Document review date February 2025.
NSD610-019.03 SPAIIN – Perinatal HIV Care Pathway – 20 Weeks Checklist
Please complete the 20 weeks checklist electronically or print off and complete a paper version.
Obstetric Management
Continued Care
- Confirm patient understands transmission risks and delivery options based on HIV PCR, See BHIVA 2018 (2020 third interim update) Pregnancy Guidelines
- Discuss infant feeding advice, see BHIVA 2018 (2020 third interim update) – Pregnancy Guidelines – Section 9.4: Infant Feeding
- Patient information leaflets are available on the BHIVA website:
- Inform patient about help available for formula feeding (contact www.waverleycare.org for more information).
- Routine growth scans monthly from 28 weeks.
- Modify as obstetrically indicated.
- Contraceptive needs should be discussed
- HIV Management and Prevention of Transmission
Maternal ART – Virological Monitoring/TDM
- Ensure appropriate ART started – See BHIVA 2018 (2020 third interim update – Pregnancy Guidelines – Section 6: Current issues in the use of ART in pregnancy and outcomes
- In women commencing ART in pregnancy, LFTs should be performed as per routine initiation of ART and then with each routine blood test.
- Consider twice daily darunavir if initiating darunavir-based ART or if known resistance – see BHIVA 2018 (2020 third interim update) Pregnancy Guidelines – Section 6.3: Woman is not already on cART: what to start
- Consider third trimester TDM particularly if combining tenofovir and atazanavir – see BHIVA 2018 (2020 third interim update) Pregnancy Guidelines – Section 6.7: Pharmacokinetics of antiretrovirals in pregnancy
- Ensure pharmacy team knows of potential maternal and neonatal drugs and formulations that may be required.
- HIV PCR/CD4 count and routine biochemistry and haematology at/around 24 weeks.
Maternal ART – MDT Communication
- Ensure regular MDT linking care between Infectious Disease/GUM, obstetrics and neonates/paediatrics.
Maternal ART – Psycho-social Support
- Ensure partner notification complete for newly diagnosed patients and all other children screened.
- Ensure any counselling or psychiatric support needed for patient, particularly if new diagnosis, is in place.
Premature Neonatal Care Plan – PEP/Feeding
- Ensure documented plan for neonatal PEP recorded in notes.
- Ensure paediatrician has seen maternal resistance reports, maternal ART exposure history and HIV PCR results.
- Ensure infant feeding plan documented in notes.