Selecting regimen and dispensing infant prophylaxis

Clinical description

• Dispense NVP syrup or 2P tablets based on maternal risk assessment and birth weight (see below

and Table 22 on page 109)

• As soon as the mother is known to be HIV-infected at ANC (or maternity):

o Demonstrate how to give ARV prophylaxis to the baby.

o Dispense the total amount needed for the 6-week course to take home.

o Unopened bottles of NVP syrup or 2P have a long shelf-life. Therefore, never delay dispensing until later in pregnancy. Make sure the expiry date is at least 2 months after the estimated delivery date.

o Ask at every following visit if the 2P or NVP syrup and the syringes are still available. Replace without delay any items that may have been lost or spoilt.

Newborn care and postnatal follow up 109 High risk infant prophylaxis

• Infants with any of the following conditions are at high risk

o Mother initiating or re-starting ART in 2nd or 3rd trimester, at maternity or post-partum o Mother interrupted ART in pregnancy o Mother with known low-level viraemia or viraemia 1000+ during pregnancy/ delivery or within the first 4 weeks post-partum

• Dispense 1 tin of 60 tabs of 2P to take home.
• Give 1⁄4 tablet of 2P (AZT/3TC/NVP) 12-hourly for 6 weeks. Explain:

o Dissolve the 1⁄4 tablet in a clean spoon with some expressed breastmilk.

o Ensure the entire amount is actually swallowed.

o Give 1⁄4 of the split 2P tablet in the morning and the other 1⁄4 in the evening to average out the daily dosing. This is because splitting 2P tablets into quarters may not be very accurate.

o Note: Minimum birth weight for 2P infant prophylaxis is 3000g. Use NVP syrup for smaller high-risk babies.

Low risk infant prophylaxis

• Infants without any of the high-risk conditions listed above.
• Dispense 2 x 100ml-bottles of NVP syrup with dosing syringe to take home.
• Give 1.5 ml NVP syrup 24-hourly. Give 1.0 ml to babies below 2500g birth weight.