
tals
) Th
e ag
greg
ated
dat
a is
di
ssem
inat
ed t
o th
e H
ealth
Man
agem
ent
Info
rmat
ion
Syst
em N
atio
nal A
IDS
Con
trol
Cou
ncilrsquo
s (N
AC
C)
natio
nal
data
ban
k an
d re
sour
ce c
entr
e T
he f
ocal
pe
rson
s he
re a
re t
he d
irec
tor
NA
CC
and
the
Mamp
E m
anag
er D
ata
is d
isse
mishy
nate
d ba
ck to
the
prov
ince
s an
d re
ferr
al h
ospi
tals
for
use
in d
ecis
ion-
mak
ing
7
Dat
a flo
w f
rom
fac
ility
lev
el t
o na
tiona
l le
vel
At
the
heal
th f
acili
ty P
MTC
T in
divi
dual
le
vel d
ata
reco
rded
in t
he M
oH s
tand
ardi
sed
regi
ster
s (A
NC
Mashy
tern
ity a
nd P
ostn
atal
) is
sum
mar
ised
ag
greg
ated
on
a m
onth
ly b
asis
ont
o M
oH F
orm
726
F
orm
726
is
then
for
war
ded
upw
ards
to
the
dist
rict
Lev
el
(DA
SCO
rsquos O
ffice
) for
agg
rega
tion
of th
e D
istr
ict l
evel
dat
a on
to F
orm
727
Cop
shyie
s of
For
m 7
26 a
nd F
orm
727
are
forw
arde
d to
the
Nat
iona
l Offi
ce (N
ASC
OP)
w
ith a
noth
er c
opy
of F
orm
727
bei
ng s
ent t
o th
e Pr
ovin
cial
Offi
ce (P
ASC
O)
8
Dat
a di
ssem
inat
ion
Thi
s is
car
ried
out
at
all
leve
ls s
tart
ing
from
fac
ility
to
natio
nal l
evel
It i
s th
e re
spon
sibi
lity
of N
AC
C to
coo
rdin
ate
the
diss
emin
atio
n an
d us
e of
all
HIV
AID
S da
ta a
nd in
form
atio
n fo
r na
tiona
l res
pons
e J
APR
a
join
t pro
gram
me
of a
ll st
akeh
olde
rs in
HIV
AID
S re
ceiv
es a
nd u
ses
the
data
to
disc
uss
the
chal
leng
es a
chie
vem
ents
and
les
sons
lea
rnt
from
HIV
AID
S an
d gi
ves
feed
back
for n
atio
nal r
espo
nse
9
PMTC
T in
dica
tors
and
thei
r so
urce
s H
ealth
car
e fa
cilit
ies
colle
ct th
e fo
llow
ing
data
as
a m
inim
um t
o be
use
d in
the
mon
itori
ng o
f PM
TCT
prog
ram
s T
he
data
is
to b
e ag
greg
ated
on
a m
onth
ly b
asis
ont
o th
e M
inis
try
of H
ealth
In
tegr
ated
Mon
itori
ng a
nd E
valu
atio
n R
epor
t For
m M
oH 7
26 u
sing
dat
a fr
om
the
Min
istr
y of
Hea
lth
Ken
ya A
nten
atal
and
Mat
erni
ty R
egis
ters
(D
eliv
ery
Reg
iste
r) M
oH 4
05 a
nd M
oH 3
33 r
espe
ctiv
ely
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
1
86
102
O
PER
ATI
ON
AL
GU
IDEL
INES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed in
the
mon
itorin
g an
d ev
alua
-tio
n of
PM
TCT
serv
ices
1
W
ithin
PM
TCT
prog
ram
s d
ata
is c
olle
cted
and
rep
orte
d at
the
fol
low
ing
leve
ls I
ndiv
idua
l fa
cilit
y d
istr
ict
prov
inci
al a
nd n
atio
nal
2
Indi
vidu
al l
evel
The
com
bine
d m
othe
r an
d ch
ild h
ealth
boo
klet
pro
vide
s de
shyta
iled
info
rmat
ion
on t
he w
oman
and
chi
ld i
nclu
ding
the
HIV
sta
tus
oth
er
HIV
car
e se
rvic
es d
rugs
del
iver
y in
form
atio
n im
mun
isat
ion
gro
wth
mon
itorshy
ing
and
othe
r par
amet
ers
3
Faci
lity
leve
l da
ta c
aptu
re t
ools
The
MoH
has
sta
ndar
dise
d re
gist
ers
for
reshy
cord
ing
data
at
faci
litie
s T
hese
inc
lude
the
Rev
ised
AN
C R
egis
ter
Rev
ised
M
ater
nity
Reg
iste
r an
d Po
st N
atal
Reg
iste
r an
d W
orkl
oad
MO
H 7
17 O
ther
re
gist
ers
incl
ude
Chi
ld H
ealth
and
Nut
ritio
n In
form
atio
n Sy
stem
and
Inshy
patie
nt M
orbi
dity
and
Mor
talit
y F
orm
711
and
the
Rep
rodu
ctiv
e H
ealth
Ser
shyvi
ces
mon
thly
rep
orts
are
use
d fo
r m
akin
g fa
cilit
y le
vel s
umm
arie
s on
PM
TCT
and
repr
oduc
tive
heal
th s
ervi
ces
3 F
acili
ty le
vel d
ata
capt
ure
tool
s T
he M
oH
has
stan
dard
ized
reg
iste
rs f
or r
ecor
ding
dat
a at
fac
ilitie
s T
hese
inc
lude
the
R
evis
ed A
NC
Reg
iste
r R
evis
ed M
ater
nity
Reg
iste
r an
d Po
st N
atal
Reg
iste
r an
d w
orkl
oad
MO
H 7
17 O
ther
reg
iste
rs in
clud
e C
hild
Hea
lth a
nd N
utri
tion
Info
rmat
ion
Syst
em a
nd I
n-pa
tient
mor
bidi
ty a
nd m
orta
lity
Fo
rm 7
26 a
nd
the
Rep
rodu
ctiv
e he
alth
ser
vice
s m
onth
ly r
epor
ts a
re u
sed
for
mak
ing
faci
lity
leve
l sum
mar
ies
on P
MTC
T an
d re
prod
uctiv
e he
alth
ser
vice
s
4
Dis
tric
t le
vel
data
For
m 7
27 i
s us
ed t
o su
mm
aris
e an
d re
port
dis
tric
t le
vel
data
Oth
er s
umm
ary
repo
rtin
g to
ols
are
also
use
d to
rep
ort
dist
rict
leve
l inshy
form
atio
n A
t th
e di
stri
ct le
vel
the
DAS
CO
rsquos of
fice
aggr
egat
es d
ata
from
sev
shyer
al h
ealth
faci
lity
spec
ific
Form
726
ont
o Fo
rm 7
27 th
at is
use
d to
sum
mar
ise
and
repo
rt d
istr
ict l
evel
dat
a
5
Prov
inci
al l
evel
dat
a A
t th
e pr
ovin
cial
lev
el t
he P
ASC
O r
ecei
ves
Form
727
da
ta f
rom
the
res
pect
ive
DA
SCO
rsquos of
fices
in
the
prov
ince
for
the
ir o
wn
data
us
e an
d re
cord
s A
cop
y of
the
sam
e is
sen
t to
the
Nat
iona
l Offi
ce (N
ASC
OP)
by
the
DA
SCO
rsquos of
fice
At
the
prov
inci
al le
vel
the
dist
rict
leve
l dat
a is
agg
reshy
gate
d to
giv
e th
e pr
ovin
cial
leve
l dat
a
6 N
atio
nal
leve
l da
ta
At
the
natio
nal
leve
l th
e M
ampE
Man
ager
rec
eive
s da
ta
from
the
PASC
Os
for
each
of t
he p
rovi
nces
Dat
a is
als
o re
ceiv
ed fr
om th
e R
eshyfe
rral
hos
pita
ls a
nd o
ther
fac
ilitie
s at
the
ref
erra
l ho
spita
l or
ter
tiary
lev
el
The
data
rec
eive
d at
the
nat
iona
l lev
el is
als
o co
pied
to
the
Hea
d of
NA
SCO
P an
d PM
TCT
prog
ram
me
man
ager
The
Mamp
E m
anag
er a
t NA
SCO
P ag
greg
ates
85
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
12
MA
GN
ITU
DE
OF
HIV
IN P
REG
NA
NC
YIN
KEN
YA
Ken
ya N
atio
nal
AID
SST
I C
ontr
ol P
rogr
amm
e (N
ASC
OP)
est
imat
es t
hat
ther
e w
ere
12
mill
ion
babi
es b
orn
in 2
006
in K
enya
and
that
as
man
y as
9
of p
regn
ant w
omen
inK
enya
wer
e liv
ing
with
HIV
AID
S10
At
leas
t 50
000
to
600
00 i
nfan
ts i
n K
enya
wer
e th
ough
t to
hav
e be
en i
nfec
ted
with
H
IV a
s a
resu
lt of
MTC
T th
at y
ear
With
an
estim
ated
pop
ulat
ion
of 3
72
mill
ion
in th
eye
ar 2
007
the
num
ber
of b
irth
s in
200
7 w
as 1
73
mill
ion
With
an
HIV
pre
vale
nce
of 6
7
the
num
ber
of H
IV -
expo
sed
babi
es is
114
101
and
at
leas
t 45
640
HIV
-pos
itive
bab
ies
are
born
ass
umin
g a
40
tran
smis
sion
(Tab
le 1
2)
Tabl
e 1
2 E
stim
ated
mag
nitu
de o
f MTC
T in
Ken
ya 2
007
Popu
latio
n (E
stim
ates
200
7)
372
mill
ion
Birt
hs p
er a
nnum
1
73 m
illio
n
HIV
pre
vale
nce
in m
othe
rs
67
Tota
l num
ber o
f birt
hs to
HIV
-infe
cted
mot
hers
exp
osed
14
110
1 to
MTC
T as
sum
ing
no m
ultip
le p
regn
ancy
Num
ber o
f HIV
pos
itive
infa
nts
per a
nnum
in K
enya
45
640
as
sum
ing
40
tran
smis
sion
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
22
13
RIS
KS
OF
T RA
NSM
ISSI
ON
OF
MTC
T A
T D
IFFE
REN
T
T
IME
P ER
IOD
S
In K
enya
an
estim
ated
40
000
to 5
000
0 in
fant
s ar
e in
fect
ed w
ith H
IV a
nnua
lly d
ue to
m
othe
r-to
-chi
ld t
rans
mis
sion
Th
is c
an o
ccur
in u
tero
dur
ing
labo
ur a
nd d
eliv
ery
and
thro
ugh
brea
stfe
edin
g D
urin
g pr
egna
ncy
abo
ut 5
to
8 pe
rcen
t of
HIV
-exp
osed
bab
ies
beco
me
infe
cted
thr
ough
tra
nsm
issi
on a
cros
s th
e pl
acen
ta L
abou
r an
d de
liver
y po
ses
the
grea
test
ris
k fo
r tr
ansm
issi
on w
ith 1
0 to
20
perc
ent
of e
xpos
ed i
nfan
ts b
ecom
ing
infe
cted
at t
his
time
Bre
astf
eedi
ng a
lso
expo
ses
infa
nts
to H
IV
Whe
n m
othe
rs b
reas
tfee
d fo
r 18
to
24m
onth
s an
othe
r 10
to 1
5 pe
rcen
t of i
nfan
ts b
ecom
e in
fect
ed T
hus
in n
on-b
reas
tfee
ding
po
pula
tions
with
out
antir
etro
vira
l tre
atm
ent
appr
oxim
atel
y 15
to
30 p
erce
nt in
fant
s w
ill b
ecom
e in
fect
ed
with
pro
long
ed b
reas
tfee
ding
25
to
45 p
erce
nt i
nfan
ts w
ill
beco
me
infe
cted
Tabl
e 1
3 T
rans
mis
sion
pat
tern
s in
bre
astfe
edin
g an
d no
n br
east
feed
ing
popu
latio
ns
Tran
smis
sion
rate
in
Tim
ing
No
Bre
astfe
edin
g B
reas
tfeed
ing
Bre
astfe
edin
g th
roug
h
thro
ugh
6
mon
ths
18 to
24
mon
ths
Dur
ing
preg
nanc
y 05
to 1
0 05
to 1
0 05
to 1
0
Dur
ing
labo
ur
10 to
20
10 to
20
10 to
20
Thro
ugh
brea
stfe
edin
g 10
to 2
0 05
to 1
0 05
to 1
0
Ear
ly (f
irst 2
mon
ths)
10
to 2
0 05
to 1
0 05
to 1
0
Late
(afte
r 2 m
onth
s)
10 to
20
01 to
05
05 to
10
Ove
rall
15 to
30
25 to
35
30 to
45
Sou
rce
De
Coc
k K
M (2
002)
Form
MoH
711
has
bee
n re
com
men
ded
to r
epla
ce F
orm
MoH
726
HIV
Mamp
E d
ata
flow
pip
elin
e fr
om t
he i
ndiv
idua
l he
alth
fac
ilitie
s t
o th
e di
stri
ct a
ndpr
ovin
cial
leve
ls u
p to
the
cent
ral o
r na
tiona
l lev
els
at N
ASC
OP
and
NA
CC
is s
umm
ashyri
sed
in F
igur
e 1
01
Figu
re 1
01
HIV
Mon
itorin
g an
d Ev
alua
tion
data
flow
pip
elin
e in
Ken
ya
HM
IS
NA
SC
OP
N
ACC
H
ead
Nat
iona
l Dat
a B
ank
amp
Res
ourc
e C
entre
M
E M
anag
er
The
Dire
ctor
P
rogr
amm
e M
anag
er
ME
Man
ager
Ref
erra
l Hos
pita
ls
CE
Os
Spe
cial
ists
The
Prov
ince
P
MO
P
AS
CO
P
AR
TO
PH
RIO
P
CO
The
Dis
trict
D
MO
D
AS
CO
Dat
a en
try
cler
k D
AR
TO
DH
RIO
Hea
lth F
acilit
y P
ublic
Sec
tor
FBO
etc
23
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
84
Cha
pter
10
Mon
itorin
g an
d Ev
alua
tion
of P
MTC
T Se
rvic
es
101
IN
TRO
DU
CTI
ON
PMTC
T pr
ogra
m m
onito
ring
and
eva
luat
ion
activ
ities
pro
vide
the
oppo
rtun
ity to
mea
sshyur
e an
d ap
prai
se p
erfo
rman
ce w
ithin
def
ined
par
amet
ers
that
ens
ure
acco
mpl
ishm
ent
of g
oals
and
obj
ectiv
es
Ken
ya is
com
mitt
ed to
the
ldquoThr
ee-o
nesrdquo
pri
ncip
les
whi
ch a
re
bull O
ne a
gree
d A
IDS
Act
ion
Fra
mew
ork
that
pro
vide
s th
e ba
sis
for
coor
dina
ting
the
wor
k pl
an o
f al
l par
tner
s
bull O
ne N
atio
nal A
IDS
Coo
rdin
atin
g A
utho
rity
with
a b
road
-bas
ed
mul
tisec
tora
l man
date
bull O
ne a
gree
d co
untr
y-le
vel M
onito
ring
and
Eva
luat
ion
(M
ampE
) sy
stem
In l
ine
with
thi
s t
he c
ount
ry h
as d
evel
oped
the
Nat
iona
l H
IVA
IDS
Mon
itori
ng a
ndE
valu
atio
n Fr
amew
ork
that
pro
vide
s st
akeh
olde
rs w
ith a
too
l fo
r w
ell
coor
dina
ted
in
terl
inke
d an
d fu
nctio
nal H
IVA
IDS
Mamp
E s
yste
m t
hat
allo
ws
for
effic
ient
mon
itori
ngof
int
erve
ntio
ns i
n ac
hiev
ing
the
natio
nal
prog
ram
mat
ic g
oals
usi
ng d
efin
ed t
arge
ts
This
pro
vide
s th
e fr
amew
ork
for M
ampE
act
iviti
es w
ithin
PM
TCT
prog
ram
s
Nat
iona
l PM
TCT
data
is
repo
rted
usi
ng M
oH I
nteg
rate
d M
onito
ring
and
Eva
luat
ion
Rep
ortin
g Fo
rms
For
m M
oH 7
11 o
r Fo
rm M
oH 7
27
Indi
vidu
al P
MTC
T da
ta is
col
shyle
cted
at
the
heal
th f
acili
ties
offe
ring
PM
TCT
serv
ices
usi
ng s
tand
ard
MoH
reg
iste
rs(A
NC
Mat
erni
ty a
nd P
ostn
atal
Reg
iste
rs)
On
mon
thly
bas
is t
he h
ealth
faci
litie
s w
ill a
ggre
gate
the
dat
a fr
om t
he r
egis
ters
on
to
Form
MoH
711
or
MO
H 7
26 w
hich
is th
en fo
rwar
ded
upw
ards
to th
e D
ASC
Orsquos
offic
e A
copy
is
left
at
the
heal
th f
acili
ty f
or t
heir
ow
n da
ta u
se
At
the
dist
rict
lev
el
the
DA
SCO
rsquos of
fice
aggr
egat
es d
ata
from
sev
eral
hea
lth f
acili
ty s
peci
fic F
orm
726
ont
o Fo
rm M
oH 7
27 (o
r Fo
rm 7
11) t
hat
is u
sed
to s
umm
aris
e an
d re
port
dis
tric
t le
vel d
ata
B
oth
Form
726
and
For
m M
oH 7
27 a
re th
en s
ent t
o N
ASC
OP
A c
opy
of th
e Fo
rm 7
27
or F
orm
711
is s
ent t
o th
e PA
SCO
and
ano
ther
to th
e he
alth
faci
litie
s in
the
dist
rict
for
thei
r ow
n da
ta u
se
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
14
RIS
K F
AC
TOR
SFO
R M
TCT
OF
HIV
M
any
fact
ors
are
know
n or
sus
pect
ed t
o in
crea
se t
he r
isk
of a
n H
IV in
fect
ed m
othe
r tr
ansm
ittin
g th
e vi
rus
to h
er i
nfan
t Th
ese
fact
ors
incl
ude
the
HIV
vir
al l
oad
in t
he
mot
her
as
wel
l as
othe
r m
ater
nal
obst
etri
cal
vira
l and
infa
nt fa
ctor
s (T
able
14
)
The
mos
t sig
nific
ant r
isk
fact
or a
ppea
rs to
be
the
HIV
vir
al lo
ad in
the
mot
her
thou
gh
the
othe
r fa
ctor
s m
ay a
lso
cont
ribu
te t
o in
crea
sing
an
infa
ntrsquos
expo
sure
or
susc
eptib
ilshyity
to
acqu
irin
g H
IV S
ome
fact
ors
may
cau
se a
bre
akdo
wn
in t
he p
rote
ctio
n of
fere
d to
the
foet
us b
y th
e pl
acen
ta w
hich
in n
orm
al c
ircu
mst
ance
s w
ould
not
allo
w H
IV to
cro
ssth
e pl
acen
ta fr
om m
othe
r to
foet
us
Tran
smis
sion
dur
ing
labo
ur a
nd d
eliv
ery
occu
rs w
hen
the
infa
nt s
ucks
im
bibe
s or
asshy
pira
tes
mat
erna
l bl
ood
or c
ervi
cal
secr
etio
ns t
hat
cont
ain
HIV
or
whe
n it
has
othe
r m
ucou
s m
embr
ane
expo
sure
