In 2010, new guidance from the World Health Organization (WHO) indicated that HIV-infected pregnant women in need of antiretroviral therapy (ART) for their own health--that is, women with a CD4 count ≤ 350 cells/mm3 or in WHO clinical stages 3 or 4--should receive lifelong ART. In addition, HIV-infected pregnant women not in need of treatment for their own health should receive antiretroviral (ARV) prophylaxis to prevent mother-to-child transmission (PMTCT) during pregnancy, delivery, and breastfeeding. (See the updated 2010 WHO guidelines on ARVs for PMTCT for more details on strategies and regimens for ART and ARV proplylactic use during pregnancy and breastfeeding.)

The reality, however, is that very few women receive ART in the context of PMTCT services. In addition to challenges of determining ART eligibility for HIV-infected pregnant women, several health system and social factors contribute to low uptake of ART.

PMTCT sites often do not have the capacity to initiate ART onsite. Instead, women are referred to another location, which may require another visit to the health care site. In resource-limited settings, where transportation to health care facilities can be quite difficult, women may be less likely to return for initiation of ART. Additionally, due to stigma, pregnant women may be reluctant to be seen in the same waiting area with HIV/AIDS patients or adhere to the treatment regimen itself.

As postpartum family planning counseling and provision plays a key role in PMTCT, efforts need to be made to counsel women who wish to delay or space pregnancies in the postpartum period with accurate information with regard to their family planning choices, particularly in light of the client’s ARV regimen. Healthcare providers should be provided with regularly updated technical information on family planning and ARV provision.