Table 2. Timing of publication of WHO recommendations on PMTCT of HIV and their adoption as policy by countries: maternal care, Malawi, South Africa and United Republic of Tanzania, 2013–2016 .

WHO recommendation	Study indicator	Year guideline published	Year guideline adopted as national policy
			Malawi	South Africa	United Republic of Tanzania
HIV testing
Provider-initiated testing and counselling is standard for all clients, including in antenatal care	Provider-initiated testing and counselling implemented in antenatal care	2004	2006	2010	2007
Individual as well as group pre-test counselling is recommended	Pre-test counselling always given	2003	2006 Individual or group	2010 Individual or group	2005
	Post-test counselling always given
Treatment initiation
ART should be initiated in all pregnant and breastfeeding women living with HIV regardless of WHO clinical stage and at any CD4 cell count and be continued lifelong (Option B+)	Option B+ implemented	2013	2011	2015	2013
HIV treatment (for the mothers’ own health) should be given on same day as antenatal care services	HIV treatment given on same day as antenatal care services	2015	2011	2015	2013
In generalized epidemic settings, ART should be initiated and maintained at maternal and child health-care settings for eligible pregnant and postpartum women and for infants	ART for pregnant women testing HIV-positive provided in the same building as antenatal care	2013	2011	2015	2012
Linkage to care
Clear guidance should be given on when HIV-positive pregnant women are referred to ART clinic	Women are referred to ART clinics from PMTCT during antenatal care or by 6 weeks post-delivery	2006	2011	2010	2013 When child is 24 months old
Streamlined interventions should be done to reduce time between diagnosis and engagement in care, including (i) enhanced linkage with case management, (ii) support for HIV disclosure, (iii) patient tracing, (iv) training staff to provide multiple services and (v) streamlined services	Maternal referrals to HIV care and treatment services from PMTCT are documented	2013	Not explicit	2016	2009
	Health worker accompanies woman during initial referral to routine ART services		Not stated	2015 Active referral but not explicitly accompanied	Not stated
	Check if woman arrives in routine ART services	2004	Not explicit	Not explicit	2010

ART: antiretroviral therapy; HIV: human immunodeficiency virus; PMTCT: prevention of mother-to-child transmission; WHO: World Health Organization.