Neobook — clinical reference

6 days	Retest the HIV negative mother if she was not retested in labour
10 weeks	Retest every HIV-negative mother at the 10-week visit (~three months postpartum), the six-month visit, and every three months whilst breastfeeding. Remember to offer partner testing. If no longer breastfeeding, ensure that the mother receives an HIV test at least every year
6 months
18 months

6 days	Mother to continue ART during the postpartum period and for life. If she is newly diagnosed during the breastfeeding period, initiate ART after contra-indications to ART have been excluded (Go to “ART Initiation Algorithm”). Provide appropriate fast-track initiation counselling (FTIC) as per DMOC SOP 1. Initiate TDF, 3TC, and DTG (TLD) as the preferred regimen. This is a high-risk period for poor adherence. Ensure that the mother understands the importance of continued viral suppression for her own health and that of her baby. She must also understand and anticipate the adherence challenges that may be experienced in the postpartum period. Link the mother to MomConnect, a CHW, a mentor mother, or a support group/club if available. Whether continued ART care is provided at MNCWH services (preferred) or at PHC/Wellness services, ensure that mother is retained in care, adherent to ART, and maintains a suppressed viral load.
6 weeks
10 weeks
6 months
18 months

6 Days	Check ART adherence Follow-up on result of delivery-VL. (If not yet available, follow-up again in 1 week. If VL not done at delivery, do VL at this visit) If VL ≥ 50 c/mL: - Manage mother as per “VL Non-Suppression Algorithm”. - Re-classify her infant as higher-risk and manage as per “Prophylaxis for the HIV-Exposed Infant at Birth”). - If the mother and baby are not receiving integrated care at the same service point, ensure that the delivery VL result is communicated to the clinician caring for her baby
6 Weeks	Check ART adherence Repeat VL if delivery-VL was ≥ 50 c/mL. Check mother’s ART supply and confirm where she will be receiving her ongoing ART care
10 Weeks	Check ART adherence Check, record and act on any earlier VL tests Check mother’s ART supply and confirm where she will be receiving her ongoing ART care
6 Months	Check ART adherence at every visit. Check, record and act on results of any earlier VL tests Do a VL for all HIV-positive mothers on ART at six months. Continue VL monitoring every six months (at 12,18, and 24 months) whilst breastfeeding. Ensure that the results of any VL test done is checked within 1 week. If VL ≥ 50c/mL: - Recall the mother-infant pair to the facility - Manage mother as per “VL NonSuppression Algorithm” - Restart/extend infant prophylaxis if mother is still breastfeeding. Go to ”Management of a High Maternal Viral Load after Delivery”
18 Months

Viral Load suppression is critical for the health of the mother, her baby, her subsequent pregnancies, and her partner!

6 Days	- Routine postpartum care as per the Maternity Care Guideline - TB screening, TPT, and CTMX according to guidelines - Mental Health: Screen for postpartum depression - Contraception and STI screening - Infant feeding counselling and support according to the Infant and Young Child Feeding Policy - Counselling on safe use of water, sanitation and hygiene (WASH) - A Pap smear can be done from six weeks onwards if she is due for a routine papsmear, or if indicated by an earlier abnormal smear
6 Weeks
10 Weeks	- TB screening, TPT, and CTMX according to guidelines - Mental Health: Screen for postpartum depression - Contraception and STI screening - Infant feeding counselling and support according to the Infant and Young Child Feeding Policy - Counselling on safe use of water, sanitation and hygiene (WASH) - Papsmear (if indicated)
6 Months
18 Months

South African National Department of Health, Guideline for Vertical Transmission Prevention of Communicable Infections, Version 2_August 2023