Mother-to-child transmission of the human immunodeficiency virus (HIV) is the primary route of transmission for HIV among children. Transmission occurs during pregnancy, delivery, and the breast-feeding period.

 
The Prevention of Parent to Child Transmission (PPTCT) line list is a reporting cum tracking tool which collects, retains and updates individual wise details of all HIV positive pregnant women who attend the facility during Antenatal period or Directly In labor or during Post Natal period. Each and every ICTC or ART center shall maintain their respective PPTCT line list which will contain all the details of the HIV positive pregnant women tested at their center or have registered at their center for Antenatal care.

The Line list shall be initiated and maintained primarily at the ICTC center but can also be initiated and maintained at ART center (women on ART becoming pregnant). The details required in order to enter in this line list shall be obtained from the PPTCT line list register at the ICTC and ART centers. As and when a pregnant woman is identified HIV positive or a known HIV positive case becomes pregnant, their details are entered in the PPTCT line list. The PPTCT line list shall be initiated and filled by the ICTC counsellor at the ICTC level and by the Data Manager at the ART center.

The most common route of HIV infection among the paediatric age group is from mother to child during pregnancy, during delivery and during breastfeeding. Elimination of new HIV infections among children is based on a four-pronged strategy:

i)primary HIV prevention of women in childbearing age group;
ii)prevention of unintended pregnancies among Positive Pregnant Women (PPW);
iii)prevention of parent to child transmission of HIV infection;
iv)and provision of care, treatment, and support of HIV positive women and their families.

 
Early detection of HIV and initiation of ART in the first trimester will reduce viral transmission. All pregnant women should be counselled for HIV testing during their first contact with health facilities. A triple-drug ARV for more than 24 weeks with good adherence during pregnancy, which would be continued during delivery, breastfeeding and life long will reduce mother to child HIV transmission. 

Universal work precautions are strongly recommended while conducting delivery for all pregnant women,   irrespective of their HIV status. In the case of women living with HIV, vaginal delivery is conducted with minimal vaginal examinations, avoiding an episiotomy, instrumental delivery, foetal blood sampling and artificial rupture of membrane unless indicated. The umbilical cord is clamped soon after birth, and the cord is not milked. Caesarean section is recommended only if there is an obstetric indication. 

Exclusive breastfeeding for the first six months is the recommended feeding option as per the global (WHO) and national guidelines. Exclusive artificial feeding is the option only if the mother is not alive, otherwise, the mother is not willing to give exclusive breastfeed and AFASS criteria is fulfilled (Affordable, Feasible, Acceptable, Sustainable and Safe). 

All infants born to women living with HIV must be initiated on Nevirapine (NVP) / Azidothymidine (AZT) prophylaxis. The prophylaxis should be initiated immediately after birth and continued for 6-12 weeks as per the mother’s duration on ART during pregnancy and if the mother if breast feeding. Cotrimoxazoleprophylaxis(CPT) must be initiated from 6 weeks and continued till 18 months irrespective of HIV status of the baby. CPT must be stopped at 18 months, if the child is tested negative, and continued till five years along with ART if the child’s HIV status is positive.

Objectives of PPTCT:
1. Primary prevention of HIV, especially among women of childbearing age.
2. Integration of PPTCT interventions into general health services such as basic ANC, natal and postnatal services, sexual and reproductive health, family planning, early infant diagnosis (EID), paediatric ART, adolescent reproductive and sexual health (ARSH), TB and STI/RTI services.

3. Strengthening postnatal care for the HIV-infected mother and her exposed infant.
4. Providing the essential package of PPTCT services.
5. Tracking of the Individual HIV Positive Pregnant woman and HIV exposed baby
6. Monitor the PPTCT program at various levels in the administrative hierarchy 

Early Infant Diagnosis:
Globally, the World Health Organisation (WHO) has recommended the implementation of Early Infant Diagnosis (EID) and treatment among HIV exposed infants to achieve the 2030 goal of HIV elimination. The EID programme is aimed at early HIV diagnosis and subsequent initiation of Anti-Retroviral Treatment (ART); consequently, DNA Polymerase Chain Reaction (PCR) tests are conducted at 6 weeks of age and onwards.