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Table 2 WHO guidelines, national guidelines and implementation coverage on HIV, malaria, TB, prevention, screening and treatment during pregnancy in sub-Saharan Africa

From: Achieving development goals for HIV, tuberculosis and malaria in sub-Saharan Africa through integrated antenatal care: barriers and challenges

Intervention WHO recommendationsa Inclusion in national guidelinesb Coverage (%)c; median (range)
 Prevention ART prophylaxis from 14 weeks for PMTCT Yes No data
 Screening HIV testing at first ANC visit Yes 37.9%
 Treatment ART for mother starting immediately if CD4 count ≤ 350 cells/mm3 for mother’s own health (treatment of HIV and PMTCT) Sometimes No data
 Prevention IPTp at each ANC visit from 2nd trimester to delivery, doses ≥ 1 month apart, preferably DOT Sometimes 6.6%
  Receive one LLIN through ANC visits Sometimese 39.7%
 Screening No guidelines N/A N/A
 Treatment ‘Effective case management’ – presumptive treatment of symptoms/fever as per national guidelines Rarely No data
 Prevention TB infection control in PMTCT settings No No data
 Screening TB signs and/or symptoms should be evaluated for active TB
HIV positive pregnant women should be screened for TB during HIV post-test counselling
No data
No data
 Treatment All first-line TB drugs (except streptomycin) No No data
  1. ANC antenatal care, ART antiretroviral therapy, DOT directly observed treatment, IPTp intermittent preventive therapy in pregnancy, ITN insecticide-treated net, LLIN long-lasting insecticide-treated net, SP sulfadoxine-pyrimethamine, TB tuberculosis, PMTCT prevention of mother-to-child transmission
  2. aAdapted from WHO guidelines [7885]
  3. bNational Guidelines of the nine countries (Botswana, Tanzania, Uganda, Liberia, Mozambique, Namibia, Nigeria, South Africa, and Swaziland) with accessible guidelines/policies/strategies on Ministry of Health (or similar) websites. The recommended components of ANC vary widely between and within countries, often depending on the level of care (community, district, regional or national) at which ANC is provided. Other components generally included in ANC are blood tests for blood group, anaemia, HIV and syphilis, urine dipstick for protein and glucose, checking blood pressure, providing tetanus toxoid, iron and folic acid, assessment of substance use, and performing nutrition and hygiene counselling
  4. cImplementation coverage data is based on STATcompiler: The DHS Program. Data is median (range) coverage data available for HIV screening (data from four countries) and malaria prevention (IPTp 34 countries; ITN/LLIN 25 countries)
  5. dCoverage is reported as percentage of women receiving 3+ doses of SP/Fansidar, with at least one dose during ANC visit (DOT)
  6. eIncluding any reference to provision of LLINs, ITNs or mosquito nets in general
  7. fPercentage coverage of pregnant women who slept under a LLIN the night before the survey