Service Delivery

The comprehensive approach to service delivery for prevention of mother-to-child transmission (PMTCT) of HIV recommended by the World Health Organization (WHO) and UNAIDS has four components:

  1. primary prevention of HIV among women of childbearing age
  2. preventing unintended pregnancies among women living with HIV
  3. preventing HIV transmission from a women living with HIV to her infant
  4. providing appropriate treatment, care and support to women living with HIV and their children and their families.

Service delivery issues are different for each intervention, but an optimal evidence-based PMTCT "package" will reduce the overall risk of maternal to child transmission to less than 2%. These interventions include:

  • optimal detection of HIV-infected pregnant women through effective HIV testing and counseling
  • for HIV-positive pregnant women, assessment of their eligibility for lifelong anti-retroviral therapy (ART)
  • provision of highly active ART (HAART) to those eligible for lifelong ART
  • provision of the most highly feasible antiretroviral (ARV) prophylactic regimen
  • safe obstetrical practices, including Cesarean-section when indicated and feasible
  • safe infant feeding options, including complete avoidance of breastfeeding

The resources provided in this section of the PMTCT Toolkit will help providers offer quality services for the range of needs experienced by mothers, families and children infected with or at risk for HIV, including manuals to help with service provision and resources on counseling and testing, family centered care, antiretroviral treatment and prophylaxis for PMTCT, infant feeding in the context of HIV, and integrating delviery of services. Job aids and tools throughout this section of the toolkit are collated in the Job Aids and Tools section below.