Document review date February 2025.
NSD610-019.05 SPAIIN – Perinatal HIV Care Pathway – Delivery Checklist
Please download and complete the delivery checklist electronically or print off and complete a paper version.
Healthy Mother
- All women are recommended to continue ART post-partum.
- Ensure follow-up appointment arranged at HIV clinic within 4 – 6 weeks.
- Ensure sufficient ART supplied on discharge to last until next HIV clinic appointment.
- Ensure reproductive health advice addressed, and advise this will be revisited at 4 – 6 week follow-up.
- Letter to GP.
Healthy Baby
- Neonatal PEP – Ensure neonatal PEP plan documented in notes. Ensure that mother has supply to complete remaining course of neonatal PEP on discharge.
- Neonatal Feeding – Re-iterate advice over infant feeding. See links in “Healthy pregnancy – 20 weeks” for further information on infant feeding.
Infant Testing Pathway
Ensure baby is followed up under the local testing pathway.
For non-breastfed infants, HIV diagnostic testing should be undertaken:
- during the first 48 hours and prior to hospital discharge.
- at 6 weeks (or at least 2 weeks after cessation of infant prophylaxis).
- at 12 weeks (or at least 8 weeks after cessation of infant prophylaxis).
- On other occasions if additional risk including at 2 weeks of age if HIGH RISK at delivery.
For breastfed infants, HIV diagnostic testing should be undertaken:
- during the first 48 hours and prior to hospital discharge.
- at 2 weeks.
- monthly for the duration of breastfeeding (maternal HIV PCR should also be checked monthly during breastfeeding).
- at 4 and 8 weeks after cessation of breastfeeding.
Infants with a positive test for HIV should be referred urgently to a specialist centre for management of HIV
A positive HIV diagnosis in an infant should be fed back to the obstetric unit where the infant was born to allow investigation of any avoidable factors in transmission.
- Immunisations – see BHIVA 2018 (2020 third interim update) Pregnancy Guidelines – Section 9.3: Immunisation.
Infants born to HIV-positive mothers should be given the routine national immunisation schedule as outlined in the Green Book.
Rotavirus vaccine should be given to all HIV-exposed infants unless confirmed infected and shown to be severely immunosuppressed. If uncertain about administration of live vaccines, expert advice should be sought. Infants considered at VERY LOW or LOW RISK of HIV transmission may be given BCG at birth if indicated according to UK guidelines for HIV-unexposed infants.
Neonatal immunisation with or without hepatitis B immunoglobulin (HBIG) should commence within 24 hours of delivery. The national infant HBV schedule should then be followed.
GP – Ensure discharge letter to GP with PEP, feeding, immunisation and follow-up plan.