Thursday, 18 April 2013

PMTCT services extended to health center IIIs and excites mothers

PMTCT services extended to health center IIIs and excites mothers
By Hope Mafaranga
In Ntungamo

“I never tested for HIV when I was pregnant because the health facility where such services were offered was far. I ended up infecting my first born,” These are the words of Stella Natuhwera of   Ndeija in Rwampara district.
Natuhwera says that the health where she could get services is at Itojo Hospital in Ntungamo district or Mbarara regional referral hospital about 40 and 50 kilometers respectively.
Natuhwera said that, after two years, she conceived and went to Bugamba Health Center III where she was started on treatment when her pregnancy was just three months.  Today Natuhwera is proud mother of a nine months HIV free baby girl.

Many women have infected their babies after failure to go to health because of long distance.
In 2010, Dina and Umar Mugarura their dream of having healthy babies was shattered after the couple tested positive to HIV.

Dina aged 33 and a resident of Rwashamire said  that she lost hope and almost aborted because she did not want to raise a baby with HIV.
 However her attitude changed after going to Rwashamire health center III and she was told about the EMTCT Option B+ methods.

“I was started on treatment when the pregnancy was three months and I have continued to take my one tablet which the nurses explained to me that was a new method of elimination of mother to child transmission (EMTC) Option B+ that would protect me my baby and making me healthier,” she said.

According to the Ministry of Health, since inception in 2000, the national PMTCT program has steadily scaled up to cover over 2,000 (40%) of the estimated 5,000 health facilities in the country.

However, the minister of health Dr Christione Ondoa said that despite the success in increasing geographical access to PMTCT services, some pregnant women are not being reached and many HIV positive mothers are being lost at some point. It’s from this point that they have enrolled the it to the lower health center IIIs in order to reach women in deep rural areas.

“About 82% of pregnant women were tested for HIV positive as of June 2012, only 68% of positive pregnant women received ARVs for PMTCT, and only 38% of their babies received ARVs prophylaxis after birth. To address these critical gaps, the ministry has embarked the new Option B+ guidelines for eMTCT to bridge the gap,” she said.

The transmission of HIV from mothers to their infants contributes significantly to global morbidity and mortality in children aged five years and below. 

Dr Andoa said that Uganda was for long considered a global yardstick in the fight against HIV and AIDS, having reduced its prevalence from a high estimated 30% in the eighties, 18% in the nineties, and a record 5% low in 2002. 

However, there are fears of increasing new HIV infections. The results of the 2011 Uganda AIDS Indicator Survey (UAIS) show that national prevalence now stands at 7.3% among adults aged 15-49 years, up from 6.7% in the 2004-5 national population-based survey, with HIV prevalence in South Western standing at 8.0%.
The executive director of Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Dr Edward Bitarakwate said that previously, expectant mothers were on single dose of Nevirapine tablet and Syrup for mother and baby and HIV positive pregnant  were asked to do replacement feeding (infant formulae) while  HIV testing was voluntary.
Dr Bitarakwate said that now with EMTCT Option B+, ART will be started earlier in pregnancy, which he said will significantly reduce the rates of intrauterine transmission.

 “ART can be started at the woman’s first visit and in the first trimester reducing missed opportunities Transmission through breastfeeding will decrease because the mother will be on ART. Mothers can also breastfeed for a longer time hence contributing to increased HIV free survival through reduced HIV risk as well as morbidity and mortality from malnutrition,” he said.

The EMTCT method comes in the wake of the Global Plan Towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive, which aims to reduce the number of children newly infected with HIV by 90% by 2015, and to reduce the number of women dying from HIV-related causes during pregnancy, delivery and post-natally by 50%, from a 2009 baseline.

“We want to use anti-retroviral treatment to not only prevent mothers from passing the HIV virus to their babies but also protect their own health and allow them live longer to look after their families,” Bitarakwate added.

Option B+
           Initiation of ART earlier during pregnancy at or before 14 weeks
           Giving ARV prophylaxis to baby for only 6 weeks
           HIV+ mothers recommended to breastfeed for 12 months and beyond while on ART for the entire duration of breast feeding and for life
           1st PCR at 6 weeks, 2nd PCR 6 weeks after Stopping BF, and Rapid antibody test at 18 months as infants will be breastfeeding for much longer time.
           All children under 2 years old immediately eligible for ART
           AZT replaces D4T as preferred first line treatment regimen

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