UGANDA: Government boost for PMTCT, paediatric services

Photo: Kenneth Odiwuor/IRIN

Getting more HIV-positive pregnant women on HAART will reduce the need for paediatric ART

KAMPALA, 1 December 2009 (PlusNews) - In a bid to reduce the rate of HIV transmission from mother to child, Uganda will now give all pregnant women highly active antiretroviral therapy (HAART).

HAART is a combination of three or more life-prolonging antiretroviral drugs rather than single-dose Nevirapine currently used for pregnant women in much of Africa.

Announcing the new policy at a recent national paediatric HIV conference, second deputy Prime Minister Kirunda Kivejinja said the government was committed to scaling up interventions that prevent HIV infections in children by improving prevention of mother-to-child transmission (PMTCT) services.

“We shall also ensure scale-up of access to services for early infant HIV testing and treatment, and for care and support for all children that are affected by HIV,” he added.

“We have proven that when pregnant women receive HAART, the rate of transmission from mother to child is less than 2 percent; this should go full-scale in Uganda,” Addy Kekitiinwa, executive director of the Baylor Uganda Children’s Foundation, a paediatric HIV centre supported by the government and international partners, said at the conference.

A recent Ugandan study of 1,829 women found a 1.67 percent infection rate among infants born to mothers who received HAART during pregnancy, compared with an 11.75 percent infection rate among infants whose mothers received single-dose Nevirapine, and 3.73 percent and 5.02 percent of those who received two types of combination therapy.

“This demonstrates that we can do it and be like all those countries where there is very low transmission from mother to child. HAART will help us kick out HIV transmission to infants,” said Kekitiinwa.

The scale-up comes as the UN World Health Organization (WHO) unveiled its new HIV recommendations promoting the use of ARVs earlier in pregnancy, starting at 14 weeks and continuing through to the end of the breastfeeding period.

WHO now recommends that breastfeeding continue until the infant is one year old, provided the HIV-positive mother or baby is taking ARVs during the period. This will reduce the risk of HIV transmission and improve the infant’s chance of survival, said WHO.

Uganda faces a monumental challenge in fulfilling its pledge - paediatric ARV access remains low. Of the 356 facilities that offer ART across the country, only 229 offer paediatric HIV; of these, 100 have less than 10 paediatric ART clients.

Paediatric treatment gap

“We have a big gap that we have to address in paediatric treatment and care,” Kekitiinwa said. “It is a shame that most adult facilities cannot offer paediatric services.”

Even if all factors remain constant, we still need the government to help or we shall not achieve universal access

It is estimated that 50,000 children and infants need ART, but only 17,000 children are receiving treatment.

The government hopes to improve children’s HIV treatment through a revised “child health card”, whereby health practitioners provide more information to ease follow-up treatment, as well as “child-plus days” at health centres, and higher family planning and antenatal care targets.

Funding uncertainty

However, even as the plans for scaling-up get under way, there are fears that funding uncertainties could hamper the government’s plans. The US President’s Emergency Plan for AIDS Relief (PEPFAR), one of Uganda’s largest ART providers, could be cutting as much as US$1 million over the next year, according to conference participants, who requested anonymity. This year, PEPFAR maintained funding levels, meaning that many ART programmes cannot expand unless the government steps in to fill the gap.

“Even if all factors remain constant, we still need the government to help or we shall not achieve universal access,” Kekitiinwa said.

“Uganda has had a lot of success and it will be sad to see all these efforts lost,” said Musa Bungudu, UNAIDS country coordinator for Uganda. “The government should put more money into these programmes - dependency on international resources is important but does not represent stability.”

en/kr/mw