Tab
le 1
4
Ris
k fa
ctor
s fo
r M
TCT
of H
IV
Stro
ng e
vide
nce
Lim
ited
evid
ence
VIR
AL
MA
TER
NA
L
OB
STE
TRIC
AL
FETA
LIN
FAN
T
BR
EA
ST-
FEE
DIN
G
Hig
h vi
ral l
oad
Imm
une
defic
ienc
y (lo
w
CD
4 co
unt)
HIV
infe
ctio
n ac
quire
d du
ring
preg
nanc
y o
r br
east
feed
ing
perio
d
Vagi
nal d
eliv
ery
(com
pare
d to
ele
ctiv
e ca
esar
ean
sect
ion)
ru
ptur
e of
the
mem
bran
es
for m
ore
than
4 h
ours
Prem
atur
ity
Dur
atio
n of
bre
astfe
edin
g
mix
ed fe
edin
g b
reas
t di
seas
e (m
astit
isc
rack
ed
nipp
les)
Vira
l res
ista
nce
(theo
retic
al p
ossi
bilit
y)
Vira
l gen
otyp
e an
d ph
enot
ype
Vita
min
A d
efic
ienc
y a
naem
ia s
exua
lly
trans
mitt
ed d
isea
ses
ch
orio
amni
oniti
s fr
eque
nt u
npro
tect
ed
sexu
al in
terc
ours
e m
ultip
le s
exua
l pa
rtner
s s
mok
ing
inje
ctin
g dr
ug a
buse
Inva
sive
or t
raum
atic
pro
cedu
res
in
stru
men
tal d
eliv
erie
s a
mni
ocen
tesi
s
epis
ioto
my
ext
erna
l cep
halic
ver
sion
(E
CV
) et
c i
ntra
partu
m h
aem
orrh
age
Lesi
ons
of s
kin
and
or m
ucou
s m
embr
anes
Ora
l thr
ush
(bab
y)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
3
24
15
BEN
EFIT
SO
F P R
EVEN
TIN
G M
OTH
ER-T
O-C
HIL
D
T
RA
NSM
ISSI
ON
OF
HIV
A
IDS
rela
ted
deat
hs a
re r
ever
sing
gai
ns m
ade
in c
hild
hea
lth a
nd s
urvi
val i
n K
enya
C
arin
g fo
r H
IV-in
fect
ed c
hild
ren
has
maj
or e
cono
mic
and
soc
ial
impa
cts
on f
amili
es
and
heal
th s
yste
ms
Thu
s at
the
nat
iona
l lev
el p
reve
ntin
g M
TCT
has
the
pote
ntia
l to
incr
ease
the
unde
rsta
ndin
g an
d ac
cept
ance
of t
he H
IVA
IDS
epid
emic
and
thos
e liv
ing
with
HIV
AID
S C
ouns
ellin
g t
estin
g an
d co
mm
unity
sen
sitis
atio
n ca
n co
ntri
bute
to
redu
cing
stig
ma
Red
uctio
n of
MTC
T of
HIV
bull
Dec
reas
es n
umbe
rs o
f H
IV in
fect
ed c
hild
ren
bull
Incr
ease
s ch
ild h
ealth
and
sur
viva
l
bull
Dec
reas
es t
he lo
ad o
n th
e he
alth
sys
tem
bull
Giv
es a
n op
port
unity
to im
prov
e an
d ex
pand
hea
lth s
ervi
ces
as w
ell a
s to
str
engt
hen
the
exis
ting
heal
th in
fras
truc
ture
16
BEN
EFIT
SO
F H
IV C
OU
NSE
LLIN
GA
ND T
ESTI
NG
(CT)
(a) I
t pro
mot
es b
ehav
iour
cha
nge
by
bull R
educ
ing
high
ris
k be
havi
our
for
HIV
bull Id
entif
ying
HIV
dis
cord
ant
coup
les
bull In
crea
sing
the
use
of
dual
met
hods
of f
amily
pla
nnin
g an
d S
TI
prev
entio
n
bull Im
prov
ing
ante
nata
l car
e
bull G
uidi
ng in
fant
fee
ding
(b) I
t ena
bles
pre
vent
ive
ther
apy
for
bull
Mal
aria
bull O
ppor
tuni
stic
infe
ctio
ns (
eg
Pne
umoc
ystis
jiro
veci
i pn
eum
onia
)
bull T
B
25
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
82
Foo
tnot
es
9
Use
oth
er o
ptions
for
child
ren o
ver
9 k
ilogra
ms
10
Use
reg
ula
r or
double
-str
ength
tab
lets
for
child
ren o
ver
16 k
ilogra
ms
NO
T A
PP
LIC
AB
LE
bullPsp
sm
ear
The
fram
ewor
k be
low
illu
stra
tes
poin
ts o
f int
egra
tion
of c
ompr
ehen
sive
HIV
ca
re p
acka
ge in
to e
xist
ing
child
hea
lth s
ervi
ces
Fram
ewor
k for
integ
ratio
n F
rom
Ped
iatr
ic H
IV P
reve
nti
on
to C
are
A
Co
nce
ptu
al F
ram
ewo
rk N
ewb
orn
In
fan
t W
om
an
H
IV e
duca
tion
Pre
gn
an
cy
prev
entio
n C
T
bull F
ocus
ed A
NC
incl
udin
g
AR
V p
roph
ylax
is s
tagi
ng
STI
syph
ilis
CT
Z p
roph
ylax
isA
RT
M
alar
ia tr
eatm
ent amp
pre
vent
ion
CD
4 w
here
ava
ilabl
e in
clud
ing
IPT
amp I
TNs
Infa
nt f
eedi
ng c
ouns
elin
g (I
FC)
Lab
ou
r an
d D
eliv
ery
U
nive
rsal
pre
caut
ions
CT
for
unt
este
d m
othe
rs in
clud
ing
bull D
eliv
ery
care
bull E
OC
-Em
erge
ncy
obst
etri
c ca
re
part
ner
bull R
efer
ral s
yste
m
AR
V p
roph
ylax
is
(mot
her
and
infa
nt)
AR
T C
TZ
pro
phyl
axis
Exc
lusi
ve b
reas
t fe
edin
g or
rep
lace
men
t fe
edin
g
Post
Na
tal
Ca
re
Infa
nt fe
edin
g co
unse
ling
bull B
reas
t hea
lth
Dia
gnos
is (
antib
ody)
if
bull Se
xual
hea
lth
expo
sure
unk
now
n bull
Fam
ily
plan
ning
D
NA
PC
R if
exp
osed
CT
Z p
roph
ylax
is I
FC-
infa
nt f
eedi
ng c
ouns
elin
g
CT
for
unt
este
d m
othe
rs
CT
for
par
tner
D
BS
resu
lt I
FC
IFC
Wea
ning
Bf
eedi
ng
cess
atio
n s
uppo
rt
bullBre
ast e
xam
D
iagn
osis
(an
tibod
y
bullPap
sm
ear
test
) C
T f
or n
egat
ive
wom
en a
nd p
artn
ers
Dia
gnos
is (
antib
ody
test
)
New
born
Ca
re
bull B
CG
bull P
olio
0
bull Is
sue
child
hea
th c
ard
bullEnt
er b
irth
wei
ght
HIV
an
d A
RV
Exp
osur
e st
atus
on
chi
ld h
ealth
car
d Tw
o w
eeks
Infa
nt fe
edin
g co
unse
ling
Six
wee
ks
Imm
uniz
atio
ngr
owth
mon
itori
ng
Ten
wee
ks
im
mun
izat
ion
GM
Fou
rtee
n w
eeks
Im
mun
izat
ion
grow
th m
onito
ring
Si
x m
onth
s
Com
plem
enta
ry fe
eds
Vita
min
A S
uppl
emen
tatio
n
9 m
onth
s
imm
uniz
atio
nG
M
12 amp
18
mon
ths
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
17
(c) I
t pro
mot
es a
cces
s to
ear
ly m
edic
al c
are
bull
Obs
tetr
ical
car
e
bull T
B th
erap
y
bull M
alar
ia t
reat
men
t
bull S
TI t
reat
men
t
bull A
RV
the
rapy
for
mot
her
and
fam
ily
(d) I
t hel
ps to
pla
n fo
r the
futu
re
bull In
fant
fee
ding
sup
port
sys
tem
s
bull F
amily
pla
nnin
g
bull P
erso
nal a
nd f
inan
cial
dec
isio
ns
(e) I
t ena
bles
pre
vent
ive
ther
apy
of m
alar
ia a
nd
othe
r opp
ortu
nist
ic in
fect
ions
suc
h a
PCP
(f) It
giv
es ti
me
to p
lan
for t
he fu
ture
eg
inf
ant
feed
ing
supp
ort s
yste
ms
TH
E F O
UR-P
RO
NG
ED A
PPR
OA
CH
TO P
MTC
T Th
e In
ter
Age
ncy
Task
Tea
m o
n Pr
even
tion
of H
IV T
rans
mis
sion
in p
regn
ant
wom
en
mot
hers
and
the
ir c
hild
ren
(IA
TT)
has
prop
osed
a f
our-
pron
ged
appr
oach
for
the
pre
shyve
ntio
n of
HIV
tra
nsm
issi
on t
hat
targ
ets
non-
preg
nant
and
pre
gnan
t w
omen
mot
hers
and
thei
r ch
ildre
n
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
8
1
26
The
four
pro
ngs
are
1 P
rimar
y pr
even
tion
of H
IV in
fect
ion
in w
omen
2 P
reve
ntio
n of
uni
nten
ded
preg
nanc
y am
ong
HIV
-inf
ecte
d w
omen
3 I
nter
vent
ions
to
redu
ce t
rans
mis
sion
fro
m H
IV-i
nfec
ted
preg
nant
and
la
ctat
ing
wom
en t
o th
eir
child
ren
4 C
are
and
supp
ort
of w
omen
ch
ildre
n an
d fa
mili
es in
fect
ed a
nd
affe
cted
by
HIV
and
AID
S (
The
PM
TC
T-p
lus)
Ove
rall
the
cov
erag
e of
PM
TCT
prog
ram
mes
and
the
upt
ake
of s
ervi
ces
prov
ided
thro
ugh
thes
e pr
ogra
mm
es
incl
udin
g H
IV
test
ing
and
coun
selli
ng
and
AR
V
prop
hyla
xis
are
still
ver
y lo
w I
n 20
06 w
orld
wid
e le
ss t
han
10
of
preg
nant
wom
ente
stin
g H
IV-p
ositi
ve r
ecei
ved
AR
V d
rugs
for
PMTC
T11
In K
enya
acc
ordi
ng to
the
2007
Ken
ya A
IDS
Indi
cato
r Su
rvey
(KA
IS) 7
the
re h
as b
een
a sm
all i
ncre
ase
in H
IV te
stin
g am
ong
wom
en a
nd m
en c
ompa
red
to th
e 20
03 K
DH
S
KA
IS s
how
s th
at t
houg
h a
vast
maj
ority
(83
)
of H
IV-in
fect
ed w
omen
and
men
in
Ken
ya d
o no
t kn
ow t
heir
HIV
sta
tus
the
re h
as b
een
a cl
ear
and
dram
atic
incr
ease
inco
vera
ge o
f HIV
-tes
ting
amon
g A
NC
clin
ic a
tten
dees
PMTC
T se
rvic
es a
re t
here
fore
im
port
ant
entr
y po
ints
for
HIV
pre
vent
ion
and
trea
tshym
ent
Ove
rall
AR
V c
over
age
for
HIV
infe
cted
peo
ple
who
nee
d tr
eatm
ent
in K
enya
ison
ly 3
5
bull 9
0
of K
enya
n w
omen
who
del
iver
ed in
the
last
4 y
ears
att
end
AN
C
bull 5
7 o
f th
ose
atte
ndin
g A
NC
tes
ted
for
HIV
bull A
mon
g H
IV in
fect
ed w
omen
with
rec
ent
birt
hs
47
wer
e te
sted
in
AN
C
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
(8)
HIV
dis
ease
sta
ging
in H
IV-in
fect
ed c
hild
ren
Dis
ease
sta
ging
with
or
with
out
labo
rato
ry s
uppo
rt f
ollo
ws
HIV
dia
gshyno
sis
Sta
ging
HIV
dis
ease
pro
vide
s a
guid
e to
the
prog
nosi
s an
d in
tershy
vent
ions
nee
ded
at th
e di
ffere
nt s
tage
s (R
efer
to C
hapt
er 5
and
8)
(9)
AR
V th
erap
y
Chi
ldre
n w
ho a
re e
ligib
le fo
r A
RT
shou
ld b
e lin
ked
with
the
AR
T pr
oshygr
am a
nd p
rovi
ded
with
trea
tmen
t acc
ordi
ng to
Nat
iona
l Gui
delin
es a
sso
on a
s an
HIV
dia
gnos
is i
s m
ade
Ear
ly t
reat
men
t si
gnifi
cant
ly r
eshydu
ces
mor
talit
y in
HIV
infe
cted
chi
ldre
n
(10)
C
omm
unic
atio
n
Com
mun
icat
ing
with
car
e-pr
ovid
ers
and
prov
idin
g ps
ycho
soci
al s
upshy
port
for
the
child
mot
her
care
give
r an
d fa
mily
are
a c
ruci
al c
ompo
nent
of
car
e
Pare
nts
care
give
rs a
ndo
r th
e ch
ild n
eed
to p
artic
ipat
e in
mak
ing
deci
shysi
ons
and
plan
ning
app
ropr
iate
car
e fo
r th
e ch
ild i
nclu
ding
dec
isio
nsab
out t
hera
py a
nd w
here
the
child
sho
uld
rece
ive
care
In
this
res
pect
he
alth
wor
kers
mus
t en
sure
tha
t th
e fa
mily
con
side
rs t
he s
ocia
l nee
ds
of H
IV in
fect
ed a
nd a
ffect
ed c
hild
ren
Hea
lth c
are
wor
kers
sho
uld
ensu
re th
at th
ey p
rovi
de a
dequ
ate
time
for
care
give
rs to
ask
que
stio
ns s
o th
at th
ey c
an fu
lly u
nder
stan
d th
e im
plishy
catio
ns o
f HIV
and
HIV
tes
ting
for
them
selv
es a
nd fo
r th
eir
child
ren
H
ealth
car
e w
orke
rs s
houl
d co
unse
l car
egiv
ers
on d
iscl
osur
e in
clud
ing
disc
losu
re to
the
child
(11)
R
efer
rals
Ref
erra
ls a
re a
n im
port
ant p
art o
f man
agin
g an
HIV
exp
osed
or
infe
cted
chi
ld
Thes
e in
clud
e re
ferr
als
to
bull H
ighe
r le
vels
of s
peci
alis
ed c
are
for
furt
her
inve
stig
atio
ns a
nd
trea
tmen
t
bull S
ocia
l sup
port
pro
gram
mes
bull C
omm
unity
-bas
ed c
are
prog
ram
mes
bull P
ITC
site
s fo
r pa
rent
s an
d si
blin
gs
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
7
80
Tabl
e 9
2 W
HO
Rec
omm
enda
tions
for
Follo
w-u
p of
an
HIV
-Exp
osed
Chi
ld
bull A
t birt
h (f
or in
fant
s de
liver
ed a
t ho
me)
bull A
t age
1 t
o 2
wee
ks (
mai
nly
for
infa
nt f
eedi
ng c
ouns
elin
g)
bull A
t ag
e 6
10
and
14
wee
ks (
for
imm
uniz
atio
n an
d in
fant
fee
ding
co
unse
ling)
bull A
fter
age
14
wee
ks
mon
thly
thr
ough
age
12
mon
ths
bull A
fter
age
12 m
onth
s e
very
3 m
onth
s th
roug
h 24
mon
ths
bull A
t 18
mon
ths
do
conf
irm
ator
y H
IV la
bora
tory
test
(if
ther
e ar
e no
re
sour
ces
for
an e
arlie
r an
tigen
-bas
ed t
est)
bull A
fter
2 ye
ars
a m
inim
um o
f ye
arly
vis
its
For t
he H
IV-in
fect
ed f
ollo
w th
ese
guid
elin
es
From
M
onito
r
6 w
eeks
ndash12
mon
ths
Mon
thly
12 ndash
24 m
onth
s Ev
ery
3 m
onth
s
24 m
onth
s an
d on
war
ds
Yea
rly i
f not
sym
ptom
atic
If sy
mpt
omat
ic f
ollo
w u
p as
nee
ded
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
18
OV
ERV
IEW
OF
THE
NEW
PM
TCT
GU
IDEL
INES
Ken
yarsquos
Min
istr
y of
Hea
lth (
MO
H)
thro
ugh
NA
SCO
P h
as t
aken
sev
eral
act
ions
to
expa
nd a
nd s
tren
gthe
n PM
TCT
inte
rven
tions
in
the
coun
try
In
2000
a
Nat
iona
lTe
chni
cal
Wor
king
Gro
up (
TWG
) on
PM
TCT
was
for
med
Th
e TW
G
co-c
hair
ed b
yN
ASC
OP
and
the
Div
isio
n of
Rep
rodu
ctiv
e H
ealth
co
ordi
nate
s im
plem
enta
tion
and
prov
ides
tec
hnic
al s
uppo
rt t
o th
e N
atio
nal
PMTC
T Pr
ogra
m
The
TWG
ser
ves
as a
foru
m t
o up
date
sta
keho
lder
s an
d di
scus
s ch
alle
nges
and
upc
omin
g ac
tiviti
es
The
TWG
is
also
res
pons
ible
for
upd
atin
g na
tiona
l gu
idel
ines
for
PM
TCT
The
nat
iona
l PM
TCT
prog
ram
was
offi
cial
ly l
aunc
hed
in 2
002
NA
SCO
P al
so e
stab
lishe
d se
vera
lpi
lot P
MTC
T si
tes
thro
ugho
ut th
e co
untr
y an
d pr
epar
ed n
atio
nal P
MTC
T gu
idel
ines
The
goal
of t
he n
atio
nal P
MTC
T pr
ogra
m is
in li
ne w
ith th
e go
al s
et o
ut a
t the
Uni
ted
Nat
ions
Gen
eral
Ass
embl
y Sp
ecia
l Ses
sion
on
HIV
AID
S (U
NG
ASS
) in
2001
to
redu
ceth
e pr
opor
tion
of in
fant
s in
fect
ed w
ith H
IV b
y 20
b
y th
e ye
ar 2
005
and
50
by
2010
In
Ken
ya t
he n
atio
nal P
MTC
T pr
ogra
m p
lann
ed t
o ex
tend
its
serv
ices
to
at le
ast
80
of
all
heal
th f
acili
ties
by 2
0071
2 A
ccor
ding
to
the
2003
PM
TCT
serv
ice
stat
istic
sap
prox
imat
ely
9 o
f al
l pr
egna
nt w
omen
rec
eive
d PM
TCT
serv
ices
in
that
yea
rC
urre
ntly
mor
e th
an 5
0 o
f al
l pr
egna
nt w
omen
in
Ken
ya r
ecei
ve P
MTC
T se
rvic
es
Thes
e gu
idel
ines
are
bas
ed o
n a
publ
ic h
ealth
app
roac
h to
car
e t
akin
g in
to c
onsi
dera
shytio
n is
sues
of
feas
ibili
ty a
nd a
ccep
tabi
lity
in
addi
tion
to e
ffica
cy a
nd c
ost-
bene
fit i
ndi
ffere
nt s
ettin
gs
The
guid
elin
