HIV infections in children can be tackled by taking services nearer
Sep 01, 2011
For over a decade now, access to prevention of mother to child transmission (PMTCT) of the HIV services has remained a challenge to the Ugandan health sector.
For over a decade now, access to prevention of mother to child transmission (PMTCT) of the HIV services has remained a challenge to the Ugandan health sector.
The problem is more pronounced with inaccessibility to PMTCT anti-retroviral medicines which is the major reason that resulted into an estimated 10% of babies born to HIV positive mothers getting infected with the virus in 2009 because only a half and a third of mothers and babies respectively received drugs.
Even worse, the HIV service performance country report (2010) indicated that over 50% of the mothers that received PMTCT medicines used single dose nevirapine which is no longer recommended by the World Health Organization (WHO).
It is estimated that if coverage of PMTCT services exceeds 90%, new HIV infections in children will be eliminated in a short time. Through scaling services to all health units, countries like Botswana achieved 93% anti-retroviral treatment coverage for PMTCT and virtually eliminated transmission of HIV from mothers to children (UNAIDS 2010).
The Uganda National HIV Strategic Plan (2007-2012) and Health Sector Strategic Plan (2010 - 2015) target to eliminate new HIV infections in children through, among others, offering PMTCT services in all public health centre IIIs and making it an integral component of antenatal care.
The achievement reported as at end of 2009 was that these services were offered in only 66% of the health units that are supposed to offer them, which figure is currently estimated to have increased to over 90% (of health centre level III) as of today. This, therefore, implies that on average, pregnant mothers travel about 20 kilometres before reaching the nearest health centre to be able to receive comprehensive PMTCT services.
In order to address this challenge of long distances and mothers’ failure to receive required drugs, the health ministry should refocus interventions during the new planning period; by building capacity of districts to set own district specific PMTCT targets for the new planning period. In-depth assessments of programme needs at district level should be conducted to guide planning for scale-up of services towards population-based coverage and not only health facility-based coverage.
Drugs and other supplies as integral components of PMTCT services should be availed through all public and private health centres as well as at the community level. The ministry of health in collaboration with the national medical stores should step up the use of the WHO (2010) guidelines for PMTCT which call for the use of multiple combinations of anti-retroviral drugs by the mothers and babies instead of single dose nevirapine, by addressing prevailing bottlenecks and providing adequate stocks at all times.
Guidelines should be made available to districts that enable full scale involvement of communities and private practitioners in PMTCT service delivery. This should go hand in hand with building a strong community and private sector health information system that will enable tracking of all health interventions in the community and private sector.
All in all, the health ministry should direct resources towards taking PMTCT services nearer to the people through the robust network of public, private not-for-profit and private for-profit health units as well as village health teams. Increasing PMTCT service coverage to all health points of care will definitely address the inaccessibility to services including anti-retroviral drugs for PMTCT; that mothers face.
The writer is a MakSPH-CDC fellow based at the Makerere University School of Public Health
The problem is more pronounced with inaccessibility to PMTCT anti-retroviral medicines which is the major reason that resulted into an estimated 10% of babies born to HIV positive mothers getting infected with the virus in 2009 because only a half and a third of mothers and babies respectively received drugs.
Even worse, the HIV service performance country report (2010) indicated that over 50% of the mothers that received PMTCT medicines used single dose nevirapine which is no longer recommended by the World Health Organization (WHO).
It is estimated that if coverage of PMTCT services exceeds 90%, new HIV infections in children will be eliminated in a short time. Through scaling services to all health units, countries like Botswana achieved 93% anti-retroviral treatment coverage for PMTCT and virtually eliminated transmission of HIV from mothers to children (UNAIDS 2010).
The Uganda National HIV Strategic Plan (2007-2012) and Health Sector Strategic Plan (2010 - 2015) target to eliminate new HIV infections in children through, among others, offering PMTCT services in all public health centre IIIs and making it an integral component of antenatal care.
The achievement reported as at end of 2009 was that these services were offered in only 66% of the health units that are supposed to offer them, which figure is currently estimated to have increased to over 90% (of health centre level III) as of today. This, therefore, implies that on average, pregnant mothers travel about 20 kilometres before reaching the nearest health centre to be able to receive comprehensive PMTCT services.
In order to address this challenge of long distances and mothers’ failure to receive required drugs, the health ministry should refocus interventions during the new planning period; by building capacity of districts to set own district specific PMTCT targets for the new planning period. In-depth assessments of programme needs at district level should be conducted to guide planning for scale-up of services towards population-based coverage and not only health facility-based coverage.
Drugs and other supplies as integral components of PMTCT services should be availed through all public and private health centres as well as at the community level. The ministry of health in collaboration with the national medical stores should step up the use of the WHO (2010) guidelines for PMTCT which call for the use of multiple combinations of anti-retroviral drugs by the mothers and babies instead of single dose nevirapine, by addressing prevailing bottlenecks and providing adequate stocks at all times.
Guidelines should be made available to districts that enable full scale involvement of communities and private practitioners in PMTCT service delivery. This should go hand in hand with building a strong community and private sector health information system that will enable tracking of all health interventions in the community and private sector.
All in all, the health ministry should direct resources towards taking PMTCT services nearer to the people through the robust network of public, private not-for-profit and private for-profit health units as well as village health teams. Increasing PMTCT service coverage to all health points of care will definitely address the inaccessibility to services including anti-retroviral drugs for PMTCT; that mothers face.
The writer is a MakSPH-CDC fellow based at the Makerere University School of Public Health