ANC: Panacea to Prevention of Mother to child transmission of HIV

By Olawale Adewale, The Nigerian Voice, Osogbo 

Mrs Nniola Lawrence was rushed to a private hospital in Osogbo by her neighbours when she complained of stomach-ache. The doctor asked if she was pregnant and she said no. Surprisingly, she was delivered of a baby boy 25 minutes later. Apparently, she trusted a family planning that she did and she never knew that she was pregnant. Without any form of antenatal care, the baby came to the world safely.

Unlike Niniola who omitted antenatal because she didn’t know that she was pregnant, there are other women who deliberately avoided it and many of them were not usually fortunate like the lucky Niniola. While such pregnant women tend to lose their lives, the tendency of exposing their unborn children to various forms of risks is also very high. Some of them that are HIV positive might event infected their innocent babies inadvertently.

The former United Nations Secretary-General, Mr Ban Ki-moon while speaking on the importance of antenatal care for pregnant women said to achieve the "Every Woman, Every Child" vision and the "Global Strategy for Women's, Children's and Adolescents' Health", there is need for innovative, evidence-based approaches to antenatal care which is aim at putting women at the centre of care, enhancing their experience of pregnancy and ensuring that babies have the best possible start in life.

Given the fact that Nigeria has the second largest global burden of Acquired Immunodeficiency Syndrome (AIDS) a chronic, potentially life-threatening condition caused by the Human Immunodeficiency Virus (HIV), and considering that the country contributes the largest proportion of new vertically acquired HIV infections among children, the antenatal care for pregnant women becomes very necessary as a way of nip the menace in the bud.

The Joint United Nations Programme on HIV and AIDS (UNAIDS) said Nigeria is responsible for over 12.4% of the global burden of HIV infected children with an estimated number of 267,000 children living with HIV in the country, According to ‘UNAIDS 2017’.

The National AIDS and STI Control Programme (NASCP) of the Federal Ministry of Health said Nigeria is committed to the goal of eliminating Mother to child Transmission of HIV by 2020 and has initiated a number of strategies to achieve it.

To achieve the goal of elimination of MTCT, the federal government says at least 90% of HIV infected women must have access to comprehensive treatment to prevent such mothers from transmitting the HIV to their unborn. These treatments include anti-retroviral drugs (ARVs) during pregnancy, labour, delivery and breastfeeding periods.

The core activities by government towards achieving this goal include routine HIV Testing Services (HTS) for all pregnant women attending antenatal care (ANC), Labor and postnatal with appropriate documentation. Also, initiation of all newly identified positive pregnant women on ART with referral to adult ART clinic after PMTCT and appropriate classification of HEI risk and Initiation on recommended ARV prophylaxis are among the efforts.

Dr. Gbenga Ijaodola, Assistant Director at National AIDS and STI Control Programme (NASCP) of the Federal Ministry of health while speaking at a media dialogue in Calabar, Cross River State said the country has established a national Treatment and PMTCT Program to gradually take responsibility of the Treatment and PMTCT program. He said concerted efforts are required to meet 90-90-90 global targets including strengthening coordination of the health sector response for effective HIV services delivery.

The media dialogue which was organised by the Child Rights Information Bureau of the Federal Ministry of Information and Culture in collaboration with the United Nations Children's Fund (UNICEF) was attended by journalists drawn from various part of the country.

UNICEF Communication Specialist, Dr Geoffrey Njoku said the aim of the media dialogue is to furnish the journalists with useful information on the subject matter with facts and figures to spur them to report it effectively. Dr Njoku charged the media to mainstream the issue of PMTCT so as to increase the knowledge among spouses, partners and family members, sensitize the public properly on HIV-related stigma and to galvanise the authorities to act appropriately in addressing the problem.

He said the National Treatment and PMTCT Programme (NTPP) would ensure sustainability of the HIV response, and consolidate the gains of previous initiatives. He highlighted the efforts by government and partners to address the problem of mother to child transmission of HIV.

According to him, “At the moment, 95 percent of the national HIV response is supported by partners. This includes PMTCT and Paediatric Treatment. Partners support is from USG PEPFAR, Global Fund, AIDS healthcare Foundation, Clinton Health Access Initiative (CHAI).”

