• Prevention of mother-to-child transmission (PMTCT) of HIV, Syphilis and Hepatitis B
(triple elimination) should be offered as part of a comprehensive package of fully
integrated, routine antenatal care interventions.
• All pregnant women, unless known positive, should be counseled and tested for HIV, Syphilis (using the HIV-Syphilis dual test) and HBV during their first ANC visit, and if negative a repeat HIV-Syphilis dual test should be performed in the 3rd trimester.
• Lifelong ART should be initiated in all pregnant and breastfeeding women living
with HIV, regardless of gestational age, WHO clinical stage or CD4 count
• ART should be started as soon as possible, ideally on the same day HIV diagnosis is made,
with ongoing enhanced adherence support
• The preferred first line ART regimen for pregnant and breastfeeding women is TDF + 3TC
• For pregnant and breastfeeding women newly initiated on ART, obtain VL 3 months after
initiation, and then every 6 months until complete cessation of breastfeeding
• For HIV positive women already on ART at the time of confirming pregnancy or
breastfeeding, obtain a VL irrespective of when prior VL was done, and then every 6
months until complete cessation of breastfeeding.
• For pregnant or breastfeeding women with a VL ≥ 200 copies/ml (unsuppressed): assess for and address potential reasons for viremia, including intensifying adherence support, and repeat the VL after 3 months of excellent adherence.
If the repeat VL is < 200 copies/ml (suppressed) then continue routine
If the repeat VL is ≥ 1,000 copies/ml (treatment failure), prepare for change to
an effective regimen.
If the repeat VL is 200 – 999 copies/ml (low level viremia), reassess adherence
and other causes of viremia and consult the Regional or National TWG.