Country misses mother-to-child transmission target by 5pc
Anita Iminza, (not her real name) learned she was HIV positive through a routine test in 2010 while pregnant with her child, now 11.
The news came as a complete shock to her and family. At just five months pregnant, this life-changing revelation was difficult to deal with; she didn’t know how exactly to handle it.
“I was completely devastated. I kept picturing myself so weak and emaciated at the end of my life,” she starts.
The hardest part of the situation was breaking the news to her former husband.
“It took me about two weeks to break the news to him. For someone who looked very healthy, I was certain he would blame it on me and ignore my request to have a test done,” she recalls.
However, he took it completely differently and agreed to be tested. His test came out negative.
“When I found out that we are discordant, I was more worried. Questions of where I might have gotten the virus from clogged my mind. This really affected my pregnancy because I was constantly in and out of hospital,” she says.
She also had to deal with the accompanying stress. Tracing where she might have contracted the virus drained her emotionally, so she decided to focus on ensuring she was healthy enough for her children.
“Although at that time I was going through a lot, my primary focus was on seeking counselling and lifesaving anti-retroviral medication.”
She would religiously take the pills without hesitating, enduring side effects that included nausea. Even with no support from her former husband, she made it through her pregnancy without developing any complications.
She was fortunate to give birth to a healthy bouncing baby; whose test came back negative at first.
However, after a few weeks, her son’s health started deteriorating and weeks later, he began to rapidly lose weight.
With fear that the child had been infected, she quickly rushed him to hospital where he was put on a respirator in the intensive care unit, where he spent weeks fighting a respiratory virus his young body couldn’t fend off.
“He was so sick; he couldn’t feed properly, his weight was slowly changing and this got me so worried. I was certain I had saved him from the virus, but was yet to confirm my fears,” she says.
The weeks that followed weren’t looking good for her son. He braved numerous tests accompanied by long hospital stays, but still got no answers. It was becoming her worst nightmare.
“Four weeks after so many back and forth rounds with the doctors and several blood work, my son was diagnosed with HIV,” she recalls.
She was devastated. That her son was positive is a burden he shouldn’t have been dealing with, especially when mother to child transmission (MTCT) is completely preventable.
“I was constantly thinking how his future would be and prayed many times for it to be easier for him to live with. To date, he has proven to be a champion and I hope the rest of his life is that easy,” she says.
The Joint United Nations Programme on HIV and Aids (UNAids) report in 2020 shows that 1.4 million people in the country are living with HIV. Of this, 82,000 are children aged 0-14 years old. This age group also accounted for 5,200 new cases and 3,100 deaths in 2020.
The agency’s statistics also show that out of the 54,000 pregnant women needing ARV for Prevention Of Mother To Child Transmission (PMTCT), only a little over 50,000 received it. Early infant rate is at 76 per cent and the rate of MTCT, including during breastfeeding is 9.65.
Dr Francis Ndwiga, PMTCT/STI Manager, National Aids and STIs Control Programme (NASCOP), says Kenya is one of the 22 priority countries focused on elimination of MTCT of HIV and Syphilis.
He adds that the Kenya Strategic Framework for the Elimination of Mother-To-Child Transmission of HIV and Syphilis 2016-2021 target for Kenya was to reduce transmission to below five per cent.
So far, significant progress has been made following implementation of this framework and keeping mothers alive, through universal access to comprehensive HIV, maternal and child health services.
“There has been an increase in the number of women accessing anti-retroviral therapy to reduce MTCT of HIV.
The programme has taken overall leadership in operationalising elimination guidelines and protocols to ensure validation of elimination of MTCT is achieved in the near future,” says Ndwiga.
Rates of mother-to-child transmission of HIV have been rising alarmingly in Arid and Semi-Arid counties over the past three years, with rates as high as 28.5 per cent in 2020, which is more than the national rate.
Currently, the coverage for HIV and syphilis testing is at 81 per cent and 82 per cent respectively, according to Kenya DHIS2 2020.
“Twenty-two counties contributed to 50 per cent of MTCT infections in Kenya, hence, a targeted approach that focuses on the high burden areas and counties is recommended,” he says.
Dr Ndwiga further attributes any increased rates to low turn-out for services during the pandemic.
“At that time the issue was around low attendance in facilities for PMTCT and other services.
However, the government had put in place measures to ensure adequate supply and distribution of ART were in place, the key issue was the spike of teenage pregnancies, which is a great concern due to the behavioural and HIV/STI risk of infection associated,” he says.
Dr Wahu Gitakah, consultant paediatrician at Aga Khan University Hospital, says paediatric Aids is a major cause for concern.
She says infants born of women with HIV with no interventions to prevent transmission will suffer from a variety of associated factors, including the risk of premature birth, and subsequent low birth weight and perinatal HIV transmission.
“The mother’s breast milk may be reduced in quantity and be inadequately fortified with antibodies. Infected or not, these infants will also have to face the relatively early death of their mothers and, perhaps, fathers. Orphaned children have their own challenges and face the threat of early death,” she says.
She adds that there is increased risk of neonatal infections for children born to HIV mothers due an increased rate of chorioamnionitis, infection at the placenta amniotic fluid. This increases neonatal morbidity and mortality.
Dr Wahu says early testing and treatment is important when it comes to paediatric HIV. Failure to which, half of HIV-positive infants die by two years old and three-quarters by five years.
“Delayed start of treatment in children results in repeated infections, poor neurocognitive development and a higher death rate.
Paediatric HIV infections contribute directly to infant and young child mortality, complicates child malnutrition, and requires life-long and expensive treatment.
Children on HIV treatment who survive to adolescence and adulthood face the additional challenge of forming relationships without transmitting their acquired infection horizontally,” she adds.
In most facilities, early infant diagnosis has been strengthened through various programmes and the turn-around time for early infant diagnosis has significantly reduced as a result of point-of-care products.
“There has been strengthening of identification and follow-up of HIV-exposed children through PMCT services. Issuing the mother-child welfare card during the initial antenatal visit, or at first contact for those who deliver at home, with a clear indication of HIV-exposure status facilitates early identification and referral, and linkage to appropriate facilities for care,” she adds.
There has been a deliberate effort to build the capacity of healthcare personnel. Using simple standardised tools such as the Integrated Management of Childhood Illnesses, they are able to identify children suspected to be HIV infected, stage, test and link them to care. Most facilities have clear directions and guidelines that assist in referring children to appropriate care.
However, the best way to manage paediatric HIV/Aids in all areas remains to save children from acquiring HIV by preventing the infection from their mothers.
“Based on the four-pronged approach promoted by the World Health Organisation, which focuses on primary prevention of HIV infection in women, prevention of unintended pregnancies, reducing transmission during pregnancy, labour and breastfeeding, and providing support to HIV+ women and their families helps in reducing transmission rates,” she says.
She adds that Kenyan guidelines encourage four or more antenatal care visits, with an essential package of services that includes counselling, medical history and examination, nutritional assessment, testing for opportunistic infections including tuberculosis, positive prevention counselling, condom use, and an effective contraception plan.
This concept, according to her, has had a great impact on the reduction of HIV in children and contributes to the elimination of MTCT, as well as encouraging children from an early age to cope and understand their illness.
Dr Ndwiga adds that one of the methods adopted is working together with community models and PLHIV networks to promote ownership, clustering of counties whereby specific county plans are developed and institutionalising the stacked bar analysis tool to enable counties to address problems on individual levels.
“We want to ensure that we are able to reduce the rates through Community-based PMTCT Programming that focuses on empowering communities to be in charge of their own health through community health strategy model,” he explains.