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Mother to child transmission and adherence

By Mwanaisha Seugendo | 19 Jun, 2016

Thanks for this important and yet challenging issue as of my area.Pregnant Mothers here are tested all through but we still have mothers who escape health environment for religious or traditional beliefs and present later with their children in advanced stages who are so ill. Hence our strategies have been also to focus on the communities to try capture them but it is still a challenge.

Replies

 

Walesi Natuman Replied at 1:33 AM, 19 Jun 2016

I share the same sentiments as we have no proper HIV core group set up we have had instances where treatment was refused to a neonate born to a HIV mother who died , both mother and child had not received treatment because of domestic and cultural issues which still hamper and creates discrimination for lack of a better word, to treatment of this illness.

RAJA MOHAMED M Replied at 2:25 AM, 19 Jun 2016

It is very important issue in HIV care settings. In south part of India, all anti natal mothers are enrolled under HIV test during their clinical visit at Govt.Health Center. If there is found positive mother, she will be followed till delivery and the baby also followed for 18 months. In this process, spouse will have counseling and test. In the last 10 years, outreach workers were doing the excellent job, but this outreach strategy stopped from November 2015. Now there is gap between identified amd unidentified HIV mothers and health care.
And, another issue that the private maternal center should be linked within the settings. Here, I would suggest, the National Strategy should go for sensitize the youth and public again.

Jostas Mwebembezi Replied at 5:06 AM, 19 Jun 2016

The issues of getting pregnant women to test and adherence are easy to solve.
1. work with community health workers to identify them and recruit them to the women groups in the villages e.g savings and loans groups. set rules for the groups to monitor their members.
2. Establish/strengthen referrals mechanisms in the community for antenatal visits etc. map pregnant women and conduct home visits, facilitate radio programs/ behavior change communications to engage men/husbands as household agents of change. integrate technologies and schedule antenatal appointments for pregnant women and send remainders through mobile phone or village health teams and make follow-up. try to inform them the likely pregnancy effects of missing ANC visits and HIV tests. we understand that most of our people lack information. Empowering our people with information will weaken their trusts in religious beliefs.
thank you
Jostas Mwebembezi
RCRA-UGANDA

Jostas Mwebembezi Replied at 6:19 AM, 19 Jun 2016

The issues of getting pregnant women to test and adherence are easy to solve.
1. work with community health workers to identify them and recruit them to the women groups in the villages e.g savings and loans groups. set rules for the groups to monitor their members.
2. Establish/strengthen referrals mechanisms in the community for antenatal visits etc. map pregnant women and conduct home visits, facilitate radio programs/ behavior change communications to engage men/husbands as household agents of change. integrate technologies and schedule antenatal appointments for pregnant women and send remainders through mobile phone or village health teams and make follow-up. try to inform them the likely pregnancy effects of missing ANC visits and HIV tests. we understand that most of our people lack information. Empowering our people with information will weaken their trusts in religious beliefs.
thank you
Jostas Mwebembezi
RCRA-UGANDA

FICARD NDAYIMIRIJE Replied at 7:19 AM, 19 Jun 2016

Thank you
Ficard Ndayimirije
BUJUMBURA BURUNDI

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Jane Carter Replied at 12:03 AM, 20 Jun 2016

Dear Jostas

Please remember that HIV testing is only one of the required lab tests for women attending antenatal clinics. They also require syphilis screening, haemoglobin measurement, urine for protein, glucose and to check for urinary tract infection, blood grouping and a malaria test (if in a malarial area). Some clinics also offer hepatitis B testing. With the focus on HIV and vertical funding, many ANC clinics in peripheral health facilities provide only HIV screening, and yet the other tests are very important. We know that haemorrhage is a major complication at delivery and so much safer if women go into labour with a normal haemoglobin (anaemia detected early and treated).

Please let us use an integrated approach to ANC testing.

Jane Carter

JAFF Didymus Kidze Replied at 3:05 AM, 20 Jun 2016

In my country Cameroon, the government has been leaving no stone unturn in the fight against HIV and AIDS. The government is doing so hand in hand with the private health care providers especially mission run health institutions. Of recent, the government has instituted the "see and test" approach to all health care providers. Pregnant women and all children from zero to 19years are tested free of charge. HIV testing is a prerequisite and mandatory in ANC visits especially for first and third trimesters. There is proper counselling and follow up for those tested positive mothers and their children for up to 18months. However, in the northern part of Cameroon where the inhabitants are mostly Muslim fulanis who donot value western education because of cultural reasons, alot of them donot even show up at all for ANC visits. They mostly deliver at home and will only show up in health care settings with disease complications after which their traditional treatment has failed. It is very difficult to handle some of these problems/complications. In Cameroon, for the past 2years, mother to child transmission of HIV has decreased on the not shell.

Evelyne MUKAKABANO Replied at 3:46 AM, 20 Jun 2016

Thank you for this senzitive issue,
In my aria(Rwanda)mothers are tested early when pregnant,however women in
poor class are always busy running up and down for casual labor to access
to food and miss health check up then at the last minute the reach health
institutions to deliver
All the best

Junior Bazile Moderator Replied at 12:30 PM, 20 Jun 2016

Thank you all for sharing your experience on such an interesting topic.
Jostas, I would like to echo your use of Community Health Workers (CHWs). This is a system that has worked and can work everywhere in the world once the CHWs are appropriately selected within the communities, well trained and well remunerated for the work that they do. The CHWs should live in the communities and serve as bridges between their communities and the health facilities.

