Wednesday, 15 October 2014

Nigeria’s High Burden Of Children Infection, Barrier To Eliminating HIV

By: Chioma Umeha

EXPERTS have raised alarm over Nigeria's failure to attain 50 per cent target in Prevention of Mother to Child Transmission (PMTCT) of HIV last year.  According to them, the trend contradicts the county's much celebrated success of reducing infection to 4.1 per cent. Nigeria  reduced infection from 4.6 per cent in 2008 to 4.1 per cent in 2013, but the country still shares  32 per cent of global burden of children infection. According to recent reports, reduction in children infection was less than 25 per cent between 2011 and 2012. 

There are fears that this development may also frustrate efforts to reduce HIV incidence among  girls and women between 15 and 49 years by 2015 by at least 50 per cent. Experts have therefore called for urgent steps to be taken  in scaling down the rising incidence of  children infection through PMTCT. 

This call is coming on the heels of recent report which quoted Dr. Rajiv Shah, the Administrator of United States Agency for International Development (USAID) announcement that United States government spent  $16 million  on prevention of mother to child transmission of HIV last year. 

According to reports, the Nigeria has about 3.5 million people living with HIV. UNAIDS Report on Global AIDS Epidemic reports showed that 220,000  deaths occurred in country in 2009. The UNAIDS report further said the disease prevalence rose from 1.8 per cent in 1991 to 3.8 per cent in 1993; 5.4 per cent in 1999 and 5.8 per cent in 2001. 

Estimates from the joint United Nations AIDS programme (UNAIDS) have also showed that not less than 3.14 million Nigerians were found living with HIV as at the end of 2011. This corresponds to 4.1 per cent of over 150 million being the estimated total population of people in Nigeria according to the most recent National Demographic Health Survey (NDHS of 2008).  

The NDHS was based on population estimates obtained by the Nigerian Population Commission (NPC) during the 2007 nationwide census. The NDHS report further said that 281,180 new infections occurred during the period in focus, of which 154,920  consist of children. 

Also, Nigeria alone accounts for 21 per cent of new children global infections in children based on the 2011 UNAIDS statistics. Further statistics from the United Nations Children Fund (UNICEF) shows  that 10 per cent of all HIV infections are as a result of mother-to-child transmission in Nigeria.

Also, the Federal Ministry of Health records show that in 2011, only 15. 89 per cent of HIV-positive pregnant women received anti retroviral (ARVs) drugs to reduce the risk of  infant  transmission. In addition,  only 2.3 per cent of   infants born to infected mothers (HIV-exposed infants) received ARV prophylaxis to reduce the risk of early transmission. 

About six million babies are born in Nigeria yearly. At the end of 2011, 229,480 pregnant women were found to be HIV positive, even as an estimated  57,000 infants were exposed to the virus. 
Healthy mother and baby free of HIV
Dr. Oliver C. Ezechi, Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba Lagos, Nigeria during an interview corroborated the dismal situation saying; “Nigeria contributes 32 per cent to the world gap in achieving a global target of eradicating MTCT.” 

Ezechi observed that the nation planned to achieve 50 per cent target in PMTCT for 2012, but regretted that PMTCT coverage is still low as the nation recorded  only 16 per cent. 

The Clinical Scientist said; “PMTCT coverage still remains low with only 1,120,178 (16.9 per cent) pregnant women counselled and tested for HIV and receiving their results in 2011.” He continued; “17.6 per cent of the HIV-infected pregnant women in 2011, received antiretroviral insisting; “there is major challenge in the area of PMTCT coverage which is 16 per cent only.” 

Also, a United Nations Development Programme (UNDP) report, few days ago confirmed that the nation reported prevention of mother-to-child Transmission (PMTCT) of HIV of less than 25 per cent, thus joining six other sub-Saharan Africa countries — Angola, Chad, Congo, Eritrea, Ethiopia and South Sudan — which also recorded a not impressive performance between 2011 and 2012.

Dr. Rosemary Audu, Head, Human Virology Laboratory, also said there is there need to scale up PMTCT,  observing that many women know their HIV status, but hardly disclose it to their partners. Audu said: “There is urgent need for PMTCT scale up; many women know their status but, disclosure of HIV status to partner remains difficult.”

Mother-to-child transmission is the term used for vertical transmission of HIV from an HIV-infected mother to her newborn child explained  Dr. Dan Onwujekwe. Dr Onwujekwe noted that effective PMTCT could be achieved through “Primary prevention of HIV infection in women of reproductive age group and their partners. 
Prevention of unintended pregnancies among HIV-positive women as well as prevention of HIV transmission from HIV-infected mothers to their unborn babies and infants, especially during deliveries would be helpful.” 

Accordingly, care and support for HIV-infected women, their children, and family members is a very important  aspect of PMTCT that must be scaled to a level that could cover all parts of the country, with concentrations on areas of high HIV burden. 

In Nigeria, the national PMTCT programme commenced in 2002 with supports from the World Health Organisation (WHO) and UNICEF. There are currently about 1,216 PMTCT service points across the country. Meanwhile, the coverage for the people in need of PMTCT still remains low. Out of 210,000 HIV positive women, only 22 per cent are covered by ARV/ART for PMTCT. This is considered low compared to the corresponding PMTCT rate of 32 per cent.

Part of the commitment is that at least 50 per cent HIV incidence among women aged between 15 and 49 be reduced by 2015 as well as ensure that at least 90 per cent of all pregnant women have access to quality HIV counselling and testing by 2015. 

The country also targeted that by 2015 at least 90 percent of all HIV positive pregnant women and breastfeeding infant-mother pairs will receive ARV prophylaxis with at least 90 per cent of all HIV exposed infants having access to early infant diagnosis services. 

The country further targeted at least 90 per cent of pregnant women requiring ART for their own health receive lifelong ART. This is based on the Joint United Nation AIDS Programme (UNAIDS) target of achieving zero mother-to-child HIV infection by December 2015. 

This might be some huge steps towards bridging the PMTCT gap if the nation lives up to its commitment, experts say. To fix the missing links, experts have said there is need for Nigeria to increase funding for PMTCT by government at all levels, strengthen health systems capacity building, improve co-ordination and integrate Maternal, Newborn and Child Health (MNCH) programmes, they added. 

The Director –General, NIMR, Prof Innocent Ujah, lamented the big gap in PMTCT and rising new HIV infections among children. Observing that this is a big challenge Ujah called for increased funding and uptake of PMTCT by pregnant mothers.

According to him, at the moment major HIV funding comes from donors. In his report during the last World AIDS Day, he said; “We must raise the momentum to increase the uptake of PMTCT by pregnant mothers if we must reduce the prevalence of new paediatric HIV infections.” 

It is also believed that if the nation lives up to her commitment to the UNAIDS target of achieving zero mother-to-child HIV infection by December 2015, that nearly all cases of mother-to-child transmission of HIV infections can be prevented by PMTCT programmes that provide highly effective Anti Retroviral Therapy (ART) and Anti Retroviral (ARV) prophylaxis interventions.

This is in line with the Global Plan towards the elimination of new HIV infections among children and keeping their mothers alive launched by Head of States across the world, including President Goodluck Jonathan come 2015.

This story was published in Daily Newswatch on January 26, 2013.

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