The Final Hurdle? Ending Mother-to-Child Transmission of HIV

We’ve come a long way since 2011, with a 48 percent decline in mother-to-child transmission, but availability of services to ensure babies are born HIV-free is still insufficient in communities across Africa.

At the end of a long, muddy road, Florence finally arrives at the com- munity health facility, made up of a couple of run-down, single story buildings in rural Uganda. After the long journey, Florence discovers the facility is stocked-out of the antiretroviral therapy (ART) drugs she has come to collect. She is HIV-positive and needs her medicine to stay healthy. The staff encourages her to come back the following week when they hope her drugs will be available, while in truth they are resigned to the knowledge that they will likely not see Florence again. The prospect of making another long and expensive roundtrip with her baby and potential stock-out of her drugs, make another visit to the clinic highly unlikely.

Florence, like many women living with HIV in Africa, adhered to her ART through her pregnancy and made sure she gave birth at the clinic with a skilled attendant, despite the cost of getting to the clinic. As a result, her son was born HIV negative, like millions of other babies whose mothers have been part of prevention of mother-to-child transmission (PMTCT) programmes. The attendants, who helped ensure a safe delivery, as well as the mentor mother counsellors supporting her, encourage Florence to come back for her treatment and to continue being adherent to drugs while breastfeeding to ensure her baby is well nour- ished and remains HIV free and healthy. From experience, these attendants know that interrupting treatment will increase the child’s risk of becoming infected through breastfeeding.

Town, a different story is unfolding. Joy takes a bus from her village and arrives opposite a newly refurbished district health centre. The atmosphere and staff here are brimming with optimism as they attend to patients. Joy joins the other women waiting for their appointments, some chatting with one another, others quietly waiting. At this facility, the nurses report that mothers are coming back to get their ART whilst breastfeeding, and testing has indicated that there have been no perinatal infections in the past year.

These are two clinics separated by a few kilometres, yet the different experiences accessing health services could have dramatic consequences for Florence and Joy and their children.

Mother-to-child infections are entirely avoidable.

 

Support Groups Can Help

In the UNAIDS Global Plan published in 2011, one major global priority was to ‘reduce the number of new infection rates among children by 90 percent’ by 2015. Globally, since 2011, there has been a 48 percent decline in the number of new infections. While this falls short of the 90 percent target, real progress has been achieved. PMTCT programs have reduced the mother-to-child transmission rate to just 14 percent globally. Only five per cent of this transmission is in utero or during child birth, with nine percent transmission occurring during breastfeeding. Breastfeeding is one of the most effective ways to improve child survival, but barriers that prevent adherence to ART, including distance of getting to clinic or ART stock-outs, increase the chances that a child can become infected through breast milk.

“Mother-to-child transmission is entirely avoidable if we can ensure HIV-positive mothers must take antiretrooviral medication while pregnant and breastfeeding to avoid infecting their baby, but these are not always available that health systems, supply chains and transport support daily, lifelong availability and adherence to treatment”, says Natalie Africa Senior Director for Private Sector Engagement for Every Woman Every Child. Local communities, such as the one in Iganga, are currently stepping in to fill the gaps, provid- ing referral mechanisms and work- ing with clinics to keep women and their children in care. “We have seen community groups – such as Protecting Women and Children against Violence – do incredible work connecting people to clinics and thereby reducing mother-to- child transmission. This needs to be replicated in communities across the continent and for that to be sustained we need concerted focus on building on our suc- cesses and finishing the job,” says Dominic Kemps, Director of the Positive Action for Children Fund at ViiV Healthcare.

Mothers Must Continue ART During Breastfeeding

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has long been championing PMTCT programmes and recognises first-hand the importance that ART adherence for breastfeeding mothers has on a child’s overall health and survival. Over 60 percent of new infections happen during the breastfeeding period, all of which can be prevented. HIV progresses very rapidly in children, with the highest mortality between two and three months of age, yet only 50 percent of this age group is tested, only half of those receive results, and even fewer are linked to treatment. Chip Lyons, President and CEO of EGPAF notes: “Scaling up diagnosis of HIV for infants – and ensuring rapid test results and treatment initiation – is a matter of life and death for this most vulnerable group. But we can’t stop there. Repeat testing of HIV-exposed infants, particu- larly at the end of breastfeeding, must continue to receive more attention”.

EGPAF, Every Woman Every Child and Positive Action are currently collaborating on a Challenge Prize to identify the challenges associated with this last hurdle in ending mother-to-child transmission. The prize seeks to find innovative solutions to support women like Florence and Joy so they remain healthy and their children HIV-free. 

This article was originally published in The Guardian.