While many dedicated clinicians and programme technical persons have worked hard to make Option B+ for PMTCT work, the fact is that a big percentage of mothers and babies are still lost in the process.
By Benjamin Mutebi Lutimba
I wish to thank the Ministry of Health in Uganda for the strong partnership with HIV/AIDS support organisations to create an enabling environment of eliminating pediatric HIV in Uganda, especially for the resources they have committed to roll out Option B+ where all pregnant mothers diagnosed HIV positive are offered HAART for life even without a CD4 count.
While many dedicated clinicians and programme technical persons have worked hard to make Option B+ for PMTCT work, the fact is that a big percentage of mothers and babies are still lost in the process. There is need to strengthen existing PMTCT programmes to register successes under the Option B+ programme by using to creative and innovative approaches.
Much as all this has been done, the Government and partners need to pilot ways of capturing the babies and children who are missed because they never have the opportunity to get diagnosed in antenatal care. A lot of emphasis on antenatal care has been done but still nearly half of all pregnant mothers never make it into antenatal care and a proportion of those women are infected with HIV and, of course, their babies are born exposed or infected. We never know about these infected and affected children -- until they get sick. I would, therefore, propose that the Ministry of Health designs a strategy of reaching women and children through immunisation clinics in the villages, who otherwise had fallen off the PMTCT cascade, or were never tested in the first place and also embark on massive HIV testing for all children who present sick to government aided health facilities. There are a number of such private health centres that do immunisation on behalf of the Government and so I believe if facilitated with some logistics, data tools and training on PMTCT and early Infant diagnosis, referral mechanisms will improve thus increasing the number of captured mothers and exposed children.
There is also a very strong linkage between peadiatric HIV and family planning and so I believe stronger interventions can be developed to make family planning and other reproductive health services available as also part of the PMTCT package at the health facilities. Policy makers in the Ministry of Health and implementing partners have the potential to make this possible through their innovative thinking.
Therefore, since it is our mandate as a nation to contribute to one of the UNAIDS goals ‘Eliminating pediatric HIV by 2015’, more emphasis should be focused to peadiatric HIV interventions.
The writer is a monitoring and evaluation specialist