Controlling mother to child HIV transmission
May 07, 2007
AT the Elizabeth Glaser AIDS Pediatric Foundation, our primary concern is prevention of mother to child (PMTCT) transmission of HIV/AIDS. When I was last here in the 1980s and 1990s, 25% of the women who went to antenatal clinics were HIV positive.
By William Salmond
AT the Elizabeth Glaser AIDS Pediatric Foundation, our primary concern is prevention of mother to child (PMTCT) transmission of HIV/AIDS. When I was last here in the 1980s and 1990s, 25% of the women who went to antenatal clinics were HIV positive.
Recently we were in Mulago Hospital with the Foundation’s President, Pam Barnes, and we were told that HIV prevalence was 10% — a very tremendous difference. The overall HIV prevalence is down as low as 6% in the general population and is higher for women than men — and in Mulago we were told it is at 10%. But this is a very tremendous decrease.
Overall, HIV prevalence in antenatal clinics is higher than in the general population. In the last two to three years ARVs have become available in Uganda in a way that no one could have believed to be possible in 1990. As women come into the antenatal clinics we now do what we call routine counselling and testing. We make sure that everyone has a chance of getting an HIV test not in a forced way but in a routine way saying “this is normal for one to check if you are HIV positive, just like we check you for anaemia, TB .... very normal tests.â€
Now women are testing and those who are HIV positive are invited to enroll for the PMTCT programme. They are given nevirapine tablets and take them home. When going into labour they are advised to swallow the tablet. They are also advised to deliver from hospital. If they deliver at home then they must bring the baby back to hospital to receive the nevirapine syrup. This programme has been running for five years and the Ministry of Health now wants to increase coverage in a large way. They want coverage to go to all facilities offering maternal services, such as Health Centre IIIs.
If a mother comes in to the antenatal clinic she can be clinically assessed for her disease and her eligibility for Highly Active Antiretroviral Therapy (HAART ) is determined. If eligible, she can start her ARVs after the first trimester of pregnancy. Studies which are ongoing suggest that this could significantly reduce the risk of transmission during breastfeeding. All of this has a very dramatic effect in reducing mother to child transmission but as the Ministry insists coverage of the program needs to be dramatically increased countrywide. This is a tremendous change that has happened in Uganda because ARVs are available. However more than two-thirds of HIV positive women are not eligible for HAART since they are still healthy and their CD4 counts are still high.
Identifying and treating children who are HIV positive
Now we can also identify babies who are HIV positive at an early age. It used to be that their antibody test could only be possible when the baby was 18 months. But now a test called PCR is available. It is carried out at regional centres of excellence in partnership with the Joint Clinical Research Centre on behalf of the Ministry of Health. Dry blood spots are taken and sent to these centres for testing and results returned. The PCR test which is carried out as early as six weeks helps us to know if the baby is HIV positive or negative. These results also give us an early indication as to whether the PMTCT intervention has been successful.
If a baby is HIV positive this means that we can now start early treatment. Imagine, this is something we hardly even dreamed of. Back in the 1980s and 1990s, these babies just died. They simply died — over 50% by their second birthday and 75% by their fifth birthday. But today, many children are on treatment.
Last December, we ran a camp for children in Jinja at “Youth with a Mission†campsite near Jinja. There were 31 children from all over Uganda aged between 10-17 years and they had a wonderful time. They played soccer, had a treasure hunt, used the adventure playground… and it was exciting.
This shows us that things have changed for the better over these years because of good science, clever research, caring doctors and nurses… I believe that these things are breaking stigma.
The writer is the Country Director of the Elizabeth Glaser Foundation
As told to Irene Nabusoba
AT the Elizabeth Glaser AIDS Pediatric Foundation, our primary concern is prevention of mother to child (PMTCT) transmission of HIV/AIDS. When I was last here in the 1980s and 1990s, 25% of the women who went to antenatal clinics were HIV positive.
Recently we were in Mulago Hospital with the Foundation’s President, Pam Barnes, and we were told that HIV prevalence was 10% — a very tremendous difference. The overall HIV prevalence is down as low as 6% in the general population and is higher for women than men — and in Mulago we were told it is at 10%. But this is a very tremendous decrease.
Overall, HIV prevalence in antenatal clinics is higher than in the general population. In the last two to three years ARVs have become available in Uganda in a way that no one could have believed to be possible in 1990. As women come into the antenatal clinics we now do what we call routine counselling and testing. We make sure that everyone has a chance of getting an HIV test not in a forced way but in a routine way saying “this is normal for one to check if you are HIV positive, just like we check you for anaemia, TB .... very normal tests.â€
Now women are testing and those who are HIV positive are invited to enroll for the PMTCT programme. They are given nevirapine tablets and take them home. When going into labour they are advised to swallow the tablet. They are also advised to deliver from hospital. If they deliver at home then they must bring the baby back to hospital to receive the nevirapine syrup. This programme has been running for five years and the Ministry of Health now wants to increase coverage in a large way. They want coverage to go to all facilities offering maternal services, such as Health Centre IIIs.
If a mother comes in to the antenatal clinic she can be clinically assessed for her disease and her eligibility for Highly Active Antiretroviral Therapy (HAART ) is determined. If eligible, she can start her ARVs after the first trimester of pregnancy. Studies which are ongoing suggest that this could significantly reduce the risk of transmission during breastfeeding. All of this has a very dramatic effect in reducing mother to child transmission but as the Ministry insists coverage of the program needs to be dramatically increased countrywide. This is a tremendous change that has happened in Uganda because ARVs are available. However more than two-thirds of HIV positive women are not eligible for HAART since they are still healthy and their CD4 counts are still high.
Identifying and treating children who are HIV positive
Now we can also identify babies who are HIV positive at an early age. It used to be that their antibody test could only be possible when the baby was 18 months. But now a test called PCR is available. It is carried out at regional centres of excellence in partnership with the Joint Clinical Research Centre on behalf of the Ministry of Health. Dry blood spots are taken and sent to these centres for testing and results returned. The PCR test which is carried out as early as six weeks helps us to know if the baby is HIV positive or negative. These results also give us an early indication as to whether the PMTCT intervention has been successful.
If a baby is HIV positive this means that we can now start early treatment. Imagine, this is something we hardly even dreamed of. Back in the 1980s and 1990s, these babies just died. They simply died — over 50% by their second birthday and 75% by their fifth birthday. But today, many children are on treatment.
Last December, we ran a camp for children in Jinja at “Youth with a Mission†campsite near Jinja. There were 31 children from all over Uganda aged between 10-17 years and they had a wonderful time. They played soccer, had a treasure hunt, used the adventure playground… and it was exciting.
This shows us that things have changed for the better over these years because of good science, clever research, caring doctors and nurses… I believe that these things are breaking stigma.
The writer is the Country Director of the Elizabeth Glaser Foundation
As told to Irene Nabusoba