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Antenatal care: Key to preventing mother-to-child transmission

A 12-year-old Yusuf Adamu, sometime in January slumps in his father’s lap, head pressed against his chest. Infected at birth with human immunodeficiency virus (HIV), he is tiny for his age and has birdlike limbs.

He has been feverish for 3 days, which is why his father, Ibrahim, brought him to the pediatric HIV/AIDS clinic at Asokoro District Hospital in Abuja, Nigeria’s capital.

“He’s been losing weight, he is not eating well, he’s still taking his drugs, and he’s complaining of chest pains and coughing,” Ibrahim tells the nurse.

Yusuf’s records show that at his last blood check six months ago, HIV had already ravaged his immune system, even though he was receiving antiretroviral (ARV) drugs.

When the doctor, Oma Amadi, examines his mouth, it is filled with white sores from candidiasis, a fungal infection. “The boy has been sick for so long, I am going to admit him’’ the doctor said.

” When Dr. Amadi removes Yusuf’s shirt to listen to his chest, the boy winces at the touch of her stethoscope. Amadi suspects Yusuf has tuberculosis, and after x-raying his lungs, the doctors put him in an isolation room.

Yusuf’s mother was never tested for HIV before he was born: She received no prenatal care and delivered at home.

Yusuf was not tested for the virus until she died of AIDS 3 years later. Ibrahim then learned that he, too, is HIV-positive, as are his two other wives. One ended up transmitting the virus to a second child, now 4.

Mother-to-child transmission is the most common mode of HIV transmission in children which can be vertically transmitted from HIV positive pregnant women to their unborn babies during pregnancy, labour, and delivery or through breastfeeding after delivery.

HIV remains a major challenge globally regardless of decades of advocacy and investment in programs to control the spread of the virus
It has continue to be a major global public health issue.

In 2017 an estimated 36.9 million people were living with HIV (including 1.8 million children) – with a global HIV prevalence of 0.8% among adults. Around 25% of these same people do not know that they have the virus.

Nigeria is slow in eliminating HIV as women contribute 90% new infections in children.

According to the Assistant Director, Prevention of Mother-To-Child Transmission (PMTCT) and Head, National AIDS and STI Programme, (NASCP) Federal Ministry of Health, Dr Gbenga Ijaodola, Nigeria has more HIV-infected babies than anywhere in the world.

Speaking during a media dialogue on PMTCT organised by the United Nations Children’s Fund (UNICEF) in collaboration with the Child Rights Information Bureau of the Federal Ministry of Information (CRIB) in Calabar, Ijaodola advised pregnant women across the country to access ante natal.

According to him, with the over nine million Nigerian women said to be pregnant every year, only about 3.6 million have access to antenatal care and about 2.4 million of them tested for HIV.

He said , the gap between pregnant women and those who are eventually tested for HIV is big because only 3.6 million access antenatal care.

“The remaining five million plus do not access antenatal, both in private or public healthcare facilities, hence it is difficult getting them to undergo HIV tests, in other to ascertain those with the virus, so as to prevent mother to child transmission and also put the women on anti retro viral drugs.

“Of the 64,000 pregnant women living with the virus, only 74 per cent of them are put on ante retroviral drugs immediately, with a high expectation that they deliver without transferring the virus to the babies.

“However, about 8.4 per cent of these babies end up been born with the virus. These children are then put on HIV treatment for life,” he said.

He explained that in general, 221,772 children are living with the disease in Nigeria, while only about 54,167 are on treatment in the country, adding that for those on treatment, their viral loads suppresses overtime, such that they no longer transmit the virus to other people.

He advised pregnant women across the country to access ante natal, as this was a major step in knowing whether they are positive to HIV or not, noting that those confirmed to be positive and on antiretroviral drugs have a very high chance of not transmitting the virus to their babies.

“That only 40 percent (3.6 million) of the over nine million pregnant women attend ante natal care yearly is unacceptable.

We must increase ante natal care uptake, increase testing coverage, and put those positive to the virus on treatment, if we must reduce the burden of PMTCT in the country.”

On why the HIV prevalence is increasing in Nigeria, he said reduced funding and low media publicity are some of the factors responsible.
“It is becoming more prominent with adolescents in the country.

So if we are able to prevent mother to child transmission, and target the adolescent group, we would have ended up reducing the statistics.

The assistant director in the federal ministry said PMTCT was one of the indices used in measuring success rates for countries, adding that it won’t be nice for Nigeria if it fails to meet up with the global target.

Meanwhile, the Minister of Health, Prof. Isaac Adewole had called for concerted efforts to increase the Prevention of Mother to Child Transmission of HIV (PMTCT) services coverage in the country.

Speaking at the dissemination of the PMTCT Cascade Evaluation in Abuja the minister decried the low PMTCT coverage in the country.

He said with more than a decade of the HIV programme in Nigeria, thousands of patients have been enrolled into treatment, care and related services in health facilities.

Adewole noted that with the scale up of the PMTCT services in the country, there are currently about 6,283 Health facilities offering PMTCT services adding that despite this increase, overall PMTCT coverage remains low at 30 per cent and according to the World Health Organization,” he said.

According to the Minister, findings from this study will help in highlighting some of the possible gaps and possible points of attritions in the National PMTCT programme

which may have a synergistic effect in increasing the risk of vertical transmission and hence the urgent need to address some of these key challenges for the country to transition from prevention to elimination of mother-to-child transmission.

“It was based on the above envisaged gaps that the PMTCT Cascade Evaluation study was commissioned with the following objectives; to estimate the uptake of HIV testing and use of ARVs to reduce mother-to-child transmission;

to estimate the proportion of HIV exposed infants who received nevirapine within 72 hours of birth, had EID done within 12 months and had a final outcome documented at 18 months and to identify risk factors associated with attrition along the PMTCT cascade,” he added.

On his part, Lead Advisor, HIV/AIDS Programme, at African Epidemiology Network (AFENET), Dr. Adebobola Bashorun, highlighted some of their findings.

“One of the key goals is to stop the transmission from mother to child and if we stop the transmission we are sure that the next generation s HIV free.

The main focus is to have a negative child. We can’t have a mother with HIV and she end up transmitting it to the child.

Our finding shows that a woman that comes for antenatal is not high enough.

We find out those women that come for antenatal that accept this testing is up to 90 per cent. And those who are tested positive usually come for treatment. The main important thing is to accept the coverage of PMTCT programme.”

With the attendance of antenatal care, Pregnant women who test HIV positive receive HIV medicines to reduce the risk of mother-to-child transmission of HIV and to protect their own health.

(HIV medicines are recommended for everyone infected with HIV. HIV medicines help people with HIV live longer, healthier lives and reduce the risk of sexual transmission of HIV.)

Young women face multiple legal, economic, and social vulnerabilities that interact to affect their sexual behaviours, decisions, and circumstances, making them more susceptible to acquiring new HIV infections.

A number of studies have found that young people are less likely to take an HIV test and that those who are HIV infected have poorer HIV treatment uptake, retention, and outcomes than adults.

Less is known about adolescent uptake of prevention of mother-to-child transmission (PMTCT) of HIV services, where new HIV infections, low HIV testing uptake, and poor initiation of and retention on treatment are significant barriers to elimination of HIV infection in children.

UNICEF support
UNICEF has played a critical leadership role in setting the global PMTCT agenda, in scaling up national PMTCT programmes in resource-limited settings. Areas of support included:
• policy,
• guideline and tool-development,
• capacity development (including development of the skills of service providers),
• promotion of methods to expand access to HIV testing and counselling,
• efficient procurement of ARVs and other essential commodities, and
• monitoring and evaluating progress.

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