Coordinating in the clinic
Q.47 What is the recommended timing of visits for dispensing of nevirapine (NVP) and infant feeding counselling and support? How often should ARVs for prophylaxis be given to mothers?
Since these interventions are being introduced into health systems for the first time, there is a need to learn what works best in different settings. In most countries, infants should be coming to clinics for immunizations at 6, 10 and 14 weeks. It makes sense to capitalize on these visits to provide ARVs and counsel mothers about feeding practices. They also coincide with some of the times when mothers have difficulty with infant feeding. For example, at around 6 weeks and also 14 weeks infants often have growth spurts and are more hungry than usual. At this time, a mother may feel that she does not have enough milk for her baby. However, she can continue to provide all the milk that a baby needs through increased breastfeeding. Mothers will benefit significantly if she receives support.
Even after infants have reached 3 months of age, continued visits every month would be the optimum frequency to dispense ARVs and provide infant feeding counselling and support. Longer intervals would be likely to result in significant losses to follow-up and therefore ineffectiveness of the interventions. For some mothers who are managing very well, longer intervals, such as every 2 months, might be considered. Specific counselling could be provided at particular times, such as when the infant is 6 months of age and complementary feeds should be introduced, or at 12 months when considering whether breastfeeding should stop.
A mother should always have the option of seeing a health worker at any time if she has a problem with her own health or concerns about her infant.