Mother to Child Transmission (MTCT) of HIV is by far the main source of HIV infection in children. UNAIDS estimates that more than 90% of children acquire HIV through MTCT during pregnancy, labour, delivery and breast feeding. Since a significant proportion of HIV infected infants die in the first year of life, Prevention of Mother to Child Transmission (PMTCT) of HIV services provide an opportunity for securing Lesotho’s posterity.

The high HIV prevalence among pregnant women in Lesotho (27.7%) indicates that if interventions are not scaled up, paediatric HIV infections will continue to reverse the gains made through child survival programmes. In light of this, the government of Lesotho through the MOHSW is committed to provide universal access to high quality, integrated PMTCT interventions. Such interventions should be provided in the context of comprehensive, fully-utilized quality Maternal and Child Health (MCH) and Sexual and Reproductive Health (SRH) services to ensure a reduction in maternal and childhood morbidity and mortality. It is for these reasons that the Ministry of Health and Social Welfare (MOHSW) developed the National Guidelines for Prevention of Mother to Child Transmission of HIV which promote a four pronged approach consisting of:

• Primary prevention of HIV infections among women of child-bearing age
• Prevention of unintended pregnancies among HIV infected women
• Prevention of HIV transmission from infected mothers to their children
• Provision of continuous care, treatment and support for infected mothers, their partners and children.

These guidelines incorporate the 2010 WHO PMTCT recommendations which reflect the most current and up to date evidence and place increased emphasis on improving the mother’s health while at the same time providing maximum protection against HIV infection to her infant. For the first time since implementation of the PMTCT programme, HIV positive women can now safely breastfeed their infants without fear of transmitting the virus as ARV prophylaxis will be provided for the duration of the breastfeeding period.

The guidelines promote the integration of PMTCT services with maternal, newborn and child health services, provision of ART, family planning, STI and TB services and will equip service providers with the knowledge and skills required to provide consistently high-quality, client-sensitive services. Implementation of a PMTCT programme therefore involves the establishment of necessary linkages to other support programmes within the framework of a continuum of care for people infected and affected by HIV. It is my hope that these guidelines will help to strengthen such linkages in a bid to deliver high quality services to all mothers in the country.

This document has been mainly developed for use by health care providers and provides guidelines on how to implement integrated and comprehensive PMTCT services at health facilities.