Speaking further, Ijaodola said the goal of the NTPP is to fast track towards 90-90-90 treatment targets for Nigeria by ensuring that 90 per cent of all HIV positive persons are diagnosed provide the antiretroviral therapy (ART) for 90 per cent of those diagnosed so as to achieve viral suppression for 90 percent of those treated and this is expected to be achieved by 2020. He said the overall results of the national HIV treatment, he said the coverage has increased and that government funded HIV treatment coverage contribution has also increased while the health sector coordination capacity has also been strengthened.

Going forward, Ijaodola recommended that the health sector should be empowered for effective coordination of HIV treatment program interventions and implementation in Nigeria. His words “That NASCP and State AIDS Control Programmes in the 36 states and the Federal Capital Territory should be empowered for effective coordination of HIV treatment programme interventions and implementation and all persons that require HIV Testing must have unhindered access to HIV testing services including pregnant women. All PLHIV including HIV positive pregnant women and Children living with HIVAIDS should have unhindered access to Antiretroviral Treatment Prevention of Mother to Child Transmission and other related services”.

In Osun State, the Government said as part of efforts to prevent transmission of HIV from positive pregnant women to their unborn children during delivery, the state hospitals in the state are giving adequate care to them without financial burden, even for Caesarean Section.

The State Supervisor for Ministry of Health, Dr Rafiu Isamotu said this in a chat with Daily Trust on the efforts of the state government in preventing positive pregnant mothers from transmitting HIV to their unborn children. Rafiu said every pregnant woman that visits any of the state hospitals in Osun gets comprehensive antenatal care and that HIV test remains compulsory for them to be sure of their status so that the pregnant women that are positive would be given special treatment.

He said antenatal care and delivery at the state hospitals in the state are free of charge and that the positive mothers wouldn’t need to worry over cost of Caesarean Section to deliver their unborn children without the risk of being infected with HIV during the delivery. According to him, “In Osun State, the proportion of pregnant women who received HIV counselling during antenatal care increased from 40.4% in 2013 to 57.9% in 2015 while the Prevention of Mother to Child Transmission (PMTCT) Services coverage increased from 14% in 2014 to 36% in 2015.”

“The Mother to Child Transmission (MTCT) rate in this state reduced from 16% to 13% during this period. However, in order to achieve elimination of MTCT, at least 90% of pregnant women should receive HIV counselling and testing during antenatal care and at least 90% PMTCT coverage is required. Achieving elimination of MTCT of HIV will contribute significantly to reduction in under-five mortality”, Rafiu stated.

The Head of Child Rights Information Bureau in the Federal Ministry of Information and Culture, Abuja, Mr Olumide Osanyinpeju who is also a Deputy Director in the ministry said the federal government was working relentlessly with stakeholders to achieve an HIV/AIDS free nation, especially with regard to the children. He said the larger number of children in the country that face the risk of HIV infection was worrisome and that proactive measures must be taken by all stakeholders to save the kids from the imminent danger.

Osanyinpeju commended UNICEF for its contributions, support and partnership with the Nigerian Government as well as the consistent effort being made to ensure the wellbeing of the Nigerian child. His words "We commend UNICEF for all activities being implemented in partnership with the federal government to ensure that the rights of Nigerian children to adequate and standard health care, besides other basic social services, are preserved. I also wish to acknowledge the collaboration of Federal Ministry of Health, other line partners, and other Stakeholders in making sure that this intervention is a success. I appreciate the National Aids and STIs Control Programme, and other HIV/AIDS partners here present for always working with us in the best interest of Nigerian children."

His words "It is worthy to note that it has been a difficult task propagating that children reserve the rights to issues affecting them, the right to live free from diseases, HIV/AIDS in focus here. May we not lose sight of the fact that a large number of Nigerian children are still at risk of the infection, a host of them living in our communities under emergencies and insurgencies. We must understand that the deprivation of the foregoing is an infringement on the rights of a child. There is need for all to rise up against this menace, as routine transmission may leave life-long scars that may affect the child emotionally and psychologically."

"As you know, government alone cannot fight this cause, hence, the need to collaborate with Agencies, NGOs and other line partners and organizations to advocate on how best addressing the issue. We need media to start making the Nigerian people think in the interest of the Nigerian child, to tackle the low level of awareness that exists amongst our people towards the realisation of the health needs of children within the framework of child’s right, and obtaining the desired support from government and institutions”, Osanyinpeju noted.