The overall goal of the PMTCT/ARTProgram is to reduce HIV morbidity and mortality and to reduce new infections through interventions with clear evidence for impact. New ART eligibility criteria have been implemented since April 2014, and these include increasing eligibility for ART from CD4 cell count threshold of 350 to 500, and universal eligibility for children under 5, regardless of their WHO stage* and/or CD4 cell count. About 80% of people living with HIVare eligible for ART under the 2014 guidelines. The national program has also introduced a standard pre-ART follow-up program to enhance timely ART initiation and an exposed infant follow-up program, where infants are followed up from birth up to 24 months, with HIV status ascertained at 6 weeks (using DNA-PCR), and 12 and 24 months (using a rapid HIV antibody test). The national program has championed Option B+ for reduction of mother-to-child transmission of HIV. Option B+, which was adopted by WHO, considers all HIV-infected pregnant andbreastfeeding women aseligible for ART, irrespective of their CD4 cell count and /or WHO stage.

Quality of PMTCT/ART services:

The national program will ensure quality of HIV services through the following activities:

• National clinical mentorship program
• Quarterly supportive supervision visits to all 700 plus sites in the country providing PMTCT/ART services
• Scale-up of routine viral load testing for all clients on ART to enhance adherence and a timely switch to a second-line therapy for those failing first-line

ART

Implementation of continuous quality improvement (CQI) interventions through clinical review meetings and the mentorship program

* World Health Organisation (WHO) Disease Staging System for HIV Infection and Disease in Adults and Adolescents