Table 1.

Summary of Guidance for Routine Care of HIV Exposed Infants (Adapted from WHO Guidelines) [62]

Goal/type of the intervention	Timing of interventions	Recommended Intervention
Prevention of HIV Transmission	Antenatal (maternal interventions)	Maternal screening for HIV infection at first antenatal visit Maternal triple ARV prophylaxis for all HIV-infected pregnant women using preferred 1st line adult regimen: TDF+3TC (or FTC)+ EFV Provision of at least the minimum package of recommended care for antenatal visits
	Intrapartum (maternal and infant interventions)	Continued maternal support to ensure adherence to ART or HIV specific prophylaxis HIV testing of women of unknown status presenting at the time of delivery or repeat testing for previously negative pregnant women Encourage facility-based delivery Avoidance of unnecessary instrumentation and premature ROM Non-invasive suctioning of nasogastric secretions in the newborn Washing away maternal secretions and blood on the newborn after delivery
	Postpartum (maternal and infant interventions)	Continued maternal ART to prevent breastfeeding transmission and to preserve maternal health. Infant HIV prophylaxis to be initiated at birth or when HIV exposure is recognized postpartum For breastfeeding infants, daily NVP for a minimum of 6 weeks should be initiated shortly after birth. Prophylaxis may be extended to 12 weeks in case of late maternal presentation or suboptimal viral suppression; may be restarted if mother interrupts ART during breastfeeding Infants receiving exclusive replacement feeds 4-6 weeks of daily NVP or twice daily AZT If infant NVP is not available, 3TC may be substituted
Cotrimoxazole Prophylaxis	4-6 weeks of age (infants)	Initiation of cotrimoxazole prophylaxis with continued administration until/if HIV infection is excluded
HIV Testing	4-6 weeks of age (infants)	Virologic HIV testing for infants with known HIV exposure Serologic testing for mothers of infants with unknown HIV exposure
	9 months of age (infants)	Serologic testing at time of last immunization (measles immunization) followed by virological testing if serology is reactive
	Symptomatic infant at any age	Serologic testing for any infant with signs and symptoms suggestive of HIV infection followed by virological testing if serology reactive (presumptive treatment may be initiated in severely ill infants while awaiting diagnostic confirmation)
	End of breastfeeding exposure (12-24 months)	Serologic testing at least 6 weeks after the end of breastfeeding followed by virological testing for infants with reactive HIV serology
Infant Feeding/Nutrition	Birth - 6 months	Exclusive breastfeeding for first six months of life with strict avoidance of mixed feeding should be encouraged Exclusive replacement feeding if AFASS criteria can be met if mother not breastfeeding
	6- 12 months of age	Introduction of complementary foods at 6 months and continued breastfeeding
	At 12 months	Weaning for breastfeeding infants and transition to full family diet if adequate nutrition can be provided.
Additional services for mother infant pairs	Birth to 24 months*	Safe water interventions Maternal malaria prophylaxis Insecticide treated bed nets Growth monitoring and routine childhood immunizations

^*Some services may need to be extended beyond 24 months, depending on the duration of breastfeeding and other factors.