In Kenya, children under 15 years account for 16% of all new infections which is and mainly due to Mother-to-child transmission of HIV (MTCT). The estimated magnitude of annual child birth in Kenya as at 2007 was 1.5million with HIV infected mothers (at 6.7% prevalence i.e. 142,101) and at 40% MTCT, thus 45,640 HIV positive infants. Over 90% of paediatric HIV is acquired through MTCT. This leads to increased need for healthcare services, reduced child survival rates and disruption of education for children as most children infected through MTCT (“vertical transmission” or “perinatal transmission”) develop symptoms before they are 2 years old.
MTCT can occur; during pregnancy; during labour and delivery; and during breastfeeding. Pregnant women who are HIV-infected are at a risk of passing HIV infection to their infants.
Barriers to Universal Access (the right to prevention, care, support and treatment) to PMTCT include:
- Weak healthcare systems
- Low (antenatal care) ANC attendance and Skilled Birth Attendance
- Limited access to pre-test counselling
- Lack of effective coordination to oversee implementation
- Inadequate community engagement
- Stigma and discrimination
- Lack of awareness that HIