Mother-to-Child Transmission (PMTCT) Pathway

Prevention of Mother-to-Child Transmission · NACO 2021 · v1.7
← HIV Clinical Hub
How to use this tool: Enter the maternal and infant details at the relevant stage. The tool returns the PMTCT plan. Under Option B+, all pregnant and breastfeeding women living with HIV receive lifelong ART, whatever the CD4 count or WHO stage.
1. Maternal Parameters
2. Infant Parameters
PMTCT Evidence Summary
MTCT risk without intervention: 15 to 45% (5 to 10% in utero, 10 to 15% during labour, 5 to 20% through breastfeeding). With optimal PMTCT, risk reduces to < 2%.
1. Infant NVP Dosing by Weight
Birth WeightNVP DoseVolume (10mg/mL syrup)
≥ 2.5 kg15mg OD1.5 mL OD
2.0 to 2.49 kg10mg OD1.0 mL OD
< 2.0 kg2mg/kg ODCalculated per weight
2. Infant AZT Dosing (High-Risk Prophylaxis)
Birth WeightAZT DoseVolume (10mg/mL syrup)
≥ 2.5 kg4mg/kg BDCalculate per weight
2.0 to 2.49 kg2mg/kg BDCalculate per weight
< 2.0 kg2mg/kg BDCalculate per weight
3. Early Infant Diagnosis (EID) Schedule
AgeTestRationale
6 weeksHIV DNA PCR (DBS)First virological test. Detects in utero / intrapartum transmission.
6 monthsHIV DNA PCRDetects breastfeeding transmission. Repeat if still breastfeeding.
12 monthsHIV DNA PCR (if breastfeeding)End-of-breastfeeding test.
18 monthsHIV Antibody (Rapid test)Confirmatory. Maternal antibodies cleared by 18 months.
Abbreviations: AFASS (Affordable, Feasible, Acceptable, Sustainable, Safe) · ART (Antiretroviral Therapy) · AZT (Zidovudine) · BD (Twice Daily) · BF (Breastfeeding) · CD4 (Cluster of Differentiation 4) · CrCl (Creatinine Clearance) · DBS (Dried Blood Spot) · DNA (Deoxyribonucleic Acid) · DTG (Dolutegravir) · EID (Early Infant Diagnosis) · GA (Gestational Age) · Hb (Haemoglobin) · HIV (Human Immunodeficiency Virus) · LBW (Low Birth Weight) · MTCT (Mother-to-Child Transmission) · NACO (National AIDS Control Organisation) · NTD (Neural Tube Defect) · NVP (Nevirapine) · OD (Once Daily) · PCR (Polymerase Chain Reaction) · PHC (Primary Health Centre) · PMTCT (Prevention of Mother-to-Child Transmission) · SBAR (Situation, Background, Assessment, Recommendation) · TDF (Tenofovir Disoproxil Fumarate) · TLd (Tenofovir + Lamivudine + Dolutegravir) · VL (Viral Load) · VLBW (Very Low Birth Weight) · WHO (World Health Organization) · 3TC (Lamivudine)
References
  1. National AIDS Control Organisation (NACO), Ministry of Health and Family Welfare, Government of India. National Guidelines for Elimination of Vertical Transmission of HIV and Syphilis. New Delhi: NACO; 2024. [Current NACO guidance. Elimination of vertical transmission is Goal 3 of NACP Phase V. The terminology has moved from "prevention of parent-to-child transmission" to "elimination of vertical transmission", and syphilis is now managed alongside HIV in a single document.]
  2. NACO. National Guidelines for Prevention of Parent-to-Child Transmission of HIV. 2021. [Superseded by the 2024 guideline above. This is the document the pathway logic in this module was built from, and the logic has not yet been re-checked against the 2024 edition.]
  3. NACO. National Guidelines for HIV Care and Treatment. 2021.
  4. WHO. Consolidated guidelines on HIV. 2021.
  5. World Health Organization. WHO updated recommendations on HIV clinical management: recommendations for a public health approach. Geneva: WHO; 7 January 2026. [First substantial revision since 2021. DRV/r becomes the preferred boosted PI; supports reuse of TDF and ABC in subsequent regimens; long-acting injectable ART and oral two-drug regimens in defined circumstances; revised vertical transmission and TB preventive treatment guidance. NACO remains the operative source for Indian practice.]
How to Cite

AMA: Umakanth S. Mother-to-Child Transmission (PMTCT) Pathway. MEDiscuss. 2026. Accessed .

Vancouver: Umakanth S. Mother-to-Child Transmission (PMTCT) Pathway [Internet]. MEDiscuss.org; 2026 [cited ]. Available from:

Disclaimer and scope
Disclaimer: This decision-support system is intended for healthcare professionals. It does not substitute clinical judgment. These algorithms are evidence-based, but medical knowledge evolves continuously. The treating physician retains absolute responsibility for all diagnostic, dosing, and therapeutic decisions. Always verify outputs against current institutional protocols and individual patient contexts.
© 2026 MEDiscuss.org. All rights reserved. This CDSS Module was designed and developed by Dr. Shashikiran Umakanth using the available evidence base. Provided free of charge for clinical use. Unauthorised reproduction or redistribution is strictly prohibited.
Category Therapeutic & Management PathwaysPathway
Specialties Internal Medicine, Infectious Diseases, Obstetrics & Gynaecology, Paediatrics, HIV Medicine
Written and maintained by Dr Shashikiran Umakanth.
Last revised: 8 August 2026
Related Clinical Tools
First-Line ART SelectionPregnancy & Antenatal SchedulerHIV Clinical Pathway Hub
Back to All Medical Calculators & Pathways