es a
re e
xpec
ted
to i
mpr
ove
the
upta
ke
qual
ity a
nd
effe
ctiv
enes
s of
PM
TCT
serv
ices
in th
e co
untr
y
19
OB
JEC
TIV
ESA
ND O
RG
AN
ISA
TIO
NO
FTH
E G
UID
ELIN
ES
The
PMTC
T gu
idel
ines
are
par
t of
the
impl
emen
tatio
n in
stru
men
ts t
owar
ds u
nive
rsal
ac
cess
to
PMTC
T se
rvic
es a
nd a
res
pons
e to
the
cal
l to
actio
n to
war
ds H
IV-fr
ee a
ndA
IDS-
free
gen
erat
ion
Tog
ethe
r w
ith tw
o ot
her
guid
elin
es (A
RV
Ther
apy
in A
dults
and
Ad
oles
cent
s an
d AR
V Th
erap
y in
Inf
ants
and
You
ng C
hild
ren)
th
ey f
orm
a t
rilo
gy
aim
ed a
t co
ntex
tual
isin
g an
d m
ains
trea
min
g th
e W
HO
tri
logy
of
guid
elin
es o
n H
IVA
IDS
prev
entio
n an
d tr
eatm
ent
The
cont
ext
reso
urce
s an
d de
man
ds o
f PM
TCT
prog
ram
mes
diff
er g
reat
ly a
cros
s co
unshy
trie
s an
d ev
en a
cros
s pr
ogra
mm
es w
ithin
the
sam
e co
untr
y C
onsi
deri
ng t
his
vari
abilshy
ity t
hese
gui
delin
es in
clud
e th
e cu
rren
t con
sens
us o
n be
st p
ract
ices
as
wel
l as
alte
rnashy
tives
whi
ch m
ight
be
mor
e ap
prop
riat
e in
par
ticul
ar s
ettin
gs E
xper
ts a
gree
tha
t th
e ldquos
tate
of
the
artrdquo
in
PMTC
T is
cha
ngin
g ra
pidl
y an
d th
at r
ecom
men
datio
ns w
ill c
ershy
tain
ly a
lter
with
adv
ance
s in
med
ical
sci
ence
and
as
mor
e pr
ogra
mm
e ex
peri
ence
is
docu
men
ted
and
diss
emin
ated
The
are
as o
f A
RV
pro
phyl
axis
and
inf
ant
feed
ing
are
part
icul
arly
sub
ject
to r
apid
cha
nge
In 2
005
the
WH
O is
sued
pro
pose
d re
visi
ons
to it
s re
com
men
datio
ns o
n th
e us
e of
ant
ishyre
trov
iral
dru
gs f
or P
MTC
T T
he r
ecom
men
datio
ns w
ere
the
prod
uct
of e
xper
ts w
ho
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
9
28
conv
ened
to
disc
uss
impo
rtan
t ne
w i
nfor
mat
ion
conc
erni
ng t
he d
evel
opm
ent
of r
esis
shyta
nce
in w
omen
and
chi
ldre
n us
ing
sing
le d
ose
nevi
rapi
ne (S
dNV
P) fo
r PM
TCT
as w
ell
as n
ew c
linic
al fi
ndin
gs o
n st
rate
gies
that
mig
ht r
educ
e th
e de
velo
pmen
t of r
esis
tanc
e
Bas
ed o
n th
e ne
w W
HO
gui
delin
es K
enya
rsquos TW
G h
as d
evel
oped
sim
ple
pra
ctic
al a
nd
evid
ence
-bas
ed r
ecom
men
datio
ns o
n PM
TCT
that
wou
ld w
ork
in a
var
iety
of r
esou
rce-
limite
d en
viro
nmen
ts a
nd c
linic
al s
ituat
ions
that
con
fron
t hea
lthca
re w
orke
rs n
ot o
nly
in K
enya
but
als
o in
oth
er d
evel
opin
g co
untr
ies
110
U
SIN
GTH
E G
UID
ELIN
ES
Thes
e gu
idel
ines
are
inte
nded
prim
arily
for u
se b
y PM
TCT
prov
ider
s Th
ese
inclu
de n
urse
sm
idw
ives
clin
ical o
ffice
rs d
octo
rs c
ouns
ello
rs n
utrit
ioni
sts
and
othe
r he
alth
care
pro
fesshy
sion
als
They
will
als
o be
use
ful a
s a re
fere
nce
for p
rogr
amm
e m
anag
ers a
t fac
ility
dis
trict
pr
ovin
cial
and
nat
iona
l lev
els
thro
ugho
ut th
e he
alth
sec
tor
The
guid
elin
es a
re d
ivid
ed in
tote
n ch
apte
rs a
s out
lined
in T
able
15
The
spec
ific
obje
ctiv
es o
f the
new
PM
TCT
guid
elin
es a
re to
bull O
utlin
e th
e po
licy
issu
es in
pro
vidi
ng P
MT
CT
serv
ices
bull R
ecom
men
d op
erat
iona
l gui
delin
es to
be
follo
wed
by
heal
th c
are
prov
ider
s of
PM
TC
T se
rvic
es
bull E
nabl
e pr
ovid
ers
of P
MT
CT
to s
elec
t an
d pr
escr
ibe
AR
Vs
for
prop
hyla
xis
agai
nst
MT
CT
and
for
trea
tmen
t of
pre
gnan
t w
omen
in
fant
s an
d yo
ung
child
ren
bull S
tand
ardi
se t
he c
are
and
coun
selli
ng g
iven
by
PM
TC
T s
ervi
ce
prov
ider
s re
gard
ing
risk
of
MT
CT
and
on
PM
TC
T
bull I
mpr
ove
PM
TC
T se
rvic
es u
sing
eas
y-to
-use
job
aids
and
a
stan
dard
ised
Mamp
E s
yste
m
Prev
entin
g TB
Fo
r chi
ldre
n ex
pose
d to
sm
ear p
ositi
ve tu
berc
ulos
is
bull E
xclu
de a
ctiv
e T
B th
roug
h ca
refu
l his
tory
ph
ysic
al e
xam
and
in
vest
igat
ions
bull
If
ther
e is
no
evid
ence
of
activ
e T
B
star
t on
IN
H f
or p
roph
ylax
is f
or 6
m
onth
s (I
PT
) bull
If
TB
is p
rese
nt
star
t on
TB
tre
atm
ent
as p
er N
atio
nal T
B g
uide
lines
If
a ch
ild is
bor
n to
a m
othe
r with
act
ive
TB
bull S
tart
on
INH
pro
phyl
axis
(IP
T)
and
give
for
3 m
onth
s bull
Afte
r 3
mon
ths
do a
man
toux
bull
If
man
toux
is n
egat
ive
sto
p IN
H a
nd g
ive
BC
G
bull I
f man
toux
is p
ositi
ve a
t 3
mon
ths
con
tinue
for
a f
urth
er 3
mon
ths
bull A
t the
end
of
prop
hyla
xis
re-v
alua
te f
or a
ctiv
e T
B
|
If no
evi
denc
e of
act
ive
TB d
o no
t tre
at fo
r TB
|
If th
ere
is e
vide
nce
of a
ctiv
e TB
tre
at fo
r TB
as
per N
atio
nal
TB g
uide
lines
(6)
Trea
tmen
t of a
cute
infe
ctio
ns a
nd o
ther
HIV
-rel
ated
con
ditio
ns
HIV
-exp
osed
chi
ldre
n ar
e su
scep
tible
to c
omm
on in
fect
ions
as
wel
l as
OIs
for
the
HIV
infe
cted
and
HIV
may
alte
r th
e in
cide
nce
pre
senshy
tatio
n an
d re
spon
se t
o co
nven
tiona
l th
erap
y I
n so
me
case
s m
ore
aggr
essi
ve a
nd lo
nger
tre
atm
ent
cour
ses
may
be
nece
ssar
y a
s tr
eatshy
men
t fai
lure
s ar
e m
ore
freq
uent
(7)
Reg
ular
follo
w-u
p ca
re amp
refe
rral
s
Reg
ular
follo
w-u
p is
the
back
bone
to c
arin
g fo
r th
e H
IV e
xpos
ed c
hilshy
dren
and
ens
ures
opt
imal
hea
lthca
re a
nd p
sych
osoc
ial s
uppo
rt to
the
fam
ily W
HO
has
mad
e re
com
men
datio
ns o
n fr
eque
ncy
of fo
llow
-up
as s
how
n in
Tab
le 9
2 T
his
is t
he m
inim
um a
nd m
ore
freq
uent
con
shyta
ct w
ith t
he h
ealth
car
e sy
stem
may
be
indi
cate
d fo
r H
IV in
fect
ed
child
ren
and
espe
cial
ly if
they
are
on
anti-
retr
ovir
al tr
eatm
ent
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
2
9
78
Pro
phyl
axis
aga
inst
Pne
umoc
ysti
s ji
rove
cii
Pne
umon
ia (
PC
P)
in c
hild
ren
whe
re C
otri
mox
azol
e is
con
trai
ndic
ated
Ta
ble
15
The
Fou
r-Pr
onge
d A
ppro
ach
App
lied
to th
e PM
TCT
Gui
delin
e
Alte
rnat
ive
drug
s to
use
if C
TX is
con
train
dica
ted
are
give
n be
low
A s
econ
d ch
oice
wou
ld b
e ei
ther
dap
sone
or
atov
aqui
ne
Dap
sone
bull C
hild
ren
gt 1
mon
th
2 m
gkg
24
hour
s or
ally
onc
e da
ily
bull I
f bot
h C
TX
and
Dap
sone
are
con
trai
ndic
ated
(e
g
in c
hilshy
dren
with
G6P
D d
efic
ienc
y w
ho g
et h
aem
olys
is w
ith C
TX
and
D
apso
ne)
the
n us
e ei
ther
Ato
vaqu
one
bull
30m
gkg
day
for
age
1-3
mon
ths
bull H
ighe
r do
se 4
5mg
kgd
ay f
or a
ge 4
-24
mon
ths
OR
Aer
osol
ized
Pen
tam
idin
e
bull 3
00 m
g in
6 m
l wat
er v
ia in
hala
tion
nebu
lizer
onc
e m
onth
ly
bull c
hild
ren
gt 5
year
s
Cha
pter
CH
AP
TER
1
Bac
kgro
und
CH
AP
TER
2
Ant
enat
al C
are
and
Pre
vent
ion
of M
TCT
of H
IV
CH
AP
TER
3
Intra
partu
m C
are
Pron
g 1
Prim
ary
prev
entio
n of
HIV
in
fect
ion
in w
omen
Pron
g 2
Prev
entio
n of
un
inte
nded
pr
egna
ncy
amon
g H
IV in
fect
ed w
omen
Pron
g 3
Inte
rven
tions
to
redu
ce
tran
smis
sion
from
H
IV in
fect
ed
preg
nant
and
la
ctat
ing
wom
en to
th
eir c
hild
ren
Pron
g 4
Car
e an
d su
ppor
t of
wom
en c
hild
ren
and
fam
ilies
in
fect
ed a
nd
affe
cted
by
HIV
A
IDS
C
HA
PTE
R 4
U
se o
f Ant
iretro
vira
l D
rugs
in P
regn
ancy
fo
r Tre
atm
ent a
nd
Pre
vent
ion
of M
othe
r to
Chi
ld
Tran
smis
sion
of H
IV
Infe
ctio
n
CH
AP
TER
5
Imm
edia
te P
ostn
atal
an
d N
eona
tal C
are
CH
AP
TER
6
Late
Pos
tnat
al C
are
and
Fam
ily P
lann
ing
CH
AP
TER
7
HIV
Dia
gnos
is in
C
hild
ren
CH
AP
TER
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
born
to
HIV
infe
cted
m
othe
rs
CH
AP
TER
9
Car
e an
d Fo
llow
-up
of C
hild
ren
of H
IV
infe
cted
mot
hers
C
HA
PTE
R 1
0
Mon
itorin
g an
d E
valu
atio
n of
PM
TCT
se
rvic
es
77
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
30
For
each
of t
hese
cha
pter
s (e
xcep
t ch
apte
r on
e on
bac
kgro
und)
the
gui
delin
es g
ive
anin
trod
uctio
n fo
llow
ed b
y po
licy
stat
emen
ts t
hen
oper
atio
nal g
uide
lines
of w
hat p
rovi
dshyer
s sh
ould
do
to r
educ
e m
othe
r-to
-chi
ld t
rans
mis
sion
of
HIV
and
or
to i
mpr
ove
thei
r pe
rfor
man
ce a
nd th
e ef
fect
iven
ess
of th
eir s
ervi
ces
A li
st o
f job
aid
s fo
r us
e by
the
hea
lthca
re p
rovi
der
follo
ws
the
oper
atio
nal g
uide
lines
and
whe
re n
eces
sary
a li
st o
f ap
pend
ices
and
add
ition
al d
ocum
ents
tha
t m
ay b
e re
shyfe
rred
to
but
are
cons
ider
ed t
oo b
ig o
r de
taile
d to
be
incl
uded
with
in t
he m
ain
body
of
the
guid
elin
es
Foo
tnot
es
1
UN
AID
S (
2004)
Rep
ort
on t
he
Glo
bal AID
S E
pid
emic
Ava
ilable
at
ww
wu
nai
ds
org
2
Ibid
2004
3
It
is
import
ant
to r
ecognis
e th
at t
he
use
of
the
phra
se M
TC
T in n
o w
ay is
inte
nded
to
pla
ce b
lam
e on t
he
moth
er
who m
ay o
r m
ay n
ot
know
her
HIV
sta
tus
who t
ransm
its
the
viru
s to
her
child
Pa
thfinder
ack
now
ledges
that
man
y tim
es p
regnant
wom
en
may
hav
e bee
n infe
cted
by
thei
r m
ale
par
tner
and d
o n
ot
hav
e th
e ab
ility
to n
egoti-
ate
safe
r se
x o
r to
see
k M
TC
T s
ervi
ces
for
fear
of
viole
nce
st
igm
a o
r ab
andonm
ent
if t
hei
r st
atu
s is
rev
eale
d
Path
finder
uphold
s th
e re
pro
duct
ive
rights
of
all w
om
en t
o
choose
if
and w
hen
to h
ave
child
ren
regar
dle
ss o
f H
IV-s
tatu
s
4
W
HO
CD
C
Dep
artm
ent
of
Hea
lth a
nd H
um
an S
ervi
ces
(2004)
Pre
vention o
f M
oth
er-t
o-C
hild
Tra
nsm
issi
on o
f H
IV
Gen
eric
Tra
inin
g P
acka
ge
Gen
eva
Sw
itze
r-la
nd
WH
O
5
U
NAID
S (
2004)
Rep
ort
on t
he
Glo
bal AID
S E
pid
emic
Ava
ilable
at
ww
wu
nai
ds
org
6
Polic
y Pro
ject
(2004)
Cove
rage
of
sele
cted
ser
vice
s fo
r H
IVA
IDS p
reve
ntion a
nd
care
in low
and m
iddle
-inco
me
countr
ies
in 2
003
Ava
ilable
at
ww
wp
olia
pro
ject
com
7
Cen
tral Bure
au o
f Sta
tist
ics
(CBS)
[Ken
ya]
Min
istr
y of
Hea
lth (
MO
H)
[Ken
ya]
and
ORC M
acro
(2004)
Ken
ya D
emogra
phic
and H
ealth S
urv
ey 2
003
Cal
vert
on
Mar
y-la
nd
CBSM
OH
an
d O
RC M
acr
o
8
Nat
ional AID
S C
ontr
ol Counci
l 2
007
8a
Ken
ya A
IDS I
ndic
ato
r Surv
ey 2
007
9
Ibid
2004
10
NASCO
P (
2002)
Surv
eilla
nce
data
as
cite
d in N
ASCO
PM
OH
(2
003)
Nat
ional
PM
CT
Str
ate
gic
Managem
ent
Pla
n 2
003-2
007
111
2 A
IDS in K
enya
Tre
nds
Inte
rven
tions
and I
mpact
7th
editio
n
(2005)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Who
Nee
ds P
CP
Prop
hyla
xis
bull A
ll in
fant
s bo
rn t
o H
IV-i
nfec
ted
mot
hers
irr
espe
ctiv
e of
any
ant
iret
rovi
ral
ther
apy
duri
ng p
regn
ancy
and
labo
ur
Pro
phyl
axis
con
tinue
s un
til th
e in
fant
is 1
2 m
onth
s or
is P
CR
neg
ativ
e or
ant
ibod
y ne
gativ
e w
hich
ever
co
mes
ear
lier
bull A
ll in
fant
s id
entif
ied
as H
IV-i
nfec
ted
duri
ng th
e fir
st y
ear
of li
fe b
y a
PC
R
test
or
by a
clin
ical
dia
gnos
is o
f H
IV in
fect
ion
and
a po
sitiv
e an
tibod
y te
st
bull C
hild
ren
olde
r th
an 1
2 m
onth
s w
ith s
ympt
omat
ic H
IV d
isea
se o
r an
A
IDS
-def
inin
g ill
ness
(W
HO
sta
ge I
I an
d III
se
e ch
apte
r 5)
or
with
CD
4 lt
15
or
TLC
150
0m
m3
bull A
ny c
hild
with
a h
isto
ry o
f P
CP
sho
uld
cont
inue
with
sec
onda
ry
prop
hyla
xis
(dai
ly C
T)
for
life
Clin
icia
ns s
houl
d cl
earl
y in
form
HIV
inf
ecte
d m
othe
rs a
t de
liver
y th
at t
heir
chi
ldre
n ne
ed p
roph
ylax
is a
gain
st P
CP
star
ting
at 6
wee
ks o
f age
unt
il it
is e
stab
lishe
d th
at th
e ch
ild i
s no
t H
IV i
nfec
ted
A p
ract
ical
way
to
ensu
re t
hat
mot
hers
and
oth
er h
ealth
wor
kers
are
inf
orm
ed i
s to
mak
e a
note
on
the
child
rsquos im
mun
izat
ion
card
at
birt
h st
atin
g ldquoP
leas
e gi
ve c
o-tr
imox
azol
e (5
mg
kgd
ay o
rally
dai
ly) f
rom
6 w
eeks
of a
gerdquo
Tabl
e 9
1 D
ose
of C
otrim
oxaz
ole
for P
CP
Prop
hyla
xis
Wei
ght o
f C
hild
(kg)
1ndash4
5ndash8
9ndash16
17ndash5
0
gt 50
CT
tabl
ets
20 m
g TM
P1
00
mg
SM
X p
edia
tric
stre
ngth
(120
mg)
1 ta
b
2 ta
bs
Cot
rimox
azol
e su
spen
sion
40
mg
TMP
200
mg
SM
X
5ml (
240
mg)
25
ml
5 m
l
10 m
l
CT
tabl
ets
80 m
g TM
P4
00 m
g S
MX
re
gula
r stre
ngth
(4
80 m
g)
frac14 ta
b
frac12 ta
b
1 ta
b
2 ta
bs
2 ta
bs
CT
Tabl
ets
160
mg
TMP
800
mg
SM
X
Dou
ble
stre
ngth
(9
60 m
g) -
frac14 ta
b
frac12 ta
b
1 ta
b
1 ta
b
In r
are
case
s a
s in
chi
ldre
n w
ith G
6PD
def
icie
ncy
CTX
may
be
cont
rain
dica
ted
G
uid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
1
76
(3)
Mon
itor
the
child
rsquos g
row
th a
nd d
evel
