Even as the fight towards preventing mother to child transmission (PTMCT) of HIV/AIDS continues, recent indices from the World Health Organisation (WHO) reveal that approximately 400, 000 infants globally acquire HIV infection annually as a result of mother-to-child transmission.
Given this alarming index, experts at a recent program organized by Journalist against AIDS (JAAIDS) in Lagos have called for proper counseling for women as well as advocated for women with HIV to receive antiretroviral drugs with the view to reducing new HIV infections in women during pregnancy, delivery or breastfeeding to the newborn infants.
Speaking at the event, Nkiru David, Consultant Paediatrician, Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, stated that breast milk provides the nutrients needed during the first few months of life as it contains substances which offers protection to babies against common childhood illnesses such as diarrhoea and respiratory infections.
David stated that the Baby Friendly Hospital Initiative (BFHI) which was launched by WHO and UNICEF in 1991 were aimed at promoting policies and structures that support breastfeeding. However, latest research on HIV reveals that the virus can be found in breast milk thus if a HIV positive mother breastfeed, there is a significant chance of passing the virus to the new born.
According to her, “Inadequate counselling of expectant and nursing HIV positive women, non disclosure to partner/family and stigma have led some mothers to breastfeed their babies thus transmitting the virus to the newborn. Don’t forget that inflammations of the breast like mastitis, abscesses, bleeding nipples can make these infants to develop lesions around their mouth region during breastfeeding over a period of time.”
David further disclosed that in a bid to safeguard newborn infants from getting infected with HIV/AIDS, individual mothers should get appropriate conselling from a physician prior to delivery so as to know what feeding option most appropriate for the newborn. She added that if EBMS is chosen, she must be counselled on appropriate and hygienic way of preparing and feeding her baby to protect the baby from diarrhoea and other childhood infections.
Already, EBMS (EFF) has proved a resounding success in developed nations, (a success which has been reproduced at the NIMR HIV clinic and some other sites in Nigeria). EBMS is expensive and donor agencies that previously funded it are now cutting down costs.
Lending his view, Olalekun Adebimpe, PTMCT/ Reproductive Health Officer, Action Health Nigeria Institute, disclosed that prolonged use of ARVs as spelt out by WHO recommendations goes a long way in reducing the risk of mother-to-child transmission of HIV. He stated that for the first time, WHO recommended that HIV-positive mothers or their infants take ARVs(anti retroviral drugs) while breastfeeding to prevent HIV transmission.
In his words “with an estimated 33.4 million people living with HIV/AIDS and HIV/AIDS, been the leading cause of mortality among women of reproductive age, there is the need for people to learn of their health status. However, pregnancy in the HIV positive woman is an indication for prophylactic anti retroviral therapy (ART) irrespective of CD4 count, viral load or clinical stage of the disease. So, efforts should be made to ensure that all HIV positive pregnant women have access to ART.
However, all patients placed on ART should be monitored clinically, biochemically and immunologically. If facility for CD4count is not available, the client should be referred or client’s specimen sent to the nearest centre with such facility,” Olalekun concluded.
On his part, Oliver Ezechi, Chief Research Officer, Obstetrics and Gynaecology Health, NIMR, Yaba, stated that the new WHO recommendations, which is based on latest scientific research have the potential to reduce mother-to-child HIV transmission risk. He hinted that when combined with improved infant feeding practices, the recommendations can help to improve child survival.
“Expansion of ART and PMTCT services is hindered by weak infrastructure, limited human and financial resources, and poor integration of HIV-specific interventions within broader maternal and child health services. Another challenge lies in encouraging more people to receive voluntary HIV testing and counselling before they have symptoms.
Many HIV-positive people wait too long to seek treatment, usually when their CD4 count falls below 200 cells/mm3. However, the benefits of early treatment should encourage more people to undergo HIV testing and counselling and learn of their HIV status,” Ezechi concluded.
Since several clinical trials have shown the efficacy of ARVs in preventing transmission to the infant while breastfeeding, promoting the use of ARVs earlier in pregnancy, starting at 14 weeks and continuing through the end of the breastfeeding period will no doubt go a long way in reducing the risk of HIV transmission and improve the infant's chance of survival.
Also, strategies should be put in place by health authorities in the country to adopt and implement the revised guidelines on the new prevention of mother to child transmission (PMTCT). It is believed that when implemented at a wide scale will improve the health of people living with HIV as well as reduce the number of new HIV infections and save lives.
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