HIV/STI and PMTCT
This domain tests universal HIV testing in pregnancy, lifelong ART, infant prophylaxis and syndromic STI care.
Core rules
- Offer HIV testing to every pregnant woman at the first ANC visit with consent and confidentiality; retest in the third trimester or after exposure.
- Start lifelong ART for all pregnant and breastfeeding women living with HIV (Option B+), regardless of CD4 count, and support adherence.
- Give infant nevirapine prophylaxis per national guidance, arrange early infant diagnosis at 6 weeks, and counsel exclusive breastfeeding with maternal ART.
- Screen for syphilis and treat promptly; use syndromic management for STIs and offer partner notification and condoms.
Worked example
A woman at 20 weeks tests HIV-positive at ANC. Reasoning: start ART the same day after baseline tests, give adherence counselling, screen for TB and STIs, and plan infant prophylaxis and early infant diagnosis. Do not wait for a CD4 count before starting ART; delaying increases transmission risk.
Traps
- Waiting for CD4 results before ART.
- Stopping ART after delivery.
- Advising mixed feeding because the mother is on ART.
- Missing syphilis because HIV testing was done.