opm
ent
as a
mea
ns o
f id
entif
ying
the
ch
ild w
ho is
faili
ng to
thriv
e an
d al
so a
s a
tool
for m
onito
ring
the
effe
ct o
f int
ershy
vent
ions
(4)
Ens
ure
that
im
mun
isat
ions
are
sta
rted
and
com
plet
ed
acco
rdin
g to
the
re
com
men
datio
ns o
f the
nat
iona
l im
mun
isat
ion
sche
dule
|
Add
ition
al c
onsi
dera
tions
are
as
follo
ws
bull
Whe
n co
nsid
erin
g BC
G v
acci
natio
n at
a la
ter a
ge
(re-
vacc
inat
ion
for n
o sc
ar o
r mis
sed
earli
er v
acci
natio
n)
excl
ude
sym
ptom
atic
HIV
infe
ctio
n
bull
Do
not g
ive
yello
w fe
ver v
acci
ne to
sym
ptom
atic
HIV
-infe
cted
chi
lshydr
en H
owev
er a
sym
ptom
atic
chi
ldre
n in
end
emic
are
as s
houl
d re
shyce
ive
the
yello
w fe
ver v
acci
ne a
t 9 m
onth
s of
age
bull
Mea
sles
vac
cine
sho
uld
be g
iven
to H
IV in
fect
ed c
hild
ren
at 6
and
9
mon
ths
sinc
e H
IV in
fect
ed c
hild
ren
expe
rienc
e m
uch
mor
e se
vere
di
seas
e w
ith w
ild m
easl
es v
irus
whi
ch o
utw
eigh
s th
e ris
k of
a m
ilder
illn
ess
from
the
vacc
ine
(5)
Pro
vide
pro
phyl
axis
for o
ppor
tuni
stic
infe
ctio
ns
|
Pro
phyl
axis
aga
inst
Pne
umoc
ystis
jiro
veci
i Pne
umon
ia
bull
Pne
umoc
ystis
jiro
veci
i (fo
rmer
ly P
neum
ocys
tis c
arin
ii) p
neum
onia
(PC
P)
is a
sig
nific
ant c
ause
of m
orbi
dity
and
mor
talit
y am
ong
youn
g in
fant
s in
A
frica
Co-
trim
oxaz
ole
(CTX
) pro
phyl
axis
sig
nific
antly
redu
ces
the
inci
shyde
nce
and
seve
rity
of P
CP
Add
ition
al b
enef
its o
f co-
trim
oxaz
ole
incl
ude
prot
ectio
n ag
ains
t com
mon
bac
teria
l inf
ectio
ns t
oxop
lasm
osis
and
mashy
laria
All
child
ren
born
to H
IV in
fect
ed m
othe
rs s
houl
d re
ceiv
e pr
ophy
shyla
xis
agai
nst P
CP
at l
east
dur
ing
the
first
yea
r of l
ife o
r unt
il th
ey a
re
prov
en to
be
unin
fect
ed (s
ee b
ox b
elow
)
bull
CTX
is c
lear
ly th
e dr
ug o
f cho
ice
for p
roph
ylax
is b
ecau
se o
f its
hig
h
effic
acy
rela
tive
safe
ty l
ow c
ost a
nd b
road
ant
imic
robi
al s
pect
rum
In
cas
e of
CTX
hyp
erse
nsiti
vity
des
ensi
tizat
ion
is re
com
men
ded
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
CH
AP
TE
R 2
Ant
enat
al C
are
and
Prev
entio
n of
MTC
T of
HIV
21
INTR
OD
UC
TIO
N
HIV
inf
ectio
n ha
s em
erge
d in
Ken
ya a
s th
e m
ost
impo
rtan
t he
alth
ris
k fa
ctor
for
m
othe
rs a
nd t
heir
chi
ldre
n an
d ha
s a
grea
t im
pact
on
the
long
ter
m o
utco
me
ofpr
egna
ncy
and
child
sur
viva
l A
ll pr
egna
nt w
omen
sho
uld
be e
ncou
rage
d to
lear
n th
eir
HIV
infe
ctio
n st
atus
as
wel
l as
that
of t
heir
sex
ual p
artn
ers
O
nly
by k
now
ing
onersquos
H
IV s
tatu
s ca
n th
e he
alth
wor
kers
mak
e ap
prop
riat
e he
alth
car
e m
anag
emen
t re
com
men
datio
ns a
nd t
he c
oupl
e m
ake
appr
opri
ate
deci
sion
s ab
out
mai
ntai
ning
the
ir
heal
th a
nd t
hat
of t
heir
unb
orn
baby
Pr
e-co
ncep
tion
care
is
enco
urag
ed w
here
an
oppo
rtun
ity a
rise
s an
d a
birt
h pl
an is
dis
cuss
ed w
ith th
e pr
egna
nt w
oman
In m
ost
case
s t
he p
regn
ant
wom
an w
ill n
ot h
ave
HIV
infe
ctio
n P
regn
ancy
offe
rs a
n op
port
une
time
to d
iscu
ss p
reve
ntio
n of
HIV
inf
ectio
n as
man
y w
omen
com
e in
toco
ntac
t w
ith h
ealth
ser
vice
s fo
r th
e fir
st (
and
in s
ome
case
s th
e on
ly)
time
duri
ng
preg
nanc
y
In K
enya
50
o
f m
arri
ed H
IV p
ositi
ve p
erso
ns h
ave
an H
IV n
egat
ive
spou
se1
Ther
efor
e k
now
ing
the
HIV
inf
ectio
n st
atus
of
onersquos
par
tner
is
criti
cal
Add
ition
ally
th
is f
orm
s an
im
port
ant
entr
y po
int
for
esta
blis
hing
pre
vent
ion
with
po
sitiv
e (P
WP)
pro
gram
s am
ong
coup
les
as w
ell a
s pr
ovid
ing
acce
ss to
HIV
pre
vent
ion
ca
re a
nd tr
eatm
ent s
ervi
ces
for
the
who
le fa
mily
PMTC
T pr
ovid
es a
n op
port
unity
for
prev
entin
g ne
w p
aedi
atri
c H
IV in
fect
ions
as
wel
l as
for
reac
hing
the
10 to
20
of H
IV p
ositi
ve p
regn
ant w
omen
who
mee
t WH
O e
ligib
ilshyity
cri
teri
a fo
r in
itiat
ing
AR
T fo
r th
eir
own
heal
th N
ew in
fect
ions
and
hig
h vi
ral l
oads
duri
ng p
regn
ancy
pos
e th
e gr
eate
st r
isk
of M
TCT
to t
he u
nbor
n ba
by t
hus
prim
ary
prev
entio
n A
RV
pro
phyl
axis
as
wel
l as
trea
tmen
t at t
his
time
is c
ritic
al G
iven
that
25
perc
ent o
f wom
en in
Ken
ya h
ave
an u
nwan
ted
preg
nanc
y s
tren
gthe
ning
the
link
to F
P se
rvic
es a
nd c
ondo
m a
cces
s fo
r du
al p
rote
ctio
n of
fers
a c
hanc
e to
fur
ther
pre
vent
MTC
T2
22
OPE
RA
TIO
NA
L G
UID
ELIN
ES
Ant
enat
al c
are
and
prev
entio
n of
MTC
T du
ring
thi
s pe
riod
can
be
sum
mar
ised
usi
ngan
ess
entia
l pa
ckag
e of
int
egra
ted
ante
nata
l ca
re s
ervi
ces
as s
how
n in
Tab
le 2
1
This
ou
tline
s th
e pa
ckag
e of
ca
re
to
be
prov
ided
to
ev
ery
wom
an
atte
ndin
g A
NC
ser
vice
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
5
32
Tabl
e 2
1 Es
sent
ial P
acka
ge o
f Int
egra
ted
Ant
enat
al C
are
Serv
ices
Gro
up e
duca
tion
Incl
ude
info
rmat
ion
on fo
ur A
NC
vis
its b
reas
tfeed
ing
mat
erna
l and
infa
nt n
utrit
ion
per
sona
l hyg
iene
birt
h pr
epar
edne
ss d
ange
r sig
ns p
reve
ntio
n of
com
plic
atio
ns s
kille
d bi
rth a
ttend
ance
fam
ily p
lann
ing
imm
uniz
atio
n sc
hedu
le
post
-nat
al c
are
and
HIV
and
AID
S m
anag
emen
t
Clie
nt h
isto
ry O
btai
n ro
utin
e da
ta in
clud
ing
med
ical
obs
tetri
c a
nd p
sych
osoc
ial h
isto
ry D
eter
min
e dr
ug h
isto
ry k
now
n al
lerg
ies
and
use
of a
ltern
ativ
e m
edic
ines
suc
h as
her
bal p
rodu
cts
Phy
sica
l exa
min
atio
n In
clud
e vi
tal s
igns
ins
pect
ion
aus
culta
tion
and
palp
atio
n
Abd
omin
al a
nd g
enita
l exa
min
atio
n In
clud
e in
spec
tion
pal
patio
n fo
etal
aus
culta
tion
spe
culu
m a
nd b
iman
ual e
xam
inat
ions
w
here
indi
cate
d
AN
C P
rofil
e R
outin
e te
sts
for s
yphi
lis H
b b
lood
gro
up a
nd R
hesu
s fa
ctor
urin
alys
is a
nd p
rovi
de ra
pid
HIV
test
ing
to th
e pr
egna
nt w
oman
and
her
par
tner
if a
ccom
pany
ing
her
If in
dica
ted
chec
k sp
utum
for A
AFB
and
CD
4 co
unt
Cou
nsel
ing
on b
irth
prep
ared
ness
Sup
port
the
preg
nant
wom
an a
nd h
er p
artn
er to
dev
elop
an
indi
vidu
al b
irth
plan
that
in
clud
es p
lace
of d
eliv
ery
with
ski
lled
birth
atte
ndan
ce e
mer
genc
y tra
nspo
rt b
irth
com
pani
onsh
ip a
nd re
adin
ess
for i
nfan
t ca
re
Cou
nsel
ing
on p
regn
ancy
dan
ger s
igns
Pro
vide
wom
en w
ith in
form
atio
n an
d in
stru
ctio
ns o
n se
ekin
g ea
rly c
are
for p
regshy
nanc
y co
mpl
icat
ions
suc
h as
ble
edin
g fe
ver
seve
re h
eada
che
sw
olle
n fe
et f
its o
r con
vuls
ions
Cou
nsel
ing
on in
fant
feed
ing
All
wom
en re
quire
infa
nt-fe
edin
g co
unse
ling
and
supp
ort
Exc
lusi
ve b
reas
tfeed
ing
for s
ix
mon
ths
shou
ld b
e pr
omot
ed a
s th
e no
rm fo
r all
wom
en re
gard
less
of H
IV s
tatu
s W
omen
infe
cted
with
HIV
nee
d to
be
gu
ided
in th
e se
lect
ion
of s
afer
infa
nt-fe
edin
g op
tions
(ref
er to
WH
O g
uide
lines
and
MO
H c
ircul
ar o
n in
fant
and
you
ng c
hild
fe
edin
g)
Nut
ritio
nal a
sses
smen
t co
unse
ling
and
educ
atio
n In
clud
e iro
n m
ultiv
itam
in a
nd fo
late
sup
plem
enta
tion
mon
itor f
or a
naeshy
mia
ade
quat
e ca
loric
and
nut
rient
inta
ke a
nd re
com
men
d re
alis
tic d
iet a
djus
tmen
ts b
ased
on
loca
l res
ourc
es a
nd n
eeds
of
HIV
+ pr
egna
nt w
omen
(at l
east
10
mor
e of
the
RD
A)
Cou
nsel
ing
on H
IV a
nd A
IDS
Pro
vide
wom
en w
ith in
form
atio
n an
d in
stru
ctio
ns o
n se
ekin
g he
alth
car
e fo
r
sym
ptom
s of
HIV
dis
ease
pro
gres
sion
suc
h as
freq
uent
and
recu
rrent
illn
esse
s c
hron
ic p
ersi
sten
t dia
rrho
ea c
andi
dias
is
feve
r w
astin
g or
sig
ns o
f any
opp
ortu
nist
ic in
fect
ion
Lin
k w
omen
to A
IDS
trea
tmen
t and
oth
er s
uppo
rt pr
ogra
mm
es w
here
av
aila
ble
Cou
nsel
ing
the
HIV
neg
ativ
e w
oman
and
her
par
tner
Pro
vide
info
rmat
ion
on re
peat
test
ing
risk
redu
ctio
n an
d pa
rtner
test
ing
RTI
scr
eeni
ng A
ll w
omen
with
hig
h ris
k se
xual
his
tory
or p
rese
ntin
g w
ith s
igns
of R
TI s
uch
as a
bnor
mal
gen
ital d
isch
arge
ge
nita
l ulc
ers
and
pelv
ic in
flam
mat
ory
dise
ase
shou
ld b
e sc
reen
ed a
nd m
anag
ed a
ccor
ding
to K
enya
pro
toco
ls
Tube
rcul
osis
(TB
) A
ll w
omen
pre
sent
ing
for A
NC
ser
vice
s w
ith a
cou
gh o
f mor
e th
an 2
wee
ksrsquo d
urat
ion
shou
ld b
e sc
reen
ed
for T
B re
gard
less
of H
IV s
tatu
s F
ollo
w K
enya
pro
toco
ls fo
r scr
eeni
ng p
roph
ylax
is a
nd tr
eatm
ent
Teta
nus
toxo
id im
mun
isat
ions
Adm
inis
ter a
ccor
ding
to c
urre
nt K
EP
I TT
Imm
uniz
atio
n S
ched
ule
Dew
orm
ing
All
preg
nant
wom
en s
houl
d re
ceiv
e an
ti-he
lmin
thes
afte
r firs
t trim
este
r as
per t
he g
uide
lines
on
m
ater
nal n
utrit
ion
Ant
imal
aria
ls I
TNs
All
preg
nant
wom
en in
mal
aria
end
emic
are
as s
houl
d sl
eep
unde
r an
ITN
and
rece
ive
SP
inte
rmitt
ent
pres
umpt
ive
treat
men
t acc
ordi
ng to
the
Nat
iona
l Mal
aria
gui
delin
es
AR
V a
nd O
ppor
tuni
stic
Infe
ctio
ns p
roph
ylax
is (d
urin
g pr
egna
ncy)
Pro
vide
AR
V C
TX a
nd o
ther
pro
phyl
actic
m
edic
atio
ns a
ccor
ding
to th
e K
enya
AR
T pr
otoc
ol o
n O
I pro
phyl
axis
and
use
of A
RV
s in
pre
gnan
cy
AR
V tr
eatm
ent d
urin
g pr
egna
ncy
Pro
vide
HA
AR
T w
ithin
the
MC
H s
ettin
g ac
cord
ing
to th
e K
enya
pro
toco
l on
use
of A
RV
s
Est
ablis
h cl
ear r
efer
ral n
etw
orks
with
sen
ior c
linic
ians
Pre
vent
ion
with
Pos
itive
s E
ncou
rage
pos
itive
livi
ng d
iscl
osur
e c
orre
ct a
nd c
onsi
sten
t con
dom
use
and
pro
vide
psy
chos
oshyci
al s
uppo
rt to
the
affe
cted
fam
ilies
For
the
HIV
-infe
cted
and
affe
cted
fam
ilies
est
ablis
h an
dor
stre
ngth
en li
nkag
es to
car
e
treat
men
t and
sup
port
serv
ices
incl
udin
g po
st-p
artu
m fo
llow
up
Effe
ctiv
e co
ntra
cept
ion
plan
Cou
nsel
abo
ut o
ther
fam
ily p
lann
ing
met
hods
em
phas
izin
g on
par
tner
invo
lvem
ent
and
dual
pro
tect
ion
met
hods
to a
void
unw
ante
d pr
egna
ncy
new
infe
ctio
n re
-infe
ctio
n an
d fu
rther
tran
smis
sion
Sourc
e K
enya
Nat
ional PM
TC
T T
rain
ing C
urr
iculu
m
2005
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
92
OPE
RA
TIO
NA
L G
UID
ELIN
ES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed in
the
care
and
fo
llow
-up
of c
hild
ren
of H
IV-in
fect
ed m
othe
rs
bull A
ll ch
ildre
n bo
rn t
o H
IV in
fect
ed m
othe
rs s
houl
d be
see
n in
the
he
alth
car
e fa
cilit
y w
ithin
tw
o w
eeks
of
deliv
ery
bull F
or a
ll H
IV e
xpos
ed in
fant
s m
onth
ly f
ollo
w u
p vi
sits
are
re
com
men
ded
begi
nnin
g at
six
wee
ks t
hrou
gh 2
yea
rs
bull W
here
pos
sibl
e v
isits
sho
uld
be li
nked
to
the
imm
unis
atio
n an
d
grow
th m
onito
ring
vis
its
bull A
ll H
IV e
xpos
ed in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e
prop
hyla
xis
from
6 w
eeks
of
age
bull F
or in
fant
s w
ho te
st H
IV p
ositi
ve b
y D
NA
PC
R b
efor
e 18
mon
ths
or
by a
ntib
ody
test
aft
er 1
8 m
onth
s of
age
co
-trim
oxaz
ole
shou
ld b
e gi
ven
daily
for
life
bull F
or in
fant
s w
ho te
st H
IV n
egat
ive
|
If th
ey h
ave
stop
ped
brea
stfe
edin
g fo
r 2 m
onth
s or
mor
e s
top
C
otrim
oxaz
ole
|
If st
ill br
east
feed
ing
con
tinue
Cot
rimox
azol
e un
til tw
o m
onth
s af
ter
com
plet
e ce
ssat
ion
of b
reas
tfeed
ing
bull C
ompr
ehen
sive
car
e fo
r th
e H
IV e
xpos
ed o
r in
fect
ed in
fant
s sh
ould
be
pro
vide
d in
the
bro
ader
con
text
of
othe
r ch
ild h
ealth
car
e st
rate
gies
Hea
lth w
orke
rs s
houl
d pr
ovid
e th
e fo
llow
ing
pack
age
of c
are
as a
min
imum
to
thes
e ch
ildre
n
(1)
Con
firm
HIV
sta
tus
as e
arly
as
poss
ible
(R
efer
to C
hapt
er 7
)
(2)
M
othe
rs s
houl
d be
sup
porte
d to
pro
vide
opt
imal
infa
nt fe
edin
g an
d pa
rticu
larly
to
avoi
d m
ixed
feed
ing
in th
e fir
st 6
mon
ths
of li
fe I
t is
impo
rtant
that
infa
nt fe
edin
g ch
oice
s at
initi
atio
n of
feed
ing
follo
win
g ea
rly in
fant
dia
gnos
is a
t wea
ning
and
at
the
time
of in
trodu
ctio
n of
com
plem
enta
ry fe
eds
are
guid
ed b
y th
e A
FAS
S c
riter
ia
(Ref
er to
Cha
pter
8)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
3
74
Cha
pter
9
Car
e an
d Fo
llow
