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Progress in Prevention of Mother-to-Child Transmission of HIV

NAIROBI, Sep 28 2010 (IPS) - The number of pregnant women being tested for HIV and accessing treatment in Sub-Saharan Africa has shown significant progress – indicating that virtual elimination of mother-to-child transmission of the virus by 2015 is possible.

According to a new report Towards Universal Access, the proportion of pregnant women in Sub-Saharan Africa who received an HIV test increased from 43 percent in 2008 to 51 percent in 2009. The report by the World Health Organisation (WHO), the United Nations Children’s Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS assessed HIV/AIDS progress in 144 low- and middle-income countries.

It found an estimated 24 percent of the approximately 125 million pregnant women in these countries received an HIV test in 2009, an increase from 21 percent in 2008 and eight percent in 2005. Fifty-four percent of HIV-positive pregnant women in Sub-Saharan Africa received antiretroviral drugs to prevent transmission to their children in 2009, up from 45 percent in 2008.

Speaking to IPS during the launch of the report in Nairobi on Sep.28, UNICEF regional director Elhadj As Sy said the progress made in the prevention of mother-to-child transmission is testimony of the fact that virtual elimination by 2015 is achievable.

“What we need is strong political leadership, funding, good programs and activism. If we build on the progress and with renewed commitment we are well on our way to achieving virtual elimination by 2015,” Sy said. However, despite the progress there are still challenges with disparities between regions and within countries.

Some Successful Mother-to-Child Prevention Strategies

A number of countries have decentralised HIV prevention, care and treatment to primary health centres. South Africa, is doing this with nurses initiating and managing treatment, with a mentoring and referral back-up from the district team. In Zambia mother-to-child transmission services have been integrated in outreach sites and maternal and child health public facilities.

HIV-positive pregnant women are given a colour coded pre-packaged set of antiretroviral medicines, complete with clear directions for when a mother should take the drugs and also when and how to give them to her new born child. The diagrams and colours help the mother understand the changing schedule of the medicines and dosages.

Zambia is also focusing on task-shifting to involve lay providers and people living with HIV in delivery of services.

"The Zambian story is an example of government commitment and involvement of the community. A successful response involves strong initiatives from the community and in Zambia the churches association runs 50 percent of health care. This is clear indication that early responses make a difference," Sy said.

Four countries in the region report providing HIV testing and counselling to over 80 percent of pregnant women. They are South Africa, Zambia, Namibia and Botswana. These countries have already reached the target set at the United Nations General Assembly Special Session (UNGASS). This is the target of providing 80 percent of pregnant women in need of treatment with antiretroviral drugs to reduce transmission to their children.

Despite the marked progress, countries in Eastern and Southern Africa fared better than their counterparts in West and Central Africa. In Eastern and Southern Africa, 50 percent of pregnant women received HIV testing and counselling, an increase from 43 percent in 2008. In Western and Central Africa, coverage increased from 16 percent to 21 percent between 2008 and 2009.

“While the figures in Western and Central Africa are low, this does not mirror failure on their part. The burden of HIV/AIDS has leaned heavily on Eastern and Southern Africa and this is where most interventions have been directed. Western and Central Africa are just beginning to pick up the problem and their burden of the epidemic is lower,” said Dr. David Okello. Okello is director, HIV/AIDS, Tuberculosis and Malaria Cluster at the WHO regional office for Africa.

Seven countries including Nigeria, Angola, Democratic Republic of Congo (DRC) and Ethiopia provided HIV tests to less than one third of pregnant women. “Knowing and accessing treatment is very crucial. Greater investments are needed to increase HIV testing and counselling among pregnant women in order to effectively prevent mother-to-child transmission of HIV,” Okello said.

Nigeria, DRC, Ethiopia and Uganda are still far from attaining the UNGASS target. These four countries contributed to 50 percent of the global gap in reaching the UNGASS target. The global gap is the difference between the current number of pregnant women in need who have access to ARVs and the estimated number who must be reached to achieve the UNGASS goal. Nigeria alone accounts for almost one third, 32 percent of the gap.

The number of children receiving antiretroviral therapy in Sub-Saharan Africa rose from 224,100 to 296,000. However, the total coverage among children in the region is still low at 26 percent compared to adults at 37 percent. “Too many children are still dying in this time and era when we can test and treat. We need to do more to reach the 10 million who still need treatment,” Sy said.

Among infants and children exposed to HIV, access to early testing, care and treatment is still a challenge. More than 90 percent of children living with HIV are infected through mother to child transmission during pregnancy, around the time of birth or through breastfeeding. The challenges facing Sub-Saharan Africa include weak integration of services, persistent drug stock-outs and little follow up of patients started on treatment.

“To address these challenges, countries need to strengthen health systems, improve integration of services and bring facilities closer to the people,” Okello said.

Integration of services means having related areas close together such as child and maternal health, tuberculosis and reproductive health services. “We need to develop strategies to reach out to every woman and child especially those in marginalised areas, the poor and those living in rural areas. We need to counter stigma and discrimination and the risk of violence against women particularly,” Sy said.

Countries need to develop mechanisms to engage communities as partners and establish links between health facilities and the local people. Address challenges that keep people away from health facilities such as financial barriers and user fees. Strong follow-up systems are needed to monitor and ensure identified needs are actually being met. Many infants and pregnant women who test HIV-positive are lost to follow up.

However, Sub-Saharan Africa which greatly relies on donors for its HIV interventions, faces tough times in the future, with the announcement that funding is steadily declining. “Funding for HIV has flat-lined for the first time in 15 years. In 2009 we had 8.7 billion dollars, now we have 7.7 billion (dollars), the funding gap has increased to about 10 million dollars,” Okello said.

African governments are being urged to increase national budget allocation to healthcare. “Countries must live up to the Abuja declaration of 15 percent of national budget going towards health. With good governance structures and accountability, these monies can be put to good use. The advantages of increased investment in healthcare are immense,” he said.

The platform at the Global Fund replenishment conference in New York in October will be used to appeal to governments to reduce the funding gap.

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