Preventing Mother-to-Child Transmission
Maternal ART, infant prophylaxis, the early diagnosis schedule and feeding advice · v1.7- Enter the maternal ART status, the latest viral load, the gestational age and the mode of delivery.
- Add the infant birth weight band and the planned feeding, or record that the baby is not yet born.
- You get the maternal regimen, the infant prophylaxis with its dose, and the early infant diagnosis schedule.
- Under Option B+ every pregnant and breastfeeding woman receives lifelong ART, whatever the CD4 count or WHO stage.
- The Evidence and Pearls tab holds the infant nevirapine and zidovudine doses by birth weight.
- ART for an infant with confirmed infection, which is referred to a paediatric ART centre.
- The obstetric decision. It takes the mode of delivery as an entry rather than advising on one.
- A volume in millilitres below 2.0 kg. Both infant tables give a milligram per kilogram dose there and leave the volume to be worked out at the cot side.
- Switching a mother whose viral load stays at 1000 copies/mL or above, which the Virological Failure pathway decides.
1. Maternal Parameters
2. Infant Parameters
PMTCT Evidence Summary
2. Infant AZT Dosing (High-Risk Prophylaxis)
3. Early Infant Diagnosis (EID) Schedule
MTCT risk without intervention: 15 to 45% (5 to 10% in utero, 10 to 15% during labour, 5 to 20% through breastfeeding). With the full PMTCT package in place, the risk falls to < 2%.
1. Infant NVP Dosing by Weight
| Birth Weight | NVP Dose | Volume (10mg/mL syrup) |
|---|---|---|
| ≥ 2.5 kg | 15mg OD | 1.5 mL OD |
| 2.0 to 2.49 kg | 10mg OD | 1.0 mL OD |
| < 2.0 kg | 2mg/kg OD | Calculate per weight |
| Birth Weight | AZT Dose | Volume (10mg/mL syrup) |
|---|---|---|
| ≥ 2.5 kg | 4mg/kg BD | Calculate per weight |
| 2.0 to 2.49 kg | 2mg/kg BD | Calculate per weight |
| < 2.0 kg | 2mg/kg BD | Calculate per weight |
| Age | Test | Rationale |
|---|---|---|
| 6 weeks | HIV DNA PCR (DBS) | First virological test. Detects in utero / intrapartum transmission. |
| 6 months | HIV DNA PCR | Detects breastfeeding transmission. Repeat if still breastfeeding. |
| 12 months | HIV DNA PCR (if breastfeeding) | End-of-breastfeeding test. |
| 18 months | HIV Antibody (Rapid test) | Confirmatory. Maternal antibodies have cleared by 18 months, so a positive result is now the infant's own. |
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
- 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.
- NACO. National Guidelines for Prevention of Parent-to-Child Transmission of HIV. 2021. [Superseded by the 2024 guideline above]
- NACO. National Guidelines for HIV Care and Treatment. 2021.
- WHO. Consolidated guidelines on HIV. 2021.
- 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.
How to Cite This Tool
DOIhttps://doi.org/10.5281/zenodo.22401596
AMA Style:Umakanth S. Preventing Mother-to-Child Transmission. Version 1.7. MEDiscuss Clinical Decision Support System. Published 2026. Accessed . https://mediscuss.org/cdss/hiv-pmtct. doi:10.5281/zenodo.22401596
Vancouver Style:Umakanth S. Preventing Mother-to-Child Transmission [Internet]. Version 1.7. MEDiscuss.org; 2026 [cited ]. Available from: https://mediscuss.org/cdss/hiv-pmtct. doi:10.5281/zenodo.22401596
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Category Therapeutic & Management PathwaysPathway
Specialties Internal Medicine, Infectious Diseases, Obstetrics & Gynaecology, Paediatrics, HIV Medicine