Table 1. Evolution of programmatic PMTCT interventions over time in the APIN PEPFAR program, 2004-2014 [3,24-28].
| Year | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WHO CD4 threshold for ART eligibility (adult) | <200 cells/mm3 | ≤350 | ≤500 | ||||||||
| Programmatic CD4 threshold for ART eligibility (adult) | <200 | ≤350 | |||||||||
| Programmatic regimen for ART-eligible pregnant women | AZT/3TC/NVP<br>or<br>d4T/3TC/NVP | AZT/3TC/(NVP or EFVb)<br>For HBV coinfected: TDF/(3TC or FTC)/(NVP or EFVb) | EFV/TDF/(3TC or FTC)d | ||||||||
| Programmatic prophylaxis for ART ineligible pregnant women | Presenting 28-33 weeks gestation: AZT bid + sdNVP at labora<br><br>Presenting ≥34 weeks: AZT/3TC bid + sdNVP at labora<br><br>sdNVP for women presenting in labor | From 14 weeks gestation on: AZT bid + sdNVP in laborc<br>Or<br>Triple ART prophylaxis: LPV/r+AZT+3TC EFV+AZT+(3TC or FTC)<br>EFV+TDF+(3TC or FTC)<br>ABC+3TC+AZT | EFV/TDF/(3TC or FTC)e | ||||||||
Abbreviations: ABC, abacavir; AZT, zidovudine; 3TC, lamivudine; EFV, efavirenz; FTC, emtricitabine; LPV/r, lopinavir-ritonavir; NVP, nevirapine; TDF, tenofovir; sdNVP, single-dose NVP.
a
plus AZT bid “tail” for one week post-delivery
b
At this time, EFV was not recommended during the 1st trimester
c
plus AZT/3TC bid in labor and AZT/3TC bid for 7-day “tail” post-delivery
d
Restriction on EFV use during 1st trimester eliminated.
e
Started at any time in pregnancy, labor, or after delivery and continued until one week after cessation of all breastfeeding