By Chioma Umeha
That Nigeria is among the countries with the highest burden of Mother to Child transmission (MTCT) of HIV in the world having at least 50,000 HIV positive babies annually is a big issue in the public health domain.
More worrisome to health analysts is the country’s failure in meeting the global target of over 90 per cent PMTCT antiretroviral (ARV) coverage last year. Statistics from the National AIDS and STD Control Programme (NASCP) shows that Nigeria was only able to achieve 30 per cent PMTCT ARV coverage.
It would be recalled that the HIV testing and counselling (HTC) was integrated into Maternal, Newborn and Child Health (MNCH) week to help increase the coverage of PMTCT services. According to experts, the integration of HTC and MNCH will contribute to a significant reduction in mother to child transmission of HIV to enable the country to attain the global goal of an HIV free generation.
The HCT-MNCH integration was to strengthen provision of routine HCT/ PMTCT services at the Primary Health Centres, PHCs – a goal which is now unrealisable.
Sources from NASCP told Independent recently, that integration of HCT-MNCH was initially piloted in five states – Adamawa, Anambra, Benue, Kaduna, Lagos and FCT during November 2014 MNCH week which was supported by the United Nations Children’s Fund (UNICEF) and had a total of 110,397 pregnant women counselled and tested. The first round had nine states UNICEF and PEPFAR support states including FCT for ‘Testing One Million Pregnant Women Initiative.’
As at June 2015, only 20 States and FCT have integrated HCT into MNCH week with 247,560 women counseled, tested and having received their results, the NASCP source also said. Out of the 247,560 women, 2207 were positive even as 1513 clients were referred for chronic care, it added.
In the second round which started from November 30, 2015, only 14 states and FCT conducted HCT-MNCH integration activities as at December 18, 2015, the source added.
HIV can be transmitted from an HIV-positive woman to her child during pregnancy, childbirth and breastfeeding. Mother-to-child transmission (MTCT) accounts for over 90 per cent of new HIV infections among children.
However, through the HCT-MNCH and Prevention of mother-to-child transmission (PMTCT) programmes antiretroviral treatment are provided to HIV-positive pregnant women to stop their infants from acquiring the virus.
Without treatment, the likelihood of HIV passing from mother-to-child is 15 per cent to 45 per cent. However, antiretroviral treatment and other effective PMTCT interventions can reduce this risk to below five per cent.
Effective PMTCT programmes require women and their infants to have access to – and to take up – a cascade of interventions including antenatal services and HIV testing during pregnancy; use of antiretroviral treatment (ART) by pregnant women living with HIV; safe childbirth practices and appropriate infant feeding; uptake of infant HIV testing and other post-natal healthcare services.
Some of the identified challenges of HCT-MNCH and other effective PMTCT interventions include: Inadequate funding, delay in distribution of RTKs, poor coordination among MNCH week State team and HIV team activities, poor data quality and reporting, lack of harmonization of HCT data by MNCH and HIV teams and poor referral of positive clients.
Experts have therefore suggested the inclusion of high level advocacy to stakeholders to ensure timely and adequate release of funds, early planning for commencement of activities, improved co-ordination at the State level and synergy of MNCH week and HIV teams in terms of pre-implementation, implementation and post-implementation activities.
Other recommendations are training of HCT service providers and Monitoring and evaluation (M&E) officers to ensure quality data management and transmission to National operation room and proper documentation of all forms for referrals.
To this effect, UNAIDS recently appealed to the National Primary Health Care Development Agency (NPHCDA) to focus more on the grassroots in its efforts to eliminate mother-to-child transmission of HIV by 2020.
Dr Bilali Camara, Country Director, UNAIDS, who made the appeal said that the agency must push more resources to local communities where 80 per cent of mother-to-child transmission of HIV are recorded.
“If we want to test pregnant women to eliminate mother-to-child transmission of HIV/AIDS by 2020, these pregnant women must go to Primary Healthcare centres for ante-natal care.
According to him, this would push up the demand for HIV/AIDS services and help in ending the disease as a public health challenge by 2030.