7.8
Neonatal ARV Interventions for PMTCT
7.8.1 Four Week Short Course of AZT and sdNVP to the Infant
Regardless of whether or not the mother received any ARVs during pregnancy or delivery, short- course ARVs to the HIV-exposed infant must be administered as soon as possible after delivery within 72 hours, in order to maximize PMTCT:
• AZT 4mg/kg po every 12 hours for 4 weeks.
• Preterm or low birth weight, give AZT dose is 2mg/kg po every 12 hours for the first 2 weeks,
then increase to 2mg/kg dose po every 8 hours (TDS) for the final 2 weeks.
• NVP syrup 6 mg orally as a single dose
• Preterm or low birth weight, give NVP syrup 2 mg/kg orally
• HIV-exposed infants brought in > 72 hours after birth should not receive AZT prophylaxis but
rather should be referred to an HIV Specialist or ARV clinic.
7.9
Recommendations for Infant Feeding:
All women regardless of the HIV status should be provided with infant feeding information and counselling during ANC to ensure that they are supported in making the best decision for their situation, whether that decision is to formula feed or to breastfeed. Infant formula is provided at SR healthcare facilities until the infant is 12 months of age.
To achieve the goals of Vision 2016 for an AIDS-free generation, the Government of Botswana recommends that:
• HIV infected women for whom formula feeding is acceptable, feasible, affordable,
sustainable and safe(AFASS) should exclusively formula feed for the first 6 months of life and continue formula feeding until 12 months of age, introducing complementary foods beginning at age 6 months.
• HIV infected women for whom formula feeding is NOT AFASS should exclusively breastfeed
for the first 6 months of life only if they are placed on TAP or ART. At six months, assess the
mother’s situation using AFASS criteria:
* If formula feeding is still not AFASS, breastfeeding until 12 months of age (or until
formula feeding becomes AFASS) only with administration of TAP. Complementary
foods should be started at six months of age.
* If formula feeding is AFASS, gradual weaning (over a period of one month) with
introduction of formula feeding. Complementary foods should be introduced at six months of age.
Women who continue TAP through breastfeeding must continue to receive ART until 6 weeks after complete cessation of breastfeeding.
When formula feeding is AFASS, HIV infected women should be provided with adequate counselling, education and support to completely avoid breastfeeding.
Table 7.1 Botswana’s Infant and young Child Feeding Recommendations
Client Situation
At time of birth Feeding recommended from 0–6 months Feeding recommended from 6–24 months
HIV negative women Exclusive breastfeeding (no
added foods or liquids, not even plain water)
Breastfeeding until at least two years of age plus introduction of complementary foods at six months of age
Women of unknown HIV
1
status
Depending on HIV test
outcome, either EFF or EBF Complete HIV test as a matter of priority
HIV infected women for whom formula feeding is
2
AFASS
Exclusive formula feeding (no added foods or liquids, not even plain water)
Formula feeding until 6 months of age plus
introduction of complementary foods at six months of age From 12–24 months of age, offer animal milk and/or other milk products (yoghurt, cheese and madila) plus
complementary foods. HIV infected women for
whom formula feeding is not
2
AFASS
Exclusive breastfeeding (no added foods or liquids, not even plain water)
At six months, assess the mother's situation using AFASS criteria:
If formula feeding is still not
AFASS, breastfeeding until 12 months of age (or until formula feeding becomes
2,3
AFASS )
If formula feeding is AFASS,
gradual weaning (over a period of one month) with introduction of formula feeding
Introduce complementary foods when baby is six months of age; from 12–24 months of
age, offer animal milk and/or other milk products (yoghurt, cheese and madila) plus complementary foods.
1 Women of unknown HIV status should be counseled and tested for HIV. 2 AFASS = acceptable, feasible, affordable, sustainable and safe
• Acceptable: The mother perceives no significant barrier(s) to choosing a feeding option for
cultural or social reasons or for fear of stigma and discrimination.
• Feasible: The mother (or other family member) has adequate time, knowledge, skills, and
other resources to obtain formula regularly, prepare feeds, and to feed the infant as well as the support to cope with family, community, and social pressures.
• Affordable: The mother and family, with available community and/or health system support,
can pay for the costs of the formula feeds—including formula, fuel, transportation and clean water—without compromising the family’s health and nutrition spending. The formula is provided by the Government, but women must have fuel to sterilize cups and utensils and boil water for every feed.
• Sustainable: The mother has access to a continuous and uninterrupted supply of infant
formula until the infant is 12 months old.
• Safe: Formula is correctly and hygienically stored, prepared and fed in nutritionally adequate
quantities; infants are fed with clean hands using clean utensils, preferably cups.
(See Annex 15: How to Stop Breastfeeding Early, page No. 180)