Of all HIV infections in India, 39% (816,000) are among women. Early HIV testing during antenatal period, counselling of the HIV positive pregnant women and following up with them to ensure medication adherence through pregnancy and breastfeeding are crucial steps to ensure prevention of vertical transmission of HIV/AIDS from the mother to the child. In the absence of any intervention, the risk of transmission of HIV to the child is around 20 – 45%.
Mother to child transmission (MTCT) is the most important source of HIV in children less than 15 years of age. Prevention of parent to child transmission of HIV (PPTCT) programme, launched under the National AIDS Control program (NACP) is the largest national antenatal screening program in the world. However, according to NACO CMIS 2010 report, PPTCT services were provided to only 26.5% of the estimated 2.3 million pregnancies in Maharashtra leaving out the 38.4% women accessing private sector and 35.1% delivering at home. Annually, an estimated 11705 HIV positive deliveries occur in the state and without any PPTCT interventions, around 3500 infants are at risk of acquiring HIV infection.
According to the WHO recommendations adopted by the Department of AIDS Control (DAC), counselling on positive living, safe delivery, HIV testing of spouse and other living children, linkage to ART services, nutrition counselling, EBF reinforcement, services for exposed children and most importantly, adherence to treatment, is of paramount importance. Since the revised national guidelines for HIV/AIDS treatment recommend daily medication through pregnancy until the child is 6 – 12 weeks old (2) to prevent mother-to-child transmission, medication reminders that handhold the woman through the lengthy treatment process are imperative to ensure adherence. In addition it is crucial to track in real time the defaulters to ensure that there are no gaps in the continuum of care.