Prevention of Mother to Child Transmission (PMTCT)

Mother-to-child transmission of HIV is the most common way young children contract the virus and happens when HIV is passed from a mother to her unborn baby during pregnancy, birth or breastfeeding. 

An effective Prevention of Mother to Child Transmissions (PMTCT) programme requires mothers and their babies to:

• Receive antenatal services and HIV testing during pregnancy
• Have access to antiretroviral treatment (ART)
• Practice safe childbirth practices and appropriate infant feeding
• Make use of infant HIV testing and other post-natal healthcare services.

South Africa's PMTCT guidelines divide the national PMTCT programme into 3 phases:

Antenatal care during pregnancy

When a mother goes to the clinic, midwife obstetric unit (MOU) or hospital for her first antenatal visit, she's offered routine HIV counselling and voluntary testing and she's also offered screening for TB, STIs and NCDs. The results are confidential, which means that only the counsellor and healthcare workers looking after the mother will discuss the results. 

If the mother takes the test and is found to be HIV positive, she'll be offered further counselling, partner testing and will be started on ART.

All HIV positive pregnant or breastfeeding women qualify for ART. ART is very effective at reducing the risk of HIV transmission to the baby and protect the mother's health during and after pregnancy. The effectiveness of ART is monitored during pregnancy by checking the viral load (the amount of virus in an infected person’s blood). ART should be started on the same day as HIV diagnosis for pregnant women.

Labour and delivery

Women on ART continue to take their medication throughout pregnancy and labour and are able to give birth naturally.

Transmission of HIV from a mother to her baby during delivery and labour is increased by prolonged bleeding, instruments being used to assist in delivery, episiotomy (surgically cutting the area between the vagina and the anus to prevent tearing) and premature birth.

Postnatal care after labour and delivery

Women on ART can continue their treatment as normal.

Babies are tested for HIV at birth and after 10 weeks. All babies are put on HIV preventive treatment called PEP and an antibiotic to prevent infections until the mother stops breastfeeding.

Feeding your baby

Breastfeeding is encouraged since research has shown that a combination of exclusive breastfeeding and the use of antiretroviral treatment can significantly reduce the risk of transmitting HIV to babies through breastfeeding. HIV positive mothers who choose to formula-feed must be able to afford, prepare and store formula milk safely.

Those mothers who are unable to breastfeed due to medical conditions will be provided with formula milk until the baby is 6 months old. 

The mother should arrive within 1 week after birth and then 2 weeks later at the nearest baby follow-up clinic for the following:

• Monitoring of babies weight.
• Immunisation.
• Checks on feeding practices.

The baby will receive an HIV test at birth, 10 weeks, 6 months, 18 months and 6 weeks after breastfeeding has stopped.