Integrated mother/infant follow-up

Clinical description

• Ensure continued follow-up for HIV infected mothers and babies. Schedule mothers and babies

together on the same clinic day, as well as other family members if desired.

• Women in outreach and mobile ART services and in DICs should return to regular ART clinic for the

duration of pregnancy and breastfeeding.

• Enrol baby in HCC before discharge from post-natal ward:

o Fill Exposed Child patient card, enter in HCC register.

• Mothers on ART before delivery:

o Confirm next ART appointment.

o Synchronise mother’s ART appointment with baby’s first HCC visit. Aim for first HCC visit at post-natal visit or first vaccination visit.

Newborn care and postnatal follow up

• Mother initiated ART in labour:

o Fill ART patient card and enter in ART register.

o Write baby’s HCC registration number and date of birth on mother’s ART card.

o Give regular 4-week ART + HCC appointment.

• If mother wants to continue HCC and ART at another facility:

o Record ‘transfer out’ in HIV clinic and ART register and give mother her ART patient card and the baby’s Exposed child card.