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.
