eMTCT Strategy

Clinical description

• Dual elimination of mother-to-child transmission (EMTCT) of HIV and syphilis is a public health

priority for Malawi.

• Commitment to the triple eMTCT of HIV, syphilis, and hepatitis B is forthcoming.
• Multiple strategies are available to prevent the transmission of HIV from mother to child and

to reduce the HIV burden among mothers and their children.

• These strategies are grouped into the 4 Prongs of the national PMTCT program.
• Implemented together, these strategies have resulted in a drastic reduction of HIV infections

among children. Further scale-up is expected to virtually eliminate new paediatric HIV infections and AIDS deaths among children.

• Key interventions from all 4 PMTCT prongs are covered in these guidelines, but some medical

and non-biomedical interventions are beyond the scope of this document and are covered in separate guidelines.

Prong 1: Primary prevention of HIV infection in the general population

• Behaviour change communication to reduce risky sexual contacts

o Separate strategy

• Provision of condoms

o Section 11.1 Provider initiated family planning (PIFP)

o Separate condom strategy

• Voluntary medical male circumcision for HIV negative men to reduce the risk of HIV acquisition and

onward transmission o Separate MOH guidelines

• Scale-up of HIV testing in high-yield settings for early diagnosis and ART referral

o Section 6.1: Routine ascertainment of HIV infection status for children and adults

• ART provision for all HIV infected adults and children, (regardless of CD4 count and/or clinical

stage) to reduce morbidity and mortality and to prevent onward transmission o Section 16.1: When to start ART o Section 18.7: Achieving optimal adherence

• Viral load monitoring and timely switch to 2nd or 3rd line for patients on ART to ensure viral

suppression and to reduce the risk of onward transmission o Section 18.10: Monitoring for treatment failure / HIV drug resistance

• Pre-exposure prophylaxis

o Section 22: Pre-exposure prophylaxis (PrEP)

• Post-exposure prophylaxis

o Section 23: Post exposure prophylaxis (PEP)

Prong 2: Prevention of unintended pregnancies among HIV positive women

• Provider initiated family planning in ART clinics

o Section 11.1 Provider initiated family planning (PIFP)

o Separate MOH guidelines: National Sexual and Reproductive Health and Rights Policy Prong 3: Preventing transmission of HIV from infected women to their children

• Provider initiated testing at MNCH settings for early HIV diagnosis and ART initiation

o Section 6.1: Routine ascertainment of HIV infection status for children and adults o Section 20.1: HIV, syphilis and hepatitis B status ascertainment at maternity

• Initiation of lifelong ART for all HIV infected pregnant and breastfeeding women (regardless of CD4

count and/or clinical stage) to reduce the risk of transmission to the child.

o Section 16.1: When to start ART

• Safe obstetric practices

o Section 20.3: Reduce obstetric risk of HIV transmission

• Provision of infant HIV prophylaxis with 2P or Nevirapine

o Section 21.3: Infant HIV prophylaxis

• Infant feeding advice to reduce the risk of transmission through breastmilk

o Section 21.2: Infant and child feeding Prong 4: Care, treatment and support for HIV-infected women and their children and families o Section 4: Integrating HIV clinical services o Section 6.2: Routine ascertainment of HIV exposure status for children under 24 months o Section 21.1: Integrated mother/infant follow-up o Section 8: HIV-related diseases o Section 11: Preventive services for HIV patients o Section 11.2: Cotrimoxazole preventive therapy (CPT)

o Section 11.3: TB Preventive Therapy (TPT)

o Section 12: Management of non-communicable diseases o Section 18.9: Special treatment support for children and adolescents Diagnosing HIV infection and exposure