The goals of the national programme for Prevention of Mother to Child Transmission (PMTCT) of HIV include elimination of new infections among children and ensuring safe motherhood by 2020.
Specifically, Nigeria’s target is for 75 per cent of all pregnant women to receive quality HIV testing and counselling as well as their results before target period.
Next, is to ensure that 60 per cent of all HIV positive pregnant women and breastfeeding mothers receives ARVs by 2020.
The comprehensive package of PMTCT interventions include, HIV testing services (HTS), ARV and Cotrimoxazole prophylaxis for mother-infant pairs and use of lifelong antiretroviral therapy (ART) for women.
A visit to the Heart to Heart Centre (H2H) of the Badagry General Hospital, Lagos State by the Journalists’ Alliance for the Prevention of Mother-to-Child Transmission of HIV in Nigeria (JAPIN) underscores why new infant HIV infections and deaths is on the increase.
First, is due to failure of pregnant women in receiving quality HIV testing and counselling as well as their results. Second, is failure of HIV positive pregnant women and breastfeeding mothers in receiving ARVs.
At the H2H Centre, Oge John (not real names) told Independent: “This is not my first pregnancy, I lost the first one. It was during the antenatal that it was discovered that I was not taking ARV drugs. That is during my first pregnancy, I was not on ARV drugs, so the baby died. It was a stillbirth. After that, I started taking the drugs regularly. It was after I came to Heart to Heart Centre, they counseled me and I started taking drugs.”
Emmanuela Segun said: I already had my first child who is negative before I tested positive to HIV in 2010. My first husband died of AIDs and I remarried. When my present husband came and proposed to me, I told him about my status. He said, there is no problem since it’s not a death sentence that I can live normal life while on ARVs. Since then we have been living together. This second pregnancy belongs to my present husband who is negative. I have started taking my Anti-Retro Viral (ARV) drugs before I met him. We met where I am currently working. I don’t miss my drugs so that the child I am expecting will come out negative.
Mrs. Adeyinka Kunle told Independent, I was in my fourth pregnancy, when I came to Heart to Heart Centre in 2011. It supposed to be my fourth child, a baby boy, but I lost him because I refused to take my ARV drugs. I also lost the next pregnancy which was twins. My thought then was whether I use the ARV drugs or not, I will die and this made me stay away from home for three days. I was affected psychologically.
“My husband is negative likewise my first three children. After the mistake of losing my fourth and fifth pregnancy, during the sixth pregnancy, I took my drugs religiously and my boy came out HIV negative. By the grace of God, this is my baby from this seventh pregnancy will also be negative.”
Mrs. Kadiri Oluseyi, Executive Director, Centre for Positive Health Organisation, Lagos State said we are partnering with the Badagry General Hospital in working towards HIV prevention, maternal health, tuberculosis prevention, treatment, care and support at the community level.
Oluseyi added: “Our focus is that information reaches every individual about HIV counseling, testing, and treatment. We also provide access, care and support, especially to those that have tested positive.
Speaking on how to avoid new infant HIV infection, Oluseyi said, “Once a pregnant member of PLWA refuses to be counselled or receive drugs, we do not give up, we open her eyes on the risk involved by her action on herself, her unborn baby and community.”
Mrs. Bukola Salami, Psychosocial Counsellor for Abidjan- Lagos Corridor, (ACO) support group said her duties as a psychosocial are; “we follow -up PLWA, counsel them to accept their result and register for Anti-retroviral drugs. We do not force the PLWA to register for drugs; rather we educate them on the negative impact of not registering and adhering to the prescription.
“The psychosocial is very important because, the nurses cannot be in the hospital and track down a pregnant woman who refuses to come for clinic and ensure drug adherence as some of them miss their appointments.
“The benefits of registering in a support group like ACO are that, some pregnant PLWA do not know how to go about their new way of life, we educate them on the right path and importance of the drug they are taking.
The Psychosocial Counsellor further explained: “The drugs are free, but not all the tests are free. The two most important that are free is Cluster of Differentiation 4, (CD4) and Viral Load tests. We have recorded great success in this project.
“The PLWA pregnant mothers give birth to negative children. 80 per cent of our clients’ babies are negative. The 20 per cent of babies born positive with HIV is due to negligence of the mother. On breastfeeding, this is dependent on the PLWA CD4.”
Salami also said that the support group which started in March 2017 is in partnership with the Badagry General Hospital Ante natal unit. According to her, at the inception of the group, it had seven registered member but currently has over 20.
She further appealed for government’s support through increased funding and access to anti-retroviral (ARV) drugs, saying, “It will help to ameliorate the challenges of PLWHA, especially pregnant mothers and help in the elimination of new infant HIV infections.”
For instance, only an estimated 53,677 (30.16 per cent) of 177,993 HIV-infected pregnant women received antiretroviral drugs to reduce the risk of mother- to -child transmission (MTCT) of the disease in 2015.
Also, National Coordinator, National AIDS/STI Control Programme, Federal Ministry of Health, Dr Sunday Aboje corroborated that Nigeria was still home to the highest number of children living with HIV/AIDS in the world.
Dr Aboje spoke at the opening of a three-day Communication Strategic review workshop by JAPIN in Calabar, Cross Rivers State, recently.
Dr Aboje stated that currently 380,000 children are HIV positive in the country, adding that Nigeria is committed to the goal of eliminating new HIV infections among children and keeping their mothers alive by 2020.
The NASCAP coordinator declared: “Nigeria has the second highest global burden of HIV/AIDS and also contributes the largest proportion of new vertically acquired HIV infections among children.
“The country has come a long way in its effort to control the HIV/AIDS epidemic, particularly in PMTCT.
“Beginning with the pioneer 11 PMTCT-provider tertiary health facilities in 2002, the country now has 7,265 health facilities providing PMTCT services at all levels of the health care system.”
Dr Aboje, however, stated that Nigeria’s target on eliminating new HIV cases in children among other things for 2018 was to ensure 50 per cent of HIV exposed children have access to HIV prophylaxis treatment and early infant diagnosis services.
Only an estimated 15.44 per cent (27,486) of the 177,993 HIV exposed infants received ARV prophylaxis for the PMTCT within first six weeks of birth as at 2015, according to NASCAP coordinator.
Only an estimated 10.26 per cent (18,263) of the 177,993 HIV exposed infants who started CTX prophylaxis within two months as at 2015, he added.
Similarly, only 8.92 per cent (15,879) of the 177,993 HIV exposed infants whose blood samples were taken for DNA PCR test within two months of birth within the same period.
He, however, declared that funding, inadequate political commitment and funding at state and LGA levels, weak health infrastructure as well as inadequate engagement of the private health sector as some challenges against eliminating new HIV cases in children.