I would like to also echo Jane's point regarding other lab test for pregnant women besides HIV. There are many sexually transmitted infection that a pregnant woman can be at risk for besides HIV. Hence it is appropriate to have as a comprehensive and exhaustive approach as possible in providing care to those pregnant women. Besides STIs, we also know that because of certain level of malnutrition particularly in resource limited settings, many pregnant women are at risk for anemia so it's important to always run a complete blood count to have a better idea of the women situations.
Pregnant women are also at risk of developing diabetes. In many situations pre-eclampsia and even eclampsia can be seen. Therefore, it is important to rule out those conditions. The good news is in most resource limited settings even in the most remote and isolated areas, all those tests can be done to rule out or in those conditions. Overall, comprehensiveness, exhaustiveness and integration should be the guide words.

Jaff, thank you for sharing with us your experience in Cameroun. I like the "see and test" approach that the government is implementing. However I would like to know if the government is looking into implementing the "test and treat" approach as well.
For example after seeing and testing, what happens when the test returns positive? Do you decide based on the CD4+ count or do you treat regardless of CD4+ count?
Once again thank you all for your contribution. Looking forward to reading more from your experiences.
Best,

Bazile

Innocent ALI Replied at 1:03 PM, 20 Jun 2016

Hi everyone
NIce topic. Cameroon has adopted the test and treat approach and option b+
for pregnant women. We still have challenges identifying and putting
especially diagnosed children on treatment. Data from some Health
facilities indicate the global trend of increased mortality among
adolescents. Some efforts are underway to target HTC in this population.
thanks.
Innocent Ali.

--
Innocent MBULLI ALI
Researcher, Infectious Diseases Genomics and Global Health.
Laboratory for Public Health Research Biotechnologies, BP 8094
The Biotechnology Centre, University of Yaounde 1. Cameroon.

Mobile: +23777021275.

It doesn't matter if you fall down as long as you pick something up from
the floor when you get up.

Reapi Mataika Replied at 9:17 PM, 20 Jun 2016

In Fiji we are guided by our PPTCT Policy and the HIV Decree. We have adopted Option B plus and we encourage exclusive breastfeeding for those who have been on ART. Hepatitis B along with Syphilis are part of booking bloods at ANC and are compulsory while HIV needs consent. In Fiji we find that the HIV decree enables us to do a few things like ensure that mum takes her ARV to protect baby because the decree recognizes the unborn child as a person that has the right to live. The Child Welfare Decree also comes into play when circumstance arise that might need the state to intervene to ensure that baby gets the medication needed. So its a good example of having laws that assist us in our work. We have adopted the test and treat path and our guidelines are based on the most recent WHO recommendations but we still have a number of gaps. For a small country there is a lot of movement so a number of patients are lost to follow up and stigma is still a big barrier. Non- compliance is still an issue as herbal medicine is readily available and a number of our deaths is secondary to this. Test results is also not readily available but may hopefully become a thing of the past soon as we are planning to have rapid test kits available nationwide. Our UN partners have had a big role to play in the above and continue to do so.

sophie Motsamai Replied at 1:56 AM, 21 Jun 2016

Dear All,
This is very good in PMTCT. I think this this to be coupled by male/partner involvement to try to curve the transmission at all levels. Intensive health education, 'see and test' of the male partners and 'test and treat' to the HIV positive ones.

DANIEL ERNEST ELOTU Replied at 7:29 PM, 21 Jun 2016

well with regards to hiv prevention(mtct),the shift to option B plus
seems to be doing well here in our settings so far except a few
challenges that if well addressed,the rate of MTCT of HIV would really
decline to the desired levels by WHO.It being a relatively new
programme in most of the settings,i would love to commend the
countries utilising option B plus and have ac hieved the desired goal
despite the challenges.
i would therefore concuur with the above suggestions that alot still
needs to be done in terms of;
1.sensitizing the community on the possiblity of HIV free generation
of the young
2.health workers need to be properly updated on the protocols of
administering option B plus.
3.mothers should be continually come for ANC and male partner
involvement in the programme
4.scaling up ANC and PMTCT services in all health care facilities.

Ntombifuthi Dennis Replied at 2:14 PM, 22 Jun 2016

I completely agree -one of the best ways to deal with loss to follow up in
the PMTCT program is to work with community outreach workers/officers. we
have been working with expert clients who are HIV positive mothers who are
on treatment- they basically work with pregnant mothers at community
level-provide support for those on treatment and counselling for pregnant
women in the community who are reluctant to present themselves at the
health facility for whatever reason (religion, fear of knowing their
status, fear of being put on treatment etc.). they also conduct home visits
for the purpose of tracing lost clients and bringing them back into care.
Each expert client is linked to a facility which they work with in ensuring
pregnant mothers are brought into care and retained on treatment. the
partners of men who have undergone the PMTCT program are also engaged to
provide support to the male partners of pregnant women. The major challenge
now is bringing those men into care and retaining them and also curbing the
increasing rate of sero-conversion among children post 8 weeks.

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