-up
of C
hild
ren
of H
IV-in
fect
ed M
othe
rs
91
INTR
OD
UC
TIO
N
PMTC
T in
terv
entio
ns re
duce
but
do
not e
limin
ate
the
risk
of H
IV tr
ansm
issi
on fr
om m
othshy
ers t
o th
eir i
nfan
ts a
nd y
oung
child
ren
Bot
h H
IV-in
fect
ed a
nd u
ninf
ecte
d ex
pose
d ch
ildre
n ha
ve in
crea
sed
risk
s of
infe
ctio
n an
d de
ath
from
com
mon
chi
ldho
od in
fect
ions
The
sur
shyvi
val o
f H
IV-e
xpos
ed c
hild
ren
whe
ther
or
not
they
are
inf
ecte
d i
s cl
osel
y lin
ked
to t
he
heal
th a
nd s
urvi
val o
f the
ir m
othe
rs T
here
fore
lon
g-te
rm b
enef
its o
f PM
TCT
prog
ram
s w
ill o
nly
be s
usta
ined
if t
here
is o
ngoi
ng c
ompr
ehen
sive
car
e fo
r th
e ch
ildre
n an
d th
eir
mot
hers
and
or c
are
give
rs
HIV
exp
osed
chi
ldre
n ar
e vu
lner
able
to
the
com
mon
illn
esse
s af
fect
ing
othe
r ch
ildre
n
Thes
e in
fect
ions
incl
ude
neon
atal
infe
ctio
ns m
alar
ia p
neum
onia
dia
rrho
ea m
easl
es a
nd
othe
r vac
cine
pre
vent
able
dis
ease
s H
IV in
fect
ed ch
ildre
n ar
e lik
ely
to s
uffe
r mor
e se
vere
ly
and
have
a h
ighe
r lik
elih
ood
of d
ying
from
com
mon
chi
ldho
od il
lnes
ses
than
non
-infe
cted
ch
ildre
n W
here
as m
alnu
triti
on c
ause
s 53
o
f all
child
hood
dea
ths
HIV
exp
osed
chi
ldre
n ar
e m
ore
vuln
erab
le to
it th
an n
on-in
fect
ed c
hild
ren
Thi
s is
bec
ause
HIV
exp
osed
child
ren
have
hig
her
calo
ric
requ
irem
ents
as
a re
sult
of th
eir
HIV
infe
ctio
n th
e pr
esen
ce o
f opp
orshy
tuni
stic
infe
ctio
ns a
nd o
ther
com
plic
atio
ns re
late
d to
AID
S
Regu
lar
follo
w u
p ca
re is
cri
tical
for
an in
fant
bor
n to
a m
othe
r w
ith H
IVA
IDS
The
com
shypr
ehen
sive
car
e of
HIV
exp
osed
chi
ldre
n in
clud
ing
nutr
ition
im
mun
isat
ion
mon
itori
ng o
f gr
owth
and
dev
elop
men
t pr
even
tion
and
trea
tmen
t of
opp
ortu
nist
ic in
fect
ions
and
ear
ly
infa
nt d
iagn
osis
of
HIV
is f
easi
ble
in r
esou
rce-
cons
trai
ned
sett
ings
and
sig
nific
antly
imshy
prov
es th
e su
rviv
al o
f the
se ch
ildre
n
23
JOB A
IDS
Prov
ider
s ar
e en
cour
aged
to re
fer t
o th
e ap
prop
riate
job
aid(
s) w
hen
deal
ing
with
spe
cific
issu
es
bull P
MT
CT
test
ing
and
coun
selli
ng t
ools
bull C
oupl
e co
unse
lling
tool
s
bull A
NC
alg
orith
ms
for
AR
V p
roph
ylax
is a
nd in
fant
fee
ding
gui
delin
es
as a
dapt
ed f
rom
WH
O g
uide
lines
bull P
reve
ntio
n w
ith p
ositi
ves
tool
kit
on d
iscl
osur
e
bull F
ocus
ed a
nte-
nata
l car
e
bull M
alar
ia in
pre
gnan
cy
bull T
B in
pre
gnan
cy
bull K
EP
I S
ched
ule
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
7
3
34
A ra
pid
HIV
test
ing
algo
rithm
for s
eria
l tes
ting
is il
lust
rate
d be
low
35
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Pre-Test Education and or Counselling
First HIV Rapid Test ndashDETERMINE
Negative TestResult
Counsel for Negative Result
Positive TestResult
Second HIV Rapid Test ndashBIOLINE
Positive Test ResultCounsel for
Positive Result
NegativeTestResult
Third HIV Rapid Test ndashUNIGOLD
Positive Test ResultCounsel for
Positive Result
Negative Test ResultCounsel for
Negative Result
Figure 32 Rapid HIV testing algorithm Serial testing
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
72
M
othe
r and
Chi
ld H
ealth
Boo
klet
71
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
36
Cha
pter
ref
eren
ces
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
National G
uid
e-lin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
atal Car
e (
2004)
WH
O
UN
FPA
UN
ICEF
World B
ank
Manag
ing C
om
plic
atio
ns
in P
regnan
cy a
nd C
hild
birth
A g
uid
e fo
r m
idw
ives
and d
oct
ors
(2003)
WH
O
Sta
ndar
ds
for
Mat
ernal
and N
eonat
al C
are
(2006)
WH
O
Antire
trovi
ral dru
gs
for
trea
ting p
regnan
t w
om
en a
nd p
reve
nting H
IV infe
ctio
ns
in
infa
nts
in r
esourc
e lim
ited
set
tings
Tow
ard
s U
niv
ersa
l Acc
ess
Rec
om
men
dations
for
a public
hea
lth a
ppro
ach (
2006)
Min
istr
y of
Hea
lth
Nat
ional AID
S amp
STD
Contr
ol Pro
gra
mm
e (N
ASCO
P)
Guid
elin
es f
or
Antire
trovi
ral dru
g t
her
apy
in K
enya
(2005)
Min
istr
y of
Hea
lth
Ken
ya N
atio
nal
Rep
roduct
ive
Hea
lth I
nst
ruct
ional M
anual
for
Ser
vice
Pro
vider
s (M
arch
2005)
Nat
ional AID
S amp
STD
Contr
ol Pro
gra
mm
e K
enya
AID
S I
ndic
ator
Syr
vey
Foo
tnot
es
1
2Ken
ya D
emogra
phic
and H
ealth S
urv
ey (
KD
HS)
2003
37
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
70
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
CH
AP
TE
R 3
Intr
apar
tum
Car
e 3
1 IN
TRO
DU
CTI
ON
Intr
apar
tum
car
e is
the
man
agem
ent
of w
omen
fro
m t
he o
nset
of
labo
ur t
o de
liver
y T
his
peri
od p
oses
the
grea
test
ris
k fo
r tr
ansm
issi
on o
f HIV
from
the
mot
her
to th
e ch
ild (M
TCT)
w
ith 1
0 to
20
perc
ent o
f exp
osed
infa
nts
beco
min
g in
fect
ed a
t thi
s tim
e in
the
abse
nce
of a
ny
inte
rven
tion
1 In
the
con
text
of
HIV
AID
S it
is t
here
fore
im
port
ant
to e
stab
lish
the
HIV
stat
us o
f wom
en p
rior
to o
r du
ring
labo
ur a
nd d
eliv
ery
and
prov
ide
inte
rven
tions
aim
ed a
t re
duci
ng th
e ri
sk o
f tra
nsm
issi
on W
ith a
ppro
pria
te in
terv
entio
ns t
he r
isk
of M
TCT
can
bere
duce
d si
gnifi
cant
ly
32
OPE
RA
TIO
NA
L G
UID
ELIN
ES
a) O
ptim
al In
trap
artu
m C
are
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed fo
r all
wom
en a
dmitt
ed
to la
bour
and
del
iver
y un
its 2
3
1 M
inim
ise
vagi
nal e
xam
inat
ions
2 U
se a
sept
ic t
echn
ique
s in
con
duct
ing
deliv
ery
3 A
void
rou
tine
artif
icia
l rup
ture
of m
embr
anes
(A
RM
)
4 A
void
pro
long
ed la
bour
5 A
void
unn
eces
sary
trau
ma
duri
ng d
eliv
ery
6 M
inim
ise
the
risk
of p
ostp
artu
m h
aem
orrh
age
7 U
se s
afe
bloo
d tr
ansf
usio
n pr
actic
es
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
9
38
b) S
peci
fic M
anag
emen
t of H
IV P
ositi
ve P
regn
ant W
omen
Pro
phyl
acti
c A
ntir
etro
vira
l the
rapi
es4
The
AR
V p
roph
ylac
tic r
egim
en d
epen
ds o
n w
heth
er th
e m
othe
r ha
d A
RV
s du
ring
pre
gshyna
ncy
or n
ot T
hus
the
heal
th c
are
wor
ker s
houl
d es
tabl
ish
the
regi
men
use
d du
ring
th
e A
NC
whe
ther
the
wom
an h
ad ta
ken
the
SdN
VP
and
AZT
at t
he o
nset
of l
abou
r an
d de
term
ine
the
appr
opri
ate
intr
a-pa
rtum
AR
V c
are
as p
er th
e al
gori
thm
s on
pag
e80
(App
endi
x II
I) p
age
81 (A
ppen
dix
IV) a
nd a
s su
mm
aris
ed b
elow
No
AR
Vs t
aken
in p
regn
ancy
Mot
her i
n ea
rly la
bour
(up
to 4
cm c
ervi
cal d
ilata
tion)
bull
Int
rapa
rtum
per
iod
Giv
e m
othe
r S
dNV
P 2
00m
g A
ZT
600
mg
and
3T
C 1
50m
g st
at
bull P
ostp
artu
m m
othe
r G
ive
mot
her
AZ
T 3
00m
g an
d 3T
C 1
50m
g B
D
for
7 da
ys
bull P
ostp
artu
m p
erio
d G
ive
infa
nt S
d N
evir
apin
e 2
mg
kg w
ithin
72
hour
s of
birt
h P
LUS
3T
C 4
mg
kg B
D fo
r 1
wee
k an
d A
ZT
syr
up 4
mg
kg
BD
for
6 w
eeks
Mot
her r
ecei
ved
AZT
300
mg
BD
in P
regn
ancy
bull P
ostp
artu
m
Giv
e in
fant
Sd
Nev
irap
ine
2mg
kg w
ithin
72
hour
s of
birt
h
PLU
S 3
TC
4m
gkg
BD
for
1 w
eek
and
AZ
T sy
rup
4 m
gkg
BD
for
6 w
eeks
Mot
her r
ecei
ved
HA
AR
T in
Pre
gnan
cy
Reg
ardl
ess
of d
urat
ion
rece
ived
HA
AR
T bull
Giv
e m
othe
r A
RV
dos
e as
per
reg
imen
bull P
ostp
artu
m
Giv
e In
fant
Sd
Nev
irap
ine
2mg
kg w
ithin
72
hour
s of
bir
th
PLU
S 3
TC
4m
gkg
BD
for
1 w
eek
and
AZ
T sy
rup
4 m
gkg
BD
for
6 w
eeks
Mod
e of
del
iver
y E
lect
ive
caes
area
n se
ctio
n (C
S) r
educ
es t
he r
isk
of H
IV M
TCT
as c
ompa
red
to v
agin
al
deliv
ery
but
will
not
be
avai
labl
e in
man
y se
ttin
gs in
our
cou
ntry
Whe
re C
S is
per
shyfo
rmed
(ele
ctiv
e or
em
erge
ncy)
in H
IV p
ositi
ve w
omen
the
y sh
ould
rec
eive
pro
phyl
actic
an
tibio
tics
If
the
CS
is p
erfo
rmed
aft
er p
rolo
nged
lab
our
or r
uptu
re o
f m
embr
anes
lo
nger
cour
ses
of a
ntib
iotic
s sh
ould
be
cons
ider
ed
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
3
9
68
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Supp
ort d
urin
g la
bour
E
mot
iona
l su
ppor
t du
ring
lab
our
is i
mpo
rtan
t fo
r al
l w
omen
and
may
be
even
mor
ene
cess
ary
for
an H
IV p
ositi
ve w
oman
who
is c
once
rned
abo
ut h
er c
ondi
tion
and
risk
of
HIV
tran
smis
sion
to c
hild
Whe
neve
r po
ssib
le d
urin
g la
bour
war
d st
aff m
ust b
e se
nsishy
tive
to t
he fe
ars
and
conc
erns
of t
he H
IV p
ositi
ve m
othe
r ab
out
her
infe
ctio
n a
nd h
owm
uch
she
had
told
her
par
tner
Indu
ctio
n of
labo
ur
Indu
ctio
n of
labo
ur m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f H
IV M
TCT
Car
eful
asshy
sess
men
t of
the
nee
d fo
r an
d de
sira
bilit
y of
ind
uctio
n ra
ther
tha
n C
S is
nec
essa
ry
Whe
n in
duct
ion
of la
bour
is c
hose
n m
embr
anes
sho
uld
be le
ft in
tact
for
as lo
ng a
s po
sshysi
ble
Syn
toci
non
shou
ld n
ot b
e us
ed w
ith in
tact
mem
bran
es
Indi
catio
ns fo
r ele
ctiv
e C
S A
lthou
gh e
lect
ive
CS
will
not
be
avai
labl
e in
mos
t hea
lth fa
cilit
ies
as a
rou
tine
for
HIV
posi
tive
wom
en t
here
may
be
som
e ca
ses
that
mer
it co
nsid
erat
ion
for
CS
The
se i
nshycl
ude
preg
nanc
ies
whe
re l
abou
r is
exp
ecte
d to
be
prol
onge
d or
whe
re o
ther
obs
tetr
ic
com
plic
atio
ns m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f tra
nsm
issi
on (e
g a
brup
tio p
lashy
cent
ae
plac
enta
pra
evia
pr
e-te
rm r
uptu
re o
f m
embr
anes
pr
evio
us C
S an
d br
eech
pr
esen
tatio
n)
Man
agem
ent o
f lab
our a
nd d
eliv
ery
Labo
ur a
nd d
eliv
ery
man
agem
ent
shou
ld fo
llow
opt
imal
obs
tetr
ic m
anag
emen
t gu
ideshy
lines
(R
efer
to
Opt
imal
Int
rapa
rtum
car
e ab
ove
and
Nat
iona
l G
uide
lines
for
Qua
lity
Obs
tetr
ics
and
IMPA
C C
are
Man
ual)
RO
LEO
FTH
E C
OM
MU
NIT
Y
A la
rge
prop
ortio
n (6
0) o
f wom
en in
Ken
ya is
del
iver
ed o
utsid
e th
e he
alth
sys
tem
s by
fam
ilym
embe
rs n
eigh
bour
s and
TBA
s
bull T
here
is n
eed
to e
duca
te th
e co
mm
unity
on
the
risk
of M
TC
T an
d w
ays
of
prev
entio
n
bull T
hose
ass
istin
g th
e de
liver
ies
need
to u
nder
stan
d th
eir
own
risk
of in
fect
ion
and
how
to p
rote
ct th
emse
lves
bull T
he c
omm
unity
sho
uld
be e
ncou
rage
d to
faci
litat
e m
othe
rs to
del
iver
in
heal
th fa
cilit
ies
bull T
he c
omm
unity
sho
uld
be e
ncou
rage
d to
ref
er to
hea
lth fa
cilit
ies
all c
hild
ren
born
at h
ome
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
7
40
Fi
gure
81
Gui
delin
es fo
r Cou
nsel
ling
on H
IV a
nd In
fant
feed
ingJ
ob A
ids
Cha
pter
ref
eren
ces
an
d IE
C M
ater
ials
on
Infa
nt a
nd Y
oung
Chi
ld F
eedi
ng
1R
epublic
of
Ken
ya
Min
istr
y of
Hea
lth
Ess
ential
Obst
etric
Car
e M
anual
for
Hea
lth
Ser
vice
Pro
vider
s in
Ken
ya (
3rd
Editio
n J
an 2
006)
Foo
tnot
es
1 D
e Cock
KM
2002
2 K
enya
National
Rep
roduct
ive
Hea
lth I
nst
ruct
ion M
anual
for
Ser
vice
Pro
vider
s (2
006)
3 D
ivis
ion o
f Rep
roduct
ive
Hea
lth
Guid
elin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
ata
l Car
e
(2004)
4 W
HO
Antire
tovi
ral dru
gs
for
trea
ting p
regnan
t w
om
en a
nd p
reve
nting H
IV infe
ctio
n in
infa
nts
to
ward
s univ
ersa
l acc
ess
(2006)
41
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
66
85
EXTR
AC
TSFR
OM
RES
EAR
CH
ON
I NFA
NT
F EED
ING
A
ND H
IVA
IDS
Evid
ence
ava
ilabl
e fr
om c
urre
nt re
sear
ch d
ata
show
s th
at
bull I
ncre
ased
ris
k of
mor
talit
y w
ith r
epla
cem
ent
feed
ing
is s
igni
fican
t
bull H
IV f
ree
surv
ival
rat
e at
18
mon
ths
of a
ge d
oes
not
sign
ifica
ntly
var
y be
twee
n a
brea
stfe
d an
d re
plac
emen
t fed
chi
ld
bull M
odifi
ed a
nim
alrsquos
milk
doe
s no
t pr
ovid
e ad
equa
te n
utrit
ion
for
ch
ildre
n le
ss t
han
6 m
onth
s he
nce
mic
ronu
trie
nts
shou
ld b
e gi
ven
un
der
thes
e ci
rcum
stan
ces
bull A
brup
t ce
ssat
ion
of b
reas
tfee
ding
is n
o lo
nger
rec
omm
ende
d
bull E
xclu
sive
bre
astf
eedi
ng u
p to
6 m
onth
s is
rec
omm
ende
d un
less
re
plac
emen
t fee
ding
can
mee
t AF
AS
S c
rite
ria
Cha
pter
4
Use
of A
ntire
trov
iral D
rugs
in P
regn
ancy
for T
reat
men
t and
for
Prev
entio
n of
Mot
her-
to-C
hild
Tra
nsm
issi
on o
f HIV
Infe
ctio
