Guideline for the Prevention of Mother to Child Transmission of Communicable Infections - v2 - South African National Department of Health

Sep 27, 2026

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Guidelines from the South African National Department of Health focus on preventing mother-to-child transmission of communicable infections, specifically HIV, hepatitis, listeriosis, malaria, syphilis, and TB. The foreword emphasizes dual elimination priorities, integrated prevention, early diagnosis, and proper management to reduce maternal, neonatal, and child morbidity and mortality. It highlights updates including Option B+ and birth PCR testing, improvements in HIV MTCT rates, and new revisions for TPT eligibility and ART recommendations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages44

Reading Time1 h 51 min

AccessFree to download

Overview of the Structure of this Guideline

Part 1 Introduction

Background

Overall Guideline Objective

Overview of Transmittable Infections during Pregnancy and the Breastfeeding Period

Populations to whom this guideline applies

Summary of What’s New in the 2019 PMTCT Guideline

Part 2 Prevention

Universal Measures to Prevent Infections during Pregnancy

Prevention of HIV

Prevention of Unintended Pregnancies and Safe Conception in Women

| | Guideline for the Prevention of Mother to Child Transmission of Communicable Infections
South African National Department of Health
Published: November 2019 v2
| | --- | --- | | | | 2019 ii Guideline for the Prevention of Mother to Child Transmission of Communicable Infections (HIV, Hepatitis, Listeriosis, Malaria, Syphilis and TB) 2019 FOREWORD It is my pleasure to present the Guidelines for the Prevention of Transmission of Communicable infections from mother to child (HIV, Hepatitis, Listeriosis, Malaria, Syphilis and TB) . While the WHO calls for dual elimination of HIV and syphilis, South Africa aspires to eliminate all infections that are transmittable from mother to child by promoting the prevention of such infections, early diagnosis and proper management in order to reduce maternal, neonatal and child morbidity and mortality. In 2015 Option B+ (lifelong ART irrespective of CD4 count or WHO staging) and birth PCR testing were implemented. The birth PCR test provides an opportunity for early identification of babies who acquired HIV in utero and linking them to HIV care and treatment as early as possible. Monitoring of the infant PCR test positive around 10 weeks rate indicated a reduction in the MTCT rate from 1.3% in the FY 2016/17 to 0.9% in the FY 2017/18 . As we are approaching the milestones to elimination of MTCT for HIV, we are now being challenged by the rising of other transmittable diseases from mother to child. It is therefore important that in this guideline other infections such as Hepatitis, Malaria, Syphilis and TB, in addition to HIV, be given due attention. In the period 2014 – 2016, TB was responsible for 9% of all maternal deaths, hepatitis contributed 1. 1% and malaria 1.7% . In 2017, the STI sentinel sites survey reported an increase in syphilis amongst pregnant woman to 2% and the recent outbreak of Listeriosis resulted in fatalities in neonates. The integrated approach will allow clinicians to comprehensively screen all pregnant women and their newborn babies and promptly manage those who are diagnosed with these infections. The challenge that PMTCT is currently facing is an increasing number of babies who acquire HIV infection during the postnatal period. To address this challenge, the guidelines provide guidance on the following: • Strengthening antenatal and postnatal care for both HIV negative and positive mothers. • The introduction of a dolutegravir-based ART regimen which is more efficacious in reducing the risks of transmission of HIV. • Promoting integrated management of the mother-baby pair by aligning PMTCT interventions with BANC visits during antenatal period and EPI visits during postnatal period. These guidelines provide a framework for a service benefits package steering us towards the implementation of NHI. Therefore, we urge all clinicians, working in both public and private health facilities, to use these guidelines to offer quality, comprehensive services to the public. Ms MP Matsoso Director –General: Health Acknowledgement I‘ guidelines despite their demanding schedules. Your efforts are contributing t Guideline for the Prevention of Mother to Child Transmission of Communicable Infections (HIV, Hepatitis, Listeriosis, Malaria, Syphilis and TB) 2019 iii What’s new in this version? Nov 2019 version 2 Based on decisions taken by the National EML Committee in February 2020, the following two updates have been made to the guideline: 1. The CD4 count threshold for TPT eligibility in pregnancy has been amended from 100 cells/μL to 350 cells/μL. • Supported by a recent local study by Kalk et al. 17, 18 • This change affects pages 18 and 26. 2. Nevirapine is no longer recommended as part of a triple therapy ART regimen, and specifically in pregnant women living with HIV. • Toxicity associated with nevirapine is a concern • This change affects page 19 iv Guideline for the Prevention of Mother to Child Transmis

FAQs

Which infections are covered by the PMTCT guideline?

The guideline covers prevention of mother-to-child transmission of communicable infections including HIV, hepatitis, listeriosis, malaria, syphilis, and TB.

What role does birth PCR testing play in the guideline?

Birth PCR testing enables early identification of babies who acquired HIV in utero, linking them to HIV care and treatment as early as possible.

What changes were introduced in the November 2019 v2 update?

The CD4 count threshold for TPT eligibility in pregnancy was amended from 100 cells/μL to 350 cells/μL, and nevirapine is no longer recommended as part of a triple therapy ART regimen in specifically pregnant women living with HIV.

Sep 27, 2026

Uploaded by adawds