AFRICA: Pregnant, HIV-positive and falling through the PMTCT cracks

Photo: Sofia Teixeira/PlusNews

Only half of all pregnant women in east and southern Africa have access to PMTCT services

NAIROBI, 25 May 2009 (PlusNews) - An estimated 900 babies in the developing world are infected with HIV every day because governments fail to reach pregnant women with prevention of mother-to-child transmission (PMTCT) services.

"We are doing a bad job of testing women for HIV and then following them up, and an even worse job of ensuring that infants receive appropriate prevention and treatment services," Janet Kayita, regional PMTCT advisor to the UN Children's Fund (UNICEF), told a press conference in the Kenyan capital, Nairobi, on 25 May.

The press briefing followed a regional consultation, hosted by UNICEF, on accelerating PMTCT and paediatric care and treatment in the nine countries - Ethiopia, Kenya, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda and Zambia - which accounted for half of all new HIV infections globally in 2008.

In eastern and southern Africa, 70 percent of women see a healthcare provider at least once during their pregnancy, but just 43 percent have an attendant present during delivery who can administer treatment to prevent HIV transmission.

The consultation, attended by government, NGO and UN representatives, identified the continued use of single-dose nevirapine, rather than more effective combination therapies, as one of the factors limiting the impact of PMTCT programmes; delays in diagnosing and treating HIV-infected newborns were other major weaknesses.

Getting government policies to the ground

Governments have also failed to translate national PMTCT policies into locally available services, according to a new study on the failure of PMTCT programmes, Missing the Target by the International Treatment Preparedness Coalition.

According to Uganda's national policy, PMTCT services should be available at all sub-county level health centres, but a shortage of health workers means that only 53 percent of these facilities actually offer them, the report noted.

"National guidelines are not disseminated as fast as they should be to the district level - only 39 percent of all new mothers in eastern and southern Africa exclusively breastfeed their babies for six months, despite existing guidelines on this in all these countries," Kayita said.

"These policies must become a reality for the people they were designed to help," she added. "We need to strengthen primary healthcare systems at the lowest level, so that every visit a woman makes to a health centre counts."

Involving the community

Experts at the consultation said partnering with communities was vital. "Community voices must be strong, demanding and angry where they need to be; civil society must have a voice," said Mitch Besser, executive director of Mothers-2-Mothers, a community-based PMTCT programme with more than 500 projects globally that uses HIV-positive "mentor mothers" to educate pregnant women about the benefits of HIV testing and treatment.

Community involvement is essential to reducing HIV-related stigma that could lead mothers to refuse being tested for HIV or to insist on breastfeeding against medical advice.

Other recommendations by the consultation included better data management to understand trends, identification of bottlenecks, measuring the impact of interventions, and prioritising geographic areas where prevalence was highest.

Governments participating in the consultation are expected to put in place policies that will help achieve the universal access targets of 80 percent PMTCT coverage and a 50 percent reduction in new paediatric infections by the end of 2010.

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