n
41
INTR
OD
UC
TIO
N
With
out
any
inte
rven
tion
up
to 4
0 pe
rcen
t of
HIV
pos
itive
wom
en w
ill t
rans
mit
the
infe
ctio
n to
the
ir c
hild
ren
duri
ng p
regn
ancy
lab
our
and
brea
stfe
edin
g U
se o
f ant
iret
shyro
vira
l dru
gs (A
RV
s) o
bste
tric
inte
rven
tions
and
avo
idan
ce o
f all
brea
stfe
edin
g fo
r pr
eshyve
ntio
n of
mot
her
to c
hild
tran
smis
sion
of H
IV in
fect
ion
(PM
TCT)
has
red
uced
the
risk
of m
othe
r to
chi
ld tr
ansm
issi
on o
f HIV
infe
ctio
n (M
TCT)
to le
ss th
an 2
per
cent
in d
evel
shyop
ed c
ount
ries
Shor
t cou
rse
effic
acio
us A
RV
dru
g re
gim
ens
can
redu
ce th
e ri
sk o
f MTC
T to
2-4
per
cent
and
can
be i
mpl
emen
ted
in r
esou
rce-
limite
d se
ttin
gs o
n a
popu
latio
n-ba
sed
publ
ic
heal
th s
cale
AR
Vs
are
used
bot
h fo
r th
e tr
eatm
ent
of H
IV d
isea
se a
nd fo
r PM
TCT
in
HIV
-infe
cted
pre
gnan
t w
omen
and
the
ir n
eona
tes
Ant
iret
rovi
ral t
reat
men
t (A
RT)
for
wom
en w
ho q
ualif
y fo
r it
pro
long
s an
d im
prov
es t
he q
ualit
y of
the
ir l
ives
The
sur
shyvi
val
of t
he c
hild
is
clos
ely
inte
rlin
ked
with
the
hea
lth a
nd s
urvi
val
of t
he m
othe
r
Wom
en e
ligib
le fo
r A
RT
shou
ld b
e st
arte
d on
trea
tmen
t as
soon
as
poss
ible
Pre
gnan
cy
is n
ot a
rea
son
to d
elay
AR
T W
omen
who
are
alr
eady
on
AR
T be
fore
bec
omin
g pr
egshy
nant
sho
uld
cont
inue
with
thei
r tr
eatm
ent
In c
erta
in s
ituat
ions
mod
ifica
tions
may
be
need
ed to
mak
e tr
eatm
ent s
afer
for
the
mot
her
and
the
unbo
rn b
aby
The
bene
fits
of u
sing
AR
Vs
to t
reat
HIV
-infe
cted
pre
gnan
t w
omen
and
or
PMTC
T ou
tshyw
eigh
the
ris
ks H
owev
er w
hen
AR
T or
oth
er s
hort
cou
rse
AR
V r
egim
ens
are
used
ba
selin
e ev
alua
tion
and
mon
itori
ng is
enc
oura
ged
to e
nsur
e th
e sa
fety
of t
he m
othe
rsan
d th
eir
new
born
s L
inka
ges
of H
IV-in
fect
ed p
regn
ant
wom
en a
nd t
heir
chi
ldre
n to
ot
her
care
and
sup
port
pro
gram
s at
hea
lth f
acili
ty a
nd c
omm
unity
lev
els
shou
ld b
e en
sure
d
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
6
5
42
42
OPE
RA
TIO
NA
L G
UID
ELIN
ES
All
HIV
-infe
cted
pre
gnan
t w
omen
sho
uld
be c
ouns
elle
d on
com
preh
ensi
ve H
IV c
are
incl
udin
g us
e of
AR
Vs
for
thei
r ow
n he
alth
and
for
PMTC
T
All
HIV
-infe
cted
pre
gnan
t wom
en s
houl
d ha
ve th
eir H
IV d
isea
se
stag
ed u
sing
bull W
HO
clin
ical
sta
ging
(se
e A
ppen
dix
1) a
nd
bull I
mm
unol
ogic
al s
tagi
ng (
CD
4 co
unt)
(se
e ta
ble
1)
The
wom
en s
houl
d al
so b
e sc
reen
ed a
nd tr
eate
d fo
r op
port
unis
tic in
fect
ions
(OIs
) inc
ludi
ngTu
berc
ulos
is (T
B)
All
HIV
-infe
cted
pre
gnan
t wom
en s
houl
d ha
ve b
asel
ine
labo
rato
ry a
nd o
ther
nec
essa
rydi
agno
stic
eva
luat
ions
Thes
e di
agno
stic
s sh
ould
incl
ude
bull R
outin
e an
tena
tal c
are
labo
rato
ry in
vest
igat
ions
that
are
nor
mal
ly
done
for
all
preg
nant
wom
en
haem
oglo
bin
(Hb)
rh
esus
blo
od
grou
p an
d A
BO
typ
ing
VD
RL
uri
ne a
naly
sis
and
scre
enin
g fo
r S
TI
bull A
LT a
nd c
reat
inin
e le
vels
for
wom
en e
ligib
le f
or H
AA
RT
Prop
hyla
xis
amp m
icro
nutr
ient
sup
plem
enta
tion
bull
Cot
rimox
azol
e (C
TX) o
ne d
oubl
e st
reng
th o
r tw
o si
ngle
stre
ngth
tabl
ets
once
dai
ly
bull
Mul
tivita
min
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
83
OPE
RA
TIO
NA
L G
UID
ELIN
ESO
N F
EED
ING
CH
ILD
REN
6 M
ON
THS
AN
DO
LDER
The
follo
win
g sh
ould
gui
de fe
edin
g fo
r chi
ldre
n 6
mon
ths
and
olde
r
bull A
t 6
mon
ths
oth
er f
orm
s of
milk
alo
ne a
re n
ot a
dequ
ate
to m
eet
the
baby
rsquos n
utrit
iona
l req
uire
men
ts
bull C
ompl
emen
tary
foo
ds s
houl
d be
intr
oduc
ed w
ith c
ontin
ued
br
east
feed
ing
or w
ith r
epla
cem
ent
feed
ing
until
a n
utrit
iona
lly
adeq
uate
die
t ca
n be
sus
tain
ed w
ithou
t m
ilk
bull A
brup
t ces
satio
n of
bre
astf
eedi
ng s
houl
d be
dis
cour
aged
to
avoi
d
trau
ma
for
both
the
mot
her
and
the
baby
bull M
ilk s
houl
d co
ntin
ue a
s an
impo
rtan
t co
mpo
nent
of
the
diet
bull C
ompl
emen
tary
foo
ds s
houl
d be
enr
iche
d fr
om lo
cally
ava
ilabl
e
fam
ily f
oods
84
NU
TRIT
ION
AL
CA
RE
AN
D S
UPP
OR
TO
F H
IV
INFE
CTE
DC
HIL
DR
EN
bull E
nerg
y ne
eds
for
asym
ptom
atic
HIV
infe
cted
chi
ldre
n in
crea
se b
y 10
pe
rcen
t to
mai
ntai
n gr
owth
as
com
pare
d to
the
non-
infe
cted
chi
ldre
n
bull T
here
is n
o ev
iden
ce o
f in
crea
sed
prot
ein
requ
irem
ents
The
re
quir
emen
ts s
houl
d be
bas
ed o
n in
divi
dual
sym
ptom
s an
d ne
eds
bull M
icro
nutr
ient
req
uire
men
ts d
o no
t ch
ange
W
HO
rec
omm
ends
not
m
ore
than
one
RD
A
(For
fur
ther
det
ails
re
fer
to K
enya
n G
uide
lines
on
nutr
ition
and
HIV
A
IDS
)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
3
64
82
OPE
RA
TIO
NA
L G
UID
ELIN
ESO
N I N
FAN
TFE
EDIN
G (0
-6 M
ON
THS)
The
follo
win
g sh
ould
gui
de in
fant
feed
ing
for t
he fi
rst 6
mon
ths
bull A
ll w
omen
and
men
irre
spec
tive
of th
eir
HIV
sta
tus
shou
ld r
ecei
ve
coun
selin
g an
d de
mon
stra
tions
on
how
to s
afel
y fe
ed t
heir
babi
es
duri
ng t
he a
nten
atal
and
pos
tnat
al f
ollo
w u
p
bull T
he m
ost
appr
opria
te in
fant
fee
ding
opt
ion
for
an H
IV in
fect
ed
mot
her
shou
ld c
ontin
ue t
o de
pend
on
indi
vidu
al c
ircu
mst
ance
s an
d
the
av
aila
ble
supp
ort
bull E
very
HIV
infe
cted
wom
an s
houl
d be
eva
luat
ed a
t ev
ery
visi
t to
ch
eck
whe
ther
her
soc
ial
econ
omic
and
hea
lth s
tatu
s ha
s ch
ange
d
suff
icie
ntly
eno
ugh
to a
ffec
t he
r in
fant
fee
ding
opt
ion
bull E
xclu
sive
bre
astf
eedi
ng fo
r H
IV in
fect
ed w
omen
for
the
firs
t 6
mon
ths
of t
he in
fant
rsquos li
fe is
adv
isab
le
unle
ss r
epla
cem
ent f
eedi
ng is
ac
cept
able
fea
sibl
e a
ffor
dabl
e s
usta
inab
le a
nd s
afe
for
them
and
th
eir
infa
nts
befo
re t
hat t
ime
bull W
hen
repl
acem
ent
feed
ing
is a
ccep
tabl
e f
easi
ble
aff
orda
ble
su
stai
nabl
e an
d sa
fe
avoi
danc
e of
exc
lusi
ve b
reas
tfee
ding
by
HIV
in
fect
ed w
omen
is r
ecom
men
ded
bull I
f th
e co
nditi
ons
for
repl
acem
ent
feed
ing
are
still
not
met
for
6
mon
ths
then
co
ntin
uatio
n of
bre
astf
eedi
ng w
ith a
dditi
onal
co
mpl
emen
tary
fee
ding
is r
ecom
men
ded
giv
ing
prio
rity
to t
he lo
cally
av
aila
ble
food
s
bull I
nfan
t fe
edin
g de
cisi
ons
for
all H
IV e
xpos
ed in
fant
s sh
ould
be
base
d on
the
AF
AS
S c
riter
ia e
ven
whe
re e
arly
infa
nt d
iagn
osis
(E
ID)
is
avai
labl
e
bull B
reas
tfeed
ing
mot
hers
of
infa
nts
and
youn
g ch
ildre
n w
ho a
re k
now
n to
be
HIV
infe
cted
sho
uld
be s
tron
gly
enco
urag
ed to
con
tinue
bre
ast
feed
ing
How
ever
br
east
feed
ing
HIV
infe
cted
mot
hers
sho
uld
be
give
n nu
triti
on s
uppo
rt (
nutr
ition
al c
ouns
elin
g e
duca
tion
foo
d an
d nu
triti
onal
sup
plem
ents
)
63
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
44
Sulp
hur-
base
d in
term
itten
t pr
esum
ptiv
e m
alar
ia t
reat
men
t (I
PT) s
houl
d no
t be
giv
en
to w
omen
who
are
on
CTX
pro
phyl
axis
AR
V us
e
bull A
RV
s ar
e us
ed fo
r tr
eatin
g H
IV-i
nfec
ted
elig
ible
wom
en a
ndo
r fo
r pr
even
tion
of m
othe
r-to
-chi
ld tr
ansm
issi
on
bull H
IV-i
nfec
ted
preg
nant
wom
en e
ligib
le f
or A
RT
sho
uld
initi
ate
AR
T
as s
oon
as p
ossi
ble
as s
how
n in
Tab
le 4
1
bull H
IV-i
nfec
ted
preg
nant
wom
en a
lread
y on
AR
T b
efor
e be
com
ing
preg
nant
sho
uld
cont
inue
AR
T
The
bab
y sh
ould
be
give
n A
RV
pr
ophy
laxi
s so
on a
fter
birt
h as
sho
wn
in T
able
42
Tabl
e 4
1 R
ecom
men
datio
ns fo
r ini
tiatin
g A
RV
trea
tmen
t in
preg
nant
w
omen
bas
ed o
n cl
inic
al s
tage
and
ava
ilabi
lity
of C
D4
Cou
nt
WH
O
CD
4 te
stin
g
CD
4 te
stin
g
Clin
ical
Sta
ge
not a
vaila
ble
avai
labl
e
1 D
o no
t Tre
at
Trea
t if C
D4le
350
cells
mm
3
2 D
o no
t Tre
at
Trea
t if C
D4 le
350
cells
mm
3
3 Tr
eat
Trea
t irre
spec
tive
of C
D4
coun
t (c
onsi
der C
D4
valu
es fo
r bet
ter
man
agem
ent)
4 Tr
eat
Trea
t irre
spec
tive
of C
D4
cell
coun
t
Sourc
e A
dopte
d f
rom
WH
O
Anti-r
etro
vira
l dru
gs
for
trea
ting p
regnant
wom
en a
nd p
re-
venting H
IV infe
ctio
ns
Tabl
e 4
2 R
ecom
men
ded
first
-line
AR
T re
gim
en fo
r tre
atin
g pr
egna
nt w
omen
and
pro
phyl
actic
regi
men
for i
nfan
ts
Mot
her
Ant
epar
tum
AZ
T +
3TC
+ N
VP D
aily
Intra
partu
m
AZT
+ 3T
C +
NVP
Dai
ly
Pos
tpar
tum
AZ
T +
3TC
+ N
VP D
aily
Infa
nt p
roph
ylax
is
Sd
NV
P 2
mg
kg s
tat w
ithin
72
hour
s 3T
C X
1 w
eek
(4
mg
kg B
ID)
AZT
X 6
wee
ks (4
mg
kg B
ID)
Mat
erna
l dos
ages
AZT
300
mg
BID
3TC
150
mg
BID
NV
P 2
00 m
g O
D fo
r tw
o w
eeks
the
reaf
ter 2
00 m
g B
ID
Infa
nt D
osag
es
NV
P
2mg
kg s
tat w
ithin
72
hour
s
AZT
4mg
kg B
ID X
6 w
eeks
3TC
4m
gkg
BID
X 1
wee
k
Cha
pter
8
Feed
ing
Infa
nts
and
Youn
g C
hild
ren
Bor
n to
HIV
Infe
cted
Mot
hers
81
INTR
OD
UC
TIO
N T
RA
NSM
ISSI
ON
OF
HIV
THR
OU
GH
B
REA
STFE
EDIN
G
In A
fric
a 3
to 4
out
of e
very
10
infa
nts
born
to H
IV in
fect
ed w
omen
acq
uire
HIV
infe
cshytio
n T
here
is t
here
fore
a 5
ndash 2
0 pe
rcen
t ri
sk o
f inf
ants
bor
n to
HIV
pos
itive
mot
hers
ac
quir
ing
infe
ctio
n th
roug
h br
east
-fe
edin
g if
ther
e ar
e no
inte
rven
tions
in
pla
ce
For
wom
en w
ho a
re i
nshyfe
cted
with
HIV
for
the
first
tim
e or
w
ho a
re r
e-in
fect
ed w
ith a
diff
eren
t st
rain
of H
IV d
urin
g th
e br
east
feed
shyin
g ph
ase
the
ris
k in
crea
ses
up t
o29
per
cen
t H
alf (
12)
of H
IV b
reas
t m
ilk t
rans
mis
sion
tak
es p
lace
by
6 w
eeks
and
thre
e qu
arte
rs (3
4) b
y 6
mon
ths
Mix
ed fe
edin
g in
crea
ses
the
risk
of
brea
st m
ilk t
rans
mis
sion
of
HIV
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
5
62
For
prop
hyla
xis
the
reco
mm
enda
tions
are
ran
ked
and
will
dep
end
on t
ime
of fi
rst
conshy
tact
with
the
wom
an H
IV-in
fect
ed p
regn
ant w
omen
who
are
not
elig
ible
for
AR
T or
in
72
3 C
OM
PREH
ENSI
VE
CA
RE
FOR H
IV-E
XPO
SED
CH
ILD
REN
w
hom
it is
not
pos
sibl
e to
sta
rt A
RT
imm
edia
tely
and
the
mot
her
is b
eing
see
n be
twee
n28
and
38
wee
ks o
f pr
egna
ncy
sho
uld
be s
tart
ed o
n re
com
men
ded
mor
e ef
ficac
ious
shor
t co
urse
pro
phyl
actic
AR
V r
egim
ens
as s
how
n in
Tab
le 4
3a
The
bab
y sh
ould
als
obe
giv
en A
RV
pro
phyl
axis
soo
n af
ter
birt
h as
sho
wn
in th
e sa
me
tabl
e T
he r
egim
ens
asou
tline
d be
low
are
for
prop
hyla
xis
and
not f
or tr
eatm
ent
MINI
STRY
OF H
EAL
TH
Tabl
e 4
3a R
ecom
men
ded
Firs
t Lin
e A
RV
prop
hyla
xis
ALGO
RITH
M FO
R EA
RLY
INFA
NTDI
AGNO
SISFO
R HI
VEX
POSE
DCH
ILDRE
N
to p
reve
nt H
IV in
fect
ion
in in
fant
s A
mon
g Pr
egna
nt W
omen
Pr
esen
ting
Bef
ore
38 W
eeks
Ran
king
Ti
me
of A
dmin
istr
atio
n
WEL
L CHI
LD
SICK
CHI
LD
(Man
age
pres
entin
g ill
ness
and
stab
ilize
)
STAR
T CO
TRIM
OXAZ
OLE
PROP
HYLA
XIS
FOR M
OR E
INFOR
MATIO
N C ON
TACT
THE N
ATI O
NAL A
IDS S
TD CO
NTRO
L PRO
GRAM
ME ( N
ASCO
P) PO
BOX
19 36
1-00
20 2 N
AIRO
BI TE
L 02
02 72
95 02
FAX 0
2 0 2 7
1 05 1
8
Exp
osur
e sta
tus s
houl
d be
det
erm
ined
for a
ll in
fants
of u
nkno
wn s
tatu
s at t
he
6 we
ek v
isit o
r firs
t con
t act
Coun
sel o
n inf
ant f
eedi
ng a
s per
nat
iona
l gui
delin
es
Conf
irma
tory
ABt
est
at 1
8 M
onth
s
Eval
uate
for
ART
star
t on
ARV
if el
igibl
e
If HI
V+ a
t 12
Mont
hs
Evalu
ate f
or A
RT
Start
on
ARV
if eli
gible
6 Wee
ks D
BS (P
CR)
HIV
+
If HI
V-sto
p CT
X if
not
BF
for a
t lea
st 2
Mont
hs
HI
V-
Antib
ody
test
ing
12 M
onth
s
Conf
irmat
ory
ABte
st at
18 M
onth
s
Conf
irmat
ory A
B te
st at
18 M
onth
s
Eval
uate
for A
RT
star
t on
ARV
if el
igible
If HIV
+ at
12
Mon
ths
Eval
uate
for A
RT
Star
t on
ARV
if el
igibl
e
If lt1
2 Mon
ths D
BS (P
CR)
If gt
12m
o An
tibod
y te
st
HIV
+
If HIV-
stop
CTX
if n
ot
BF
for a
t lea
st 2
Mont
hs
HI
V-
Antib
ody
testi
ng
12 M
onth
s
Conf
irma
tory
AB
test
at 1
8 Mo
nths
Exp
osur
e sta
tus s
hould
be de
term
ined
for a
ll in
fant
s of u
nkno
wn st
atus
at th
e 6w
eek
visit
or fi
rst c
onta
ct
Co
unse
l on
infa
nt fe
edin
g as
per n
atio
nal g
uideli
nes
Pre
gnan
cy
Labo
ur
Pos
tpar
tum
Mat
erna
l In
fant
Rec
omm
ende
d
AZT(
28-3
