Prevention of mother-to-child HIV transmission — DTM&H MCQ

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ModerateHIV/AIDS in tropical settingsPrevention of mother-to-child HIV transmissionDTM&H

A rural antenatal clinic in Malawi finds several pregnant women newly diagnosed with HIV during booking visits. The clinic has reliable access to first-line ART and infant testing. What is the most appropriate prophylaxis?

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Correct answer: A — Immediate maternal ART with infant prophylaxis and follow-up testing

The correct answer is A, immediate maternal ART with infant prophylaxis and follow-up testing. In high-prevalence, resource-limited settings such as Malawi, WHO's Option B+ approach requires every pregnant woman diagnosed with HIV to start lifelong triple ART immediately, regardless of CD4 count or gestation, because early viral suppression is the most effective way to prevent mother-to-child transmission. This is combined with infant antiretroviral prophylaxis and structured infant HIV testing (virological testing in the neonatal period, at 6 weeks, and after breastfeeding cessation) to detect any breakthrough transmission early and start paediatric ART promptly. The stem's detail of reliable access to first-line ART and infant testing is the discriminating feature that makes the full ART plus prophylaxis plus testing pathway both feasible and correct, rather than a fallback strategy. Why the other options are wrong: B. BCG vaccination as the main HIV intervention: BCG protects against tuberculosis, not HIV, and has no role in preventing vertical transmission. E. Infant cotrimoxazole without maternal ART: Cotrimoxazole prevents opportunistic infections like Pneumocystis pneumonia in exposed infants but does not reduce transmission risk if the mother remains unsuppressed. C. Formula feeding without assessing water safety: Replacement feeding without safe water risks fatal diarrhoeal disease and malnutrition; WHO favours exclusive breastfeeding under maternal ART where water safety cannot be assured. D. Caesarean section for every woman regardless of viral load: Elective caesarean only benefits women with unsuppressed viral load near delivery; as blanket policy it adds surgical risk without benefit once ART achieves suppression. Key point: With ART access available, immediate lifelong maternal ART (Option B+) plus infant prophylaxis and scheduled infant testing, not delivery mode or feeding method alone, is the cornerstone of PMTCT.

Reference: WHO Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach, 2021, section on prevention of mother-to-child transmission (Option B+), https://apps.who.int/iris/rest/bitstreams/1357089/retrieve