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Package of essential services for pregnant and postpartum women and their children Updated and adapted from: Interagency Task Team on Prevention of HIV Infection in Pregnant Women, Mothers and their Children. Guidance on global scale-up of the prevention of mother-to-child transmission of HIV: towards universal access for women, infants and young children and eliminating HIV and AIDS among children. Geneva, World Health Organization, 2007 (www.who.int/hiv/pub/mtct/pmtct_scaleup2007/en/index.html) and Annex 1 of: Antiretroviral drugs for treating pregnant women and preventing HIV infections in infants: recommendations for a public health approach. 2010 version. Geneva, World Health Organization, 2007 2010 (http://whqlibdoc.who.int/publications/2010/9789241599818_eng.pdf). Package of essential services for high-quality maternal care Package of routine high-quality pregnancy, childbirth and postpartum care for all women, regardless of HIV status 1. Health education, information on: HIV and sexually transmitted infection prevention and care including safer sex practices; pregnancy including antenatal care, birth preparedness planning and assistance; malaria prevention and treatment; optimal infant feeding counselling; family planning counselling and related services; plan for essential newborn care; and postpartum follow-up 2. Provider-initiated HIV testing and counselling, including HIV testing and counselling for women of unknown status at labour and delivery, or postpartum during the breastfeeding period, and re-testing of women previously tested HIV-negative 3. Couples and partner HIV testing and counselling, including support for disclosure, risk reduction and ART for the HIV-positive partner in serodiscordant couples 4. Promotion and provision of condoms 5. Gender-based violence screening 6. Essential obstetric care, including history-taking, partograph monitoring, laboratory screening, physical examination and screening for high risk pregnancy and high risk for HIV 7. Maternal nutritional support 8. Counselling on infant feeding 9. Psychosocial support 10. Birth preparedness planning (including pregnancy and postpartum danger signs), facility delivery by skilled birth attendants; universal precautions; and postnatal care in facility before discharge for the mother and newborn for at least 24 hours after birth 11. Tetanus vaccination 12. Micronutrient supplementation (such as iron and folate) 1
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13. Syphilis screening and management of sexually transmitted infections 14. Hepatitis B screening (depending on context) and immunization for newborns 15. Harm reduction interventions for people who inject drugs 16. Information and counselling on early infant male circumcision where appropriate 17. Postnatal follow-up, including postnatal contacts on day 3 and between days 7–14 after birth and at 6 weeks (first immunization visit)
Additional package of services for women living with HIV 1. Additional counselling and support to encourage partner testing, adoption of risk reduction and disclosure and ART for serodiscordant couples 2. Clinical evaluation, including clinical staging of HIV disease 3. Immunological assessment (CD4 cell count) where available 4. Initiation of first-line ART; continued lifelong (option B+) or throughout the mother-to-child transmission risk period, depending on national policy and ART eligibility 5. Breastfeeding counselling and support 6. Co-trimoxazole prophylaxis where indicated 7. Additional counselling and provision of services as appropriate to prevent unintended pregnancies 8. Supportive care, including adherence and retention support 9. TB screening and treatment when indicated; preventive therapy (isoniazid prophylaxis) when appropriate 10. Advice and support on other prevention interventions, such as safe drinking-water 11. Supportive care, including adherence support, and palliative care and symptom management 12. Safe delivery practices, including minimizing invasive monitoring, avoiding prolonged rupture of membranes, reducing fetal and infant contact with maternal blood and secretions, no routine episiotomy; caesarean section only when medically indicated (not specifically for HIV) 13. Plan and support for postpartum follow-up for both mother and infant; continued ART for mother and prophylaxis for infant
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WHO/HIV/2013.59 Package of essential services for high-quality maternal care
© World Health Organization 2013
Additional package of services for all women regardless of HIV status in specific settings 1. Malaria prevention and treatment 2. Counselling, psychosocial support and referral for women who are at risk of or have experienced violence 3. Counselling and referral for women with a history of harmful alcohol or drug use 4. De-worming 5. Consider retesting late in pregnancy women previously tested HIV-negative where feasible in generalized epidemics 6. Hepatitis immunization
Essential postpartum care for mothers living with HIV and HIV-exposed infants and young children Mothers 1. Plan for maternal ART follow-up, including linkage with chronic care and treatment (continue ART either lifelong, or during the mother-to-child transmission risk period, depending on national policy and ART eligibility); treatment monitoring 2. Plan for needed follow up of the HIV-exposed child; review plan for breastfeeding in the context of HIV and ART care 3. Co-trimoxazole prophylaxis, where indicated 4. Adherence and retention support; peer support and community support 5. Reassessment of family HIV treatment and care needs
Infants and young children 1. Essential newborn and infant care, including routine immunization and growth monitoring 2. Co-trimoxazole prophylaxis 3. HIV early infant diagnosis testing (target at 6-week immunization visit); if positive, start on early ART; if negative or not tested, continue to monitor with later testing and final diagnosis testing
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after 18 months or at the end of the mother-to-child transmission risk period 4. Monitor for HIV-related clinical conditions 5. Continued infant feeding counselling and breastfeeding support, especially after early HIV testing; nutritional support, supplements and replacement foods if indicated 6. ART for children living with HIV (start in all children <5 years of age, regardless of clinical or immunological criteria); treatment monitoring 7. Assess and treat for related conditions: TB exposure, opportunistic infections and malaria 8. Diagnosis and management of common childhood infections and conditions and Integrated Management of Childhood Illness (IMCI)
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