8 w
eeks
ge
stat
ion)
sd
NV
P
+ AZ
T+3T
C
AZT+
3TC
X
7 da
ys
sdN
VP
PL
US
3TC
X1
wee
k +
AZT
X
6 w
eeks
Tabl
e 4
3b b
elow
sho
ws
alte
rnat
ive
prop
hyla
ctic
regi
men
s fo
r w
omen
pre
sent
ing
befo
re 3
8 w
eeks
of p
regn
ancy
Ran
king
Ti
me
of A
dmin
istr
atio
n
Alte
rnat
ive
Min
imum
Pre
gnan
cy
AZT(
28-3
8 w
eeks
)
Labo
ur
sd N
VP
+
AZT(
600m
gs
stat
)
sdN
VP
+ A
ZT+3
TC
Pos
tpar
tum
AZT+
3TC
X
7 da
ys
Infa
nt
sdN
VP
+
3TC
X 7
da
ys +
AZT
X
6 w
eeks
sdN
VP
+
3TC
day
s +
AZT
X 6
wee
ks
HIV
-infe
cted
pre
gnan
t w
omen
who
are
see
n fo
r th
e fir
st t
ime
afte
r 38
wee
ks o
f pr
egshy
nanc
y or
in la
bour
sho
uld
be g
iven
AR
V p
roph
ylac
tic r
egim
ens
as s
how
n in
Tab
le 4
4
The
baby
sho
uld
also
be
give
n A
RV
pro
phyl
axis
soo
n af
ter
birt
h as
sho
wn
in t
he s
ame
Bot
h H
IV-in
fect
ed a
nd u
ninf
ecte
d ch
ildre
n re
quir
e co
mpr
ehen
sive
car
e (R
efer
to C
hap-
tabl
ete
r 8
and
9)
61
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
46
Tabl
e 4
4 A
RV
prop
hyla
xis
for P
MTC
T am
ong
preg
nant
wom
en w
ho
have
not
rece
ived
ant
enat
al A
RT
or p
roph
ylax
is
Ran
king
Ti
me
of A
dmin
istr
atio
n
La
bour
P
ostp
artu
m
Mat
erna
l In
fant
Rec
omm
ende
d
sdN
VP
AZ
T+3T
C
SdN
VP
+
X 7
days
P
LUS
3TC
X 1
wee
k +
AZT+
3TC
AZ
T X
6 w
eeks
Min
imum
sd
NV
P
-S
dNV
P
PLU
S 3
TC X
1 w
eek
+
AZT
X 6
wee
ks
Dos
ages
Mot
her
Bab
y
NV
P
200
mg
stat
2m
gkg
sta
t with
in 7
2 ho
urs
AZT
300
mg
BID
4m
gkg
BID
X 6
wee
ks
3TC
15
0 m
g BI
D
4mg
kg B
ID X
1 w
eek
Tabl
e 4
5 R
ecom
men
ded
HA
AR
T fo
r Pre
gnan
t Wom
en
base
d on
CD
4 C
ount
and
Sta
ge o
f Pre
gnan
cy
CD
4 C
ount
H
AA
RT
Trim
este
r C
ells
mm
3
72
2 H
IV P
OSI
TIV
EIN
FAN
TB
Y D
NA
PC
R
bull A
ll H
IV p
ositi
ve in
fant
s sh
ould
be
eval
uate
d fo
r el
igib
ility
for
antishy
retr
ovir
al tr
eatm
ent
and
linke
d to
car
e an
d tr
eatm
ent
as a
ppro
pria
te
bull W
HO
clin
ical
sta
ging
sho
uld
be d
one
for
all H
IV p
ositi
ve in
fant
s
Chi
ldre
n w
ho a
re a
t W
HO
Clin
ical
sta
ge 3
or
4 ar
e el
igib
le f
or
antir
etro
vira
l tre
atm
ent
bull A
ll H
IV p
ositi
ve in
fant
s sh
ould
be
asse
ssed
for
CD
4 co
unt
whe
re
poss
ible
and
ava
ilabl
e R
efer
to
AR
T g
uide
lines
for
CD
4 co
unts
tha
t de
term
ine
elig
ibili
ty f
or A
RT
for
chi
ldre
n of
diff
eren
t ag
e br
acke
ts
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
hav
e a
visi
ble
guar
dian
or
care
-tak
er
befo
re t
hey
can
be s
tart
ed o
n A
RT
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e fr
om 6
w
eeks
or
on f
irst
cont
act t
here
afte
r
bull A
ll H
IV-p
ositi
ve in
fant
s sh
ould
be
star
ted
on A
RT
if el
igib
le
bull B
reas
tfeed
ing
shou
ld b
e en
cour
aged
for
all
HIV
-pos
itive
infa
nts
for
a
min
imum
of t
wo
year
s (
Ref
er t
o C
hapt
er 8
)
bull F
or a
ll H
IV-p
ositi
ve in
fant
s p
erfo
rm a
ntib
ody
test
ing
at 9
mon
ths
12
mon
ths
and
conf
irm
at
18 m
onth
s
1st T
rimes
ter
2nd T
rimes
ter
3rd T
rimes
ter
lt250
A
ZT+
3TC
+NV
P
AZ
T+3T
C+N
VP
AZT+
3TC
+NVP
250-
350
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
gt 35
0
A
ZT+3
TC+L
PVr
OR
A
BC
+3TC
+LPV
r
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
AZT
+3TC
+LPV
r O
R
AB
C+3
TC+L
PVr
47
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
60
72
OPE
RA
TIO
NA
L G
UID
ELIN
ES
72
0 G
UID
ELIN
ESFO
R H
IV D
IAG
NO
SIS
INC
HIL
DR
EN
bull P
erfo
rm r
outin
e ra
pid
HIV
ant
ibod
y te
sts
for
all m
othe
rs o
f 6
wee
k ol
d in
fant
s pr
esen
ting
with
unk
now
n st
atus
bull P
erfo
rm r
outin
e dr
y bl
ood
spot
s (D
BS
) fo
r D
NA
PC
R f
or a
ll in
fant
s kn
own
to b
e H
IV-e
xpos
ed a
t 6
wee
ks
bull P
erfo
rm r
outin
e an
tibod
y te
stin
g fo
r al
l sic
k in
fant
s in
out
patie
nt a
nd
paed
iatr
ic w
ards
to
esta
blis
h H
IV e
xpos
ure
infe
ctio
n st
atus
bull P
erfo
rm D
BS
for
all
HIV
-exp
osed
sic
k in
fant
s un
der
12 m
onth
s
bull A
ll H
IV-e
xpos
ed in
fant
s sh
ould
be
star
ted
on C
otri
mox
azol
e fr
om 6
w
eeks
of
age
or o
n fir
st c
onta
ct th
erea
fter
bull R
efer
to
chap
ter
on c
are
and
follo
w u
p of
the
HIV
-exp
osed
infe
cted
in
fant
72
1 H
IV N
EGA
TIV
EIN
FAN
TA
TA
GE
6 W
EEK
SO
RFI
RST
CO
NTA
CT
Perf
orm
ant
ibod
y te
stin
g at
9 m
onth
s an
d 12
mon
ths
of a
ge
bull I
f H
IV n
egat
ive
at 1
2 m
onth
s an
d st
ill b
reas
tfee
ding
co
ntin
ue
Cot
rim
oxaz
ole
bull I
f not
bre
astf
eedi
ng f
or a
t le
ast
2 m
onth
s s
top
Cot
rim
oxaz
ole
bull P
erfo
rm c
onfir
mat
ory
antib
ody
test
ing
at 1
8 m
onth
s
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Mat
erna
l dos
ages
AZT
30
0 m
g B
ID
3TC
15
0 m
g BI
D
NVP
200
mg
OD
for t
wo
wee
ks t
here
afte
r 200
mg
BID
AB
C
300m
g B
ID
LPV
r (4
001
00)
2 ta
blet
s B
ID
EFV
60
0mg
QID
Not
es I
mpo
rtan
t con
side
ratio
ns th
at m
odify
cho
ice
of A
RV
s du
ring
pre
gnan
cy in
clud
e C
D4
coun
t m
ater
nal a
naem
ia a
nd
stag
e of
pre
gnan
cy
bull 2
NR
TIs
(A
ZT
and
3TC
) ac
ting
as a
ldquotr
eatm
ent
back
bone
rdquo w
ith a
dditi
on o
f an
N
NR
TI (
NV
P)
rem
ains
the
pre
ferr
ed fi
rst-
line
AR
V t
hera
py in
res
ourc
e-po
or
sett
ings
bull P
rote
ase
inhi
bito
rs b
ased
reg
imen
s ar
e pr
efer
able
whe
n C
D4
coun
t is
high
er
than
250
bull R
epla
ce A
ZT
with
d4T
if H
blt 8
gm
dL
bull
EF
V m
ay b
e us
ed in
stea
d of
NV
P a
fter
first
trim
este
r
bull
Usu
ally
AR
V s
houl
d be
with
held
if C
D4
coun
t is
not
ava
ilabl
e or
not
don
e
AR
V is
how
ever
use
d fo
r P
MT
CT
and
or in
adv
ance
d H
IV d
isea
se (
WH
O
Sta
ge 3
or
4) ir
resp
ectiv
e of
CD
4 co
unt
Bab
ies
who
se
mot
hers
di
d no
t re
ceiv
e an
tepa
rtum
or
in
trap
artu
m
AR
Vpr
ophy
laxi
s sh
ould
be
give
n A
RV
pro
phyl
axis
as
show
n in
Tab
le 4
6
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
9
48
Tabl
e 4
6 A
RV
prop
hyla
ctic
regi
men
s fo
r inf
ants
bor
n to
H
IV-p
ositi
ve w
omen
who
hav
e no
t rec
eive
d an
tepa
rtum
or
intr
apar
tum
AR
T or
AR
V pr
ophy
laxi
s
Ran
king
T
ime
of a
dmin
istr
atio
n an
d In
fant
dos
age
sdN
VP (2
mg
kg s
tat)
PLU
S 3T
C (4
mg
kg B
ID) X
1 w
eek
+ AZ
T (4
mg
kg
BID
) X 6
wee
ks
Rec
omm
ende
d
sdN
VP (2
mg
kg s
tat)
Min
imum
sdN
VP
is g
iven
to th
e in
fant
with
in 7
2 ho
urs
of b
irth
Plea
se n
ote
A
t fir
st c
onta
ct a
ll H
IV i
nfec
ted
preg
nant
wom
en s
houl
d be
giv
en s
dNV
P ta
blet
s to
take
hom
e w
ith t
hem
The
y sh
ould
be
inst
ruct
ed t
o ta
ke t
he t
able
ts a
t th
e on
set
of la
shybo
ur i
f lab
our
occu
rs o
utsi
de h
ealth
faci
lity
sett
ings
The
y sh
ould
als
o be
giv
en N
VP
3T
C a
nd A
ZT s
yrup
for
thei
r ba
bies
to b
e ad
min
iste
red
soon
aft
er b
irth
Som
e w
omen
with
a C
D4
coun
t gr
eate
r th
an 2
50 c
ells
microl
on
Nev
irap
ine
(NV
P)-b
ased
AR
T m
ay d
evel
op N
VP
hype
rsen
sitiv
e re
actio
ns t
hat
can
be li
fe t
hrea
teni
ng I
n th
ese
guid
elin
es it
is r
ecom
men
ded
that
for
preg
nant
wom
en w
ith C
D4
mor
e th
an 2
50 N
VP-
base
d re
gim
en m
ay s
till
be u
sed
but
with
clo
se m
onito
ring
O
ther
wis
e th
e re
com
shym
ende
d re
gim
en to
use
with
CD
4 co
unt a
bove
250
is a
PI-
base
d H
AA
RT
regi
men
Whe
n si
ngle
dos
e N
VP
(sdN
VP)
is u
sed
in P
MTC
T s
ome
wom
en a
nd c
hild
ren
may
deshy
velo
p re
sist
ance
to
NV
P th
at m
ay l
imit
futu
re u
se o
f N
on-N
ucle
osid
e R
ever
se T
ranshy
scri
ptas
e In
hibi
tors
(NN
RTI
s) t
o tr
eat
them
Th
e ri
sk o
f NN
RTI
res
ista
nce
is p
artic
ushyla
rly
high
if
two
dose
s of
sdN
VP
are
give
n T
here
fore
SdN
VP
shou
ld n
ever
be
used
mor
e th
an o
nce
in a
ny o
ne p
regn
ancy
Whe
re p
ossi
ble
AZT
3TC
sho
uld
be g
iven
for
7 da
ys t
o co
ver
the
NV
P ta
il bo
th in
the
mot
her
and
the
baby
Th
e ba
by is
the
n co
ntin
shyue
d on
AZT
for
a to
tal o
f 6 w
eeks
for
prop
hyla
xis
agai
nst M
TCT
HIV
-infe
cted
pre
gnan
t w
omen
sta
rtin
g zi
dovu
dine
(A
ZT)
cont
aini
ng r
egim
ens
shou
ld
have
hae
mog
lobi
n (H
b) le
vels
abo
ve 8
gm
dl
The
Hb
leve
l sho
uld
be c
heck
ed m
onth
ly
for
the
first
thr
ee m
onth
s W
here
pos
sibl
e A
ZT s
houl
d be
use
d in
stea
d of
sta
vudi
ne(d
4T)
Clin
ical
judg
emen
t can
be
used
to e
stim
ate
Hb
leve
ls a
nd in
itiat
e AR
V pr
ophy
laxi
s if l
aboshy
rato
ry te
sts a
re u
nava
ilabl
e
Efa
vire
nz (
EFV
) m
ay b
e te
rato
geni
c if
used
in t
he f
irst
tri
mes
ter
If t
he p
atie
nt is
on
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Cha
pter
7
HIV
Dia
gnos
is in
Chi
ldre
n 7
1 IN
TRO
DU
CTI
ON
In g
ener
al
a ch
ild m
ay b
e te
sted
und
er a
num
ber
of c
ircu
mst
ance
s T
hese
inc
lude
sh
ortly
aft
er b
irth
for
earl
y di
agno
sis
of H
IV f
or th
e pu
rpos
es o
f ind
ivid
ual d
iagn
osis
in
a ch
ild w
ho is
ill (
eg
tho
se p
rese
ntin
g w
ith a
n H
IV r
elat
ed il
lnes
s) i
n ca
ses
whe
re a
child
has
eith
er b
een
expo
sed
or is
pot
entia
lly e
xpos
ed t
o H
IV e
g t
hrou
gh m
othe
r-to
shych
ild t
rans
mis
sion
se
xual
abu
se
sexu
al a
ctiv
ity
with
in a
hea
lthca
re s
ettin
g (e
g
thro
ugh
cont
amin
ated
nee
dles
or
rece
ipt
of p
oten
tially
infe
ctio
us b
lood
) th
roug
h ot
her
mea
ns a
nd in
orp
hans
Ear
ly i
nfan
t di
agno
sis
(EID
) re
fers
to
the
mak
ing
of H
IV d
iagn
osis
in
infa
nts
and
youn
g ch
ildre
n be
fore
18
mon
ths
of a
ge E
ID g
ives
an
oppo
rtun
ity fo
r ea
rly
iden
tific
ashytio
n of
HIV
infe
cted
infa
nts
(des
pite
PM
TCT)
and
ear
ly li
nkag
e to
car
e an
d tr
eatm
ent
Dis
ease
pro
gres
sion
in H
IV in
fect
ed in
fant
s is
fast
with
a h
igh
mor
talit
y ra
te (gt
50
)by
2 y
ears
of a
ge T
he m
edia
n ag
e of
dea
th in
the
first
two
year
s is
6 m
onth
s H
IV a
ntishy
body
tes
ting
amon
g ch
ildre
n ag
ed 1
8 m
onth
s or
mor
e is
abl
e to
det
erm
ine
whe
ther
a
child
is in
fect
ed o
r no
t
Dur
ing
preg
nanc
y m
othe
rs g
ive
thei
r ba
bies
ant
ibod
ies
to in
fect
ions
the
y ha
ve e
xper
ishyen
ced
and
thes
e an
tibod
ies
wan
e w
ith ti
me
Ant
ibod
y te
stin
g in
chi
ldre
n ag
ed le
ss th
an
18 m
onth
s id
entif
ies
child
ren
who
hav
e be
en e
xpos
ed to
thei
r m
othe
rsrsquo H
IV in
fect
ion
or
who
may
be
trul
y in
fect
ed a
nd a
re m
akin
g H
IV a
ntib
odie
s C
urre
ntly
the
re is
no
test
to
diff
eren
tiate
the
mot
herrsquos
ant
ibod
ies
from
tho
se p
rodu
ced
by t
he b
aby
In
orde
r to
id
entif
y th
e H
IV-in
fect
ed c
hild
age
d le
ss t
han
18 m
onth
s a
sec
ond
test
is r
equi
red
for
all b
abie
s te
stin
g po
sitiv
e on
ant
ibod
y te
stin
g or
kno
wn
to b
e H
IV-e
xpos
ed (m
othe
r is
H
IV-p
ositi
ve)
Infa
nt D
NA
(or
RN
A) P
CR
tes
ting
is t
he c
urre
nt r
ecom
men
ded
met
hod
for
EID
Sinc
e m
ost b
abie
s lo
se m
ater
nal a
ntib
odie
s (A
b) b
y 12
mon
ths
a n
egat
ive
antib
ody
test
will
ide
ntify
uni
nfec
ted
babi
es a
s lo
ng a
s th
ey a
re n
ot s
till
brea
stfe
edin
g A
pos
itive
antib
ody
test
at
12 m
onth
s a
lthou
gh h
ighl
y lik
ely
to b
e di
agno
stic
may
stil
l be
due
topa
ssiv
ely
carr
ied
mat
erna
l ant
ibod
ies
Suc
h te
sts
need
to
be c
onfir
med
by
PCR
tes
ting
or r
epea
t ant
ibod
y te
st a
t 18
mon
ths
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
4
9
58
CARE
SU
PPO
RTAN
DTR
EATM
ENT
FOR
HIV
PO
SITI
VEM
OTH
ERAN
DCH
ILD
HIV
-pos
itive
mot
hers
requ
ire c
are
and
supp
ort w
hich
incl
udes
bull
Cou
nsel
ing
bull P
roph
ylax
is a
nd tr
eatm
ent
bull L
ink
to s
uppo
rt g
roup
s an
d as
sess
men
t of
the
nee
d fo
r A
RT
bull E
arly
infa
nt d
iagn
osis
sho
uld
be p
rovi
ded
at s
ix w
eeks
usi
ng D
NA
shyP
CR
tes
ting
Cha
pter
ref
eren
ces
1
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
Pla
nnin
g
Guid
elin
es f
or
serv
ice
pro
vider
s
Rev
ised
in M
arch
2006
Foo
tnot
es
1
Pre
ble
and P
iwoz
2001
2
WH
O
Contr
ace
ptive
Elig
ibili
ty C
rite
ria
Guid
e
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
EFV
bef
ore
beco
min
g pr
egna
nt i
t sho
uld
be s
ubsi
tute
d w
ith N
VP
in th
e 1s
t tri
mes
ter
In c
ase
of s
ever
e hy
pere
mes
is g
ravi
daru
m A
RT
may
nee
d to
be
brie
fly in
terr
upte
d
On
aver
age
mot
her-
to-c
hild
tra
nsm
issi
on r
ates
are
15
for
sdN
VP
65
fo
r m
ore
effishy
caci
ous
dual
reg
imen
s an
d 2
4 fo
r 3-
drug
AR
V c
