The PPTCT program in India provides services through ICTCs to test pregnant women for HIV and prevent mother-to-child transmission. If tested positive, women receive counseling, ART treatment, monitoring, and are encouraged to have institutional deliveries. Infants receive post-exposure prophylaxis. The goal is to eliminate vertical transmission through antenatal, intrapartum, postnatal care and promoting safe infant feeding practices.

2.  NACO under the Ministry of Health,
Government of India, launched the
Prevention of Parent to ChildTransmission
(PPTCT) of HIV program in 2002
 In 2012, the multidrug regimen as
recommended by WHO has also been
accepted by the PPTCT program

3.  The services are provided through the ICTCs-
Integrated Counseling andTesting Centres
 Standalone ICTCs: located in the medical
colleges, district hospitals, taluk hospitals,
and community health centres
 Facility integrated ICTCs: located in the
primary health centre.The staff in PHC are
trained in counselling and testing for HIV
with kits provided. If a women tests positive,
she is referred to ICTCs.

4.  The aim of PPTCT programme is to offer
HIV testing to every pregnant women
(universal coverage) in the country, and
eliminate the transmission of HIV from
mother to child

5.  Antenatal care
 Intrapartum care
 Postnatal care

6.  Pretest and posttest counselling
>counseled regarding hygiene, nutrition, safe
sex and avoiding substance abuse, safe
delivery, birth planning and infant feeding
 Plasma viral load, CD4 counts, renal function
tests, and liver function tests done and
repeated every 3 months
 Offering termination of pregnancy to HIV-
positive women

7.  Screening for genital infections done early and
repeated at 28 weeks. Syphilis and hep B
screened on booking
 Detailed anomaly scan is a priority
 Hep B and pneumococcal vaccination is
recommended and safe
 Influenza vaccination also safe and can be
administered
>mumps, measles, rubella, varicella zoster
vaccines contraindicated

8.  Prophylaxis for Pneumocystis carinii
pneumonia is indicated when the CD4
count is <200/mm3- cotrimoxazole + folic
acid 5mg/day (CPT)
 Providing ART
 Psychosocial support
 Routine antenatal care

9. Pregnant and breastfeeding women with
HIV
Regardless of CD4 counts
or clinical stage (OR) CD4
count<500 (OR) clinical
stage 3 or 4
Lifelong
therapy with
TDF+3TC (or
FTC) + EFV
CD4 count >500
TDF+ 3TC (or FTC)
+ EFV
Stop ART after 1 week of
complete cessation of
breastfeeding

10.  Tenofovir (TDF) – 300 mg
 Lamivudine (3TC)- 300 mg
 Emtricitabine (FTC) – 200 mg
 Efavirenz (EFV) – 600 mg
 At birth, or when exposure is diagnosed
postpartum
 Infants (breastfeeding) – 6 weeks daily NVP
 Infants (replacement feeding)- NVP for 4-6
weeks or AZT twice daily

11.  Promotion of institutional deliveries of all HIV
infected women
 Caesarean section is the preferred mode of
delivery in HIV infected women
 Elective C-section is associated with reduced
rates of MTCT among women
>who have not received ARTs
>who have received AZT alone
>who have not achieved viral suppression
(>1000 copies/mL)

12.  In resource-limited regions
>vaginal delivery accepted
>amniotomy avoided unless delivery is
imminent
 Universal or standard precautions are
followed

13.  Care in handling of –
>blood (dried also),
>all other body substances, secretions
(including sweat), regardless of whether
they contain visible blood
>nonintact skin
>mucous membranes

14. Universal or standard precautions
Personal hygiene practices
>hand washing
PPE
>double gloving
>gowns
>protective eyewear
Aseptic technique
Safe disposal systems for
>sharps
>contaminated matter
Adequate sterilization of reusable equipment
Environmental controls

15.  Couselling regarding breastfeeding
>avoidance of breastfeeding is a definite way
to prevent transmission
>recommendation: exclusive breastfeeding
(exclusive replacement feeding) for 6
months inititated within an hour of delivery
 ART for mother and infant continued
 Family planning services
 EID- early infant diagnosis by HIV DNA PCR

16.  Sheila balakrishnan, 2nd edition
 Lakshmi seshadri, 1st edition
 K.Park, 23rd edition