ombi
natio
n
Futu
re P
ersp
ectiv
es
Ext
ende
d pr
ophy
laxi
s w
ith 3
AR
V d
rug
com
bina
tions
sta
rtin
g du
ring
pre
gnan
cy a
nd
cont
inui
ng a
fter
del
iver
y fo
r a
peri
od o
f up
to
6 m
onth
s a
mon
g H
IV-in
fect
ed b
reas
t-fe
edin
g m
othe
rs h
as b
een
show
n in
a f
ew r
ecen
t an
d is
olat
ed s
tudi
es a
nd p
ilot
proshy
gram
me
to le
ad to
low
er b
reas
tfee
ding
-rel
ated
pos
tnat
al M
TCT
Thi
s ap
proa
ch m
ay b
e co
nsid
ered
whe
re th
is is
feas
ible
acc
epta
ble
saf
e an
d w
here
adh
eren
ce c
an b
e as
sure
d
Mor
e st
udie
s on
this
issu
e ar
e ex
pect
ed
Thre
e A
RV
dru
g co
mbi
natio
ns g
iven
to
HIV
pos
itive
pre
gnan
t w
omen
who
are
not
yet
el
igib
le fo
r in
itiat
ion
of A
RTs
for
thei
r ow
n he
alth
als
o le
ad to
low
er M
TCT
and
may
be
cons
ider
ed in
pro
gram
mes
with
the
capa
city
to in
itiat
e th
e re
gim
en a
nd fo
llow
up
such
wom
en S
uch
inte
rven
tion
is in
itiat
ed a
t ar
ound
28
wee
ks o
r so
on a
fter
and
sto
pped
af
ter
birt
h if
CD
4 co
unt i
s st
ill a
bove
350
cel
lsm
m3
App
endi
ces
Appen
dix
I
Appen
dix
II
Appen
dix
III
Appen
dix
IV
WH
O C
linic
al S
tagin
g o
f H
IVA
IDS f
or
Adults
and A
dole
scen
ts
w
ith c
onfirm
ed H
IV infe
ctio
n
Contr
acep
tive
Options
for
Peo
ple
Liv
ing w
ith H
IV
Sum
mar
y of
ARV D
rug U
se f
or
PMTCT o
f H
IV
In
tegra
ted M
onitori
ng a
nd E
valu
ation R
eport
Form
MO
H 7
26
Cha
pter
ref
eren
ces
1
Sum
mar
y of
ARV D
rugs
Adve
rse
Effec
ts a
nd M
anag
emen
t T
able
6-1
0
pages
101-1
12 o
f G
uid
elin
es f
or
Antire
trovi
ral D
rug T
her
apy
in K
enya
3rd
Editio
n
De-
cem
ber
2005
2
Dru
g I
nte
ract
ions
Tab
le 7
-10
pag
es 1
12-1
22 o
f G
uid
elin
es f
or
Antire
trovi
ral
Dru
g T
her
apy
in K
enya
3rd
editio
n
Dec
2005
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
7
50
Cha
pter
5
Imm
edia
te P
ostn
atal
and
Neo
nata
l Car
e 5
1 IN
TRO
DU
CTI
ON
Imm
edia
te p
ostn
atal
and
neo
nata
l car
e re
fers
to th
e pa
ckag
e of
ser
vice
s pr
ovid
ed to
the
mot
her
and
infa
nt b
efor
e th
ey le
ave
the
heal
th fa
cilit
y (u
p to
48
hour
s) a
fter
del
iver
yTh
e pe
riod
pro
vide
s an
opp
ortu
nity
to e
duca
te a
ll m
othe
rs a
bout
HIV
to
prov
ide
coun
shyse
lling
and
tes
ting
if it
was
not
don
e pr
evio
usly
and
to
rein
forc
e th
e ed
ucat
ion
proshy
vide
d du
ring
the
ant
enat
al p
erio
d B
oth
HIV
inf
ecte
d an
d H
IV u
ninf
ecte
d m
othe
rs
shou
ld r
ecei
ve th
is e
duca
tion
and
coun
selli
ng b
efor
e di
scha
rge
52
OPE
RA
TIO
NA
L G
UID
ELIN
ES
The
follo
win
g gu
idel
ines
sho
uld
be fo
llow
ed fo
r all
wom
en a
nd
infa
nts
in th
e im
med
iate
pos
t par
tum
per
iod
a)
Opt
imal
pos
tpar
tum
car
e
bull R
outin
e ca
re in
clud
ing
brea
st e
xam
inat
ion
exa
min
atio
n of
the
ute
rus
ex
amin
atio
n of
the
per
ineu
m a
nd lo
chia
pa
ssag
e of
uri
ne r
egul
arly
pr
oper
hyg
iene
to
prev
ent
infe
ctio
n c
heck
ing
for
sign
s of
ana
emia
fe
ver
and
tach
ycar
dia
bull D
iscu
ss m
ater
nal n
utri
tion
bull E
stab
lish
the
HIV
sta
tus
of t
he m
othe
rs in
clud
ing
thos
e gi
ving
birt
h ou
tsid
e th
e he
alth
inst
itutio
n se
tting
bull P
rovi
de H
IV C
T f
or m
othe
rs w
ith u
nkno
wn
HIV
sta
tus
bull E
ncou
rage
HIV
res
ults
dis
clos
ure
and
part
ner
test
ing
bull F
ollo
w t
he s
tand
ard
guid
elin
es o
n th
e ca
re o
f a n
ewbo
rn (
IMP
AC
C
are
Man
ual)
bull A
ll ba
bies
sho
uld
rece
ive
thei
r ro
utin
e im
mun
izat
ion
(OP
V a
nd B
CG
) in
th
eir
first
hou
rs o
f lif
e1
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Con
trac
eptio
n A
ll m
othe
rs r
egar
dles
s of
the
ir H
IV s
tatu
s h
ave
a ri
ght
to r
ecei
ve a
dequ
ate
info
rmashy
tion
on a
vaila
ble
met
hods
of f
amily
pla
nnin
g an
d to
mak
e an
info
rmed
cho
ice
on w
hat
is b
est
for
them
H
IV-in
fect
ed w
omen
who
are
not
bre
astf
eedi
ng s
houl
d in
itiat
e a
relia
ble
cont
race
ptiv
e m
etho
d by
2-4
wee
ks p
ostp
artu
m
This
is
in a
dditi
on t
o th
epr
oper
and
con
sist
ent
use
of t
he c
ondo
m a
s a
form
of
dual
pro
tect
ion
All
met
hods
of
cont
race
ptio
n ca
n be
use
d by
HIV
pos
itive
wom
en b
ased
on
stan
dard
med
ical
elig
ibili
tycr
iteri
a in
clud
ing
taki
ng c
are
of d
rug
inte
ract
ions
as
outli
ned
belo
w2
bull L
acta
tiona
l Am
enor
rhoe
a M
etho
d (L
AM
) S
uita
ble
for
excl
usiv
ely
brea
stfe
edin
g H
IV in
fect
ed w
omen
who
hav
e no
t re
sum
ed m
ense
s
bull H
orm
onal
con
trac
eptio
n A
ll ho
rmon
al c
ontr
acep
tives
can
be
used
in
HIV
pos
itive
wom
en in
clud
ing
thos
e on
HA
AR
T
Com
bine
d or
al
cont
race
ptiv
es a
re c
ontr
aind
icat
ed f
or u
se w
ith d
rugs
that
indu
ce
hepa
tic m
icro
-enz
yme
that
may
red
uce
the
effe
ctiv
enes
s of
hor
mon
al
cont
race
ptiv
es
Som
e an
ti-T
Bs
ant
iret
rovi
rals
an
tifun
gals
and
ant
i-ep
ilept
ics
and
in c
ondi
tions
tha
t ca
use
mal
abso
rptio
n8
bull I
ntra
-ute
rine
con
trac
eptiv
e de
vice
s (I
UC
Ds)
IU
CD
s ar
e no
t co
ntra
indi
cate
d in
HIV
pos
itive
wom
en
In s
ever
ely
imm
uno
supp
rese
d w
omen
use
sho
uld
not
be d
isco
ntin
ued
but
new
inse
rtio
n is
dis
cour
aged
as
it m
ay b
e as
soci
ated
with
incr
ease
d ri
sk o
f in
fect
ion
duri
ng t
he in
sert
ion
proc
ess
bull S
urgi
cal m
etho
ds S
urgi
cal c
ontr
acep
tion
shou
ld b
e of
fere
d to
HIV
po
sitiv
e w
omen
and
the
ir pa
rtne
rs
bull B
arri
er m
etho
ds
Fem
ale
and
mal
e co
ndom
s pr
ovid
e pr
otec
tion
agai
nst
ST
Ds
and
redu
ce t
he r
isk
of H
IV t
rans
mis
sion
and
sho
uld
be
enco
urag
ed a
lone
or
toge
ther
with
oth
er c
ontr
acep
tive
met
hods
bull S
perm
icid
es
Use
d in
con
junc
tion
with
bar
rier
met
hods
spe
rmic
ides
w
ill p
rovi
de a
dditi
onal
con
trac
eptiv
e pr
otec
tion
How
ever
sp
erm
icid
es s
houl
d no
t be
use
d al
one
as t
hey
can
incr
ease
the
ris
k of
HIV
acq
uisi
tion
bull E
mer
genc
y co
ntra
cept
ion
HIV
pos
itive
wom
en s
houl
d be
info
rmed
ab
out
emer
genc
y co
ntra
cept
ion
whe
re it
is a
vaila
ble
and
how
to
obta
in a
nd u
se it
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
1
56
Bre
ast c
are
in b
reas
tfeed
ing
mot
hers
bull E
ncou
rage
dai
ly c
lean
ing
of t
he b
reas
ts a
nd a
void
ing
the
appl
icat
ion
of lo
tions
bull T
reat
mat
erna
l vag
inal
can
didi
asis
and
infa
nt o
ral c
andi
dias
is
bull E
duca
te m
othe
r on
opt
imal
bre
astf
eedi
ng te
chni
que
incl
udin
g la
tchi
ng
on t
echn
ique
ex
lusi
ve b
reas
tfee
ding
and
rem
ovin
g ba
by f
rom
bre
ast
bull E
duca
te th
e m
othe
r on
bre
ast c
are
to p
reve
nt c
ompl
icat
ions
(cr
acki
ng
and
engo
rgem
ent)
bull E
xpre
ss a
nd h
eat
trea
t th
e m
ilk if
bre
ast
has
mas
titis
or
absc
ess
Opt
imal
pos
tpar
tum
car
e fo
r HIV
pos
itive
wom
en
Loch
ia
bull P
ut e
mph
asis
on
good
per
inea
l hyg
iene
and
pro
per
hand
ling
of b
ody
fluid
s
bull A
void
con
tam
inat
ing
the
baby
with
bod
y flu
ids
or w
ith b
eddi
ng s
oile
d w
ith lo
chia
bull S
hari
ng o
f be
ds b
y m
othe
rs in
the
hos
pita
l sho
uld
be d
isco
urag
ed
Cae
sare
an S
ectio
n
Bro
ad s
pect
rum
ant
ibio
tics
shou
ld b
e us
ed r
outin
ely
afte
r C
S
Esse
ntia
l mat
erna
l edu
catio
n an
d fo
llow
-up
bull M
onito
r fo
r br
east
and
pel
vic
infe
ctio
n at
all
post
nat
al c
linic
vis
its
bull E
duca
te o
n pr
ompt
hea
lth s
eeki
ng b
ehav
iour
bull H
ealth
edu
catio
n on
hyg
iene
lo
chia
and
bre
ast
care
bull A
void
sex
ual i
nter
cour
se f
or a
t lea
st 2
wee
ks a
fter
birt
h or
unt
il th
ere
is
no lo
nger
any
loch
ia r
ubra
or
sero
sa
bull D
o pa
p sm
ear
or V
IA a
t 4-
6 w
eeks
bull F
or e
very
sex
ual a
ctiv
ity
the
coup
le s
houl
d us
e co
ndom
s
bull D
iscu
ss f
amily
pla
nnin
g at
eve
ry o
ppor
tuni
ty a
nd p
rovi
de t
he
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Supp
ort
infa
nt fe
edin
g op
tions
For
all
HIV
neg
ativ
e w
omen
wom
en o
f unk
now
n H
IV
stat
us a
nd H
IV p
ositi
ve m
othe
rs o
ptin
g fo
r ex
clus
ive
brea
stfe
edin
g in
itiat
e br
east
feed
shyin
g w
ithin
hal
f hou
r of
bir
th a
nd fo
llow
oth
er g
uide
lines
as
per
Bab
y Fr
iend
ly H
ospi
tal
Initi
ativ
e2 (B
FHI)
bull G
ive
info
rmat
ion
on fa
mily
pla
nnin
g an
d du
al p
rote
ctio
n
bull C
ouns
el o
n H
IV r
isk
redu
ctio
n
bull S
ched
ule
post
nata
l clin
ic v
isits
at
2 w
eeks
and
at
4-6
wee
ks a
nd
com
plet
e m
othe
r-ch
ild b
ookl
et (
refe
r to
DR
H m
anua
l)
(b) S
peci
fic p
ostp
artu
m c
are
for H
IV p
ositi
ve w
omen
bull S
uppo
rt e
xclu
sive
bre
astf
eedi
ng u
nles
s m
othe
r ha
s ap
prop
riat
ely
opte
d fo
r an
d be
en c
ouns
elle
d on
rep
lace
men
t fe
edin
g an
tena
tally
bull I
nitia
te o
r co
ntin
ue c
o-tr
imox
azol
e pr
ophy
laxi
s -1
dou
ble
stre
ngth
tab
shyle
t da
ily
bull F
or H
IV p
ositi
ve m
othe
rs t
hat
rece
ived
sd
nevi
rapi
ne in
trap
artu
m
initi
shyat
e A
ZT
300m
g an
d 3T
C 1
50 m
g B
D f
or 1
wee
k
bull F
or n
ewly
dia
gnos
ed m
othe
rs
do H
IV s
tagi
ng
CD
4 co
unt
and
refe
r ap
prop
riat
ely
for
cont
inue
d ca
re
(c)
Spec
ific
care
for H
IV e
xpos
ed in
fant
s
bull F
or H
IV e
xpos
ed in
fant
s a
dmin
iste
r sd
NV
P 2
mg
kg s
tat
with
in 7
2 ho
urs
Giv
e A
ZT
4 m
gkg
BID
for
6 w
eeks
and
3T
C 4
mg
kg B
ID f
or 1
w
eek
Ref
er t
o C
hapt
er 4
bull R
efer
to C
hapt
er 8
for
deta
ils o
n in
fant
fee
ding
opt
ions
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
5
52
Cha
pter
ref
eren
ces
1
Rep
ublic
of
Ken
ya M
inis
try
of
Hea
lth
Div
isio
n o
f Rep
roduct
ive
Hea
lth
Nat
ional
Guid
elin
es f
or
Qual
ity
Obst
etri
cs a
nd P
erin
ata
l Car
e (2
004)
2
2R
epublic
of
Ken
ya M
inis
try
of
Hea
lth
Ess
ential
Obst
etri
c C
are
Man
ual
for
Hea
lth
Ser
vice
Pro
vider
s in
Ken
ya 3
rd E
ditio
n (
Jan 2
006)
Foo
tnot
es
1
WH
O r
ecom
men
ds
that
all
vacc
ines
should
be
giv
en t
o H
IV-s
ero-n
egat
ive
child
ren
and t
o a
sym
pto
mat
ic s
ero-p
osi
tive
s
The
only
vac
cines
to b
e w
ithhel
d f
rom
child
ren w
ith s
ympto
mat
ic A
IDS a
re B
CG
and
Yel
low
fev
er v
acc
ines
2
The
ldquoTen
Ste
psrdquo
of
BFH
I R
ecom
men
ded
Pra
ctic
es f
or
Mat
ernity
Ser
vice
s ad
apte
d f
or
W
HO
UN
ICEF
1989
Cha
pter
6
Late
Pos
tnat
al C
are
and
Fam
ily P
lann
ing
61
INTR
OD
UC
TIO
N
Late
pos
tnat
al c
are
is p
rovi
ded
to t
he m
othe
r an
d th
e ch
ild 4
8 ho
urs
to 6
wee
ks a
fter
deliv
ery
Dur
ing
this
per
iod
the
heal
th o
f the
mot
her
and
child
is a
sses
sed
and
clos
ely
mon
itore
d
The
risk
of M
TCT
duri
ng th
e po
stpa
rtum
per
iod
can
be r
educ
ed b
y pr
ovid
ing
HIV
cou
nshyse
lling
and
test
ing
pos
t-ex
posu
re p
roph
ylax
is fo
r ex
pose
d ba
bies
cou
nsel
ling
on a
ppro
shypr
iate
infa
nt fe
edin
g op
tions
and
bre
ast c
are
Pos
tpar
tum
car
e fo
r H
IV p
ositi
ve w
omen
shou
ld in
clud
e cl
inic
al s
tagi
ng C
D4
coun
t and
AR
T fo
r th
ose
who
qua
lify
Fam
ily p
lann
ing
serv
ices
are
am
ong
the
core
inte
rven
tions
of P
MTC
T pr
ovid
ed to
hel
pw
omen
det
erm
ine
futu
re c
hild
bear
ing
patt
erns
inc
ludi
ng t
he p
reve
ntio
n of
HIV
-in
fect
ed b
irth
s
Rep
rodu
ctiv
e he
alth
cou
nsel
ling
can
help
a w
oman
pra
ctis
e sa
fer
sex
and
dete
rmin
e he
r fu
ture
ch
ildbe
arin
g pa
tter
ns
on
a m
ore
resp
onsi
ble
and
info
rmed
bas
is1
62
OPE
RA
TIO
NA
L G
UID
ELIN
ES
Opt
imal
pos
tpar
tum
car
e fo
r all
wom
en
This
ent
ails
rou
tine
care
inc
ludi
ng b
reas
t ex
amin
atio
n e
xam
inat
ion
of t
he u
teru
s
exam
inat
ion
of t
he p
erin
eum
and
loch
ia p
assa
ge o
f uri
ne r
egul
arly
pro
per
hygi
ene
topr
even
t in
fect
ion
che
ckin
g fo
r si
gns
of a
nem
ia
feve
r an
d ta
chyc
ardi
a an
d do
ing
peri
neal
exe
rcis
es
Add
ition
al c
are
incl
udes
bull C
ouns
ellin
g an
d te
stin
g fo
r m
othe
rs o
f un
know
n H
IV s
tatu
s bull
Pro
visi
on o
f co
ndom
s an
d ris
k re
duct
ion
coun
selli
ng
bull C
ouns
ellin
g on
con
trac
eptiv
e op
tions
in
clud
ing
dual
met
hod
use
bull D
iscu
ssin
g m
ater
nal n
utrit
ion
bull M
alar
ia p
reve
ntio
n bull
Scr
eeni
ng f
or S
TI a
nd c
ervi
cal c
ance
r
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
Guid
elin
es for
Prev
ention o
f M
oth
er t
o C
hild
Tra
nsm
issi
on (
PM
TCT)
of H
IVA
IDS in K
enya
(3rd
Editio
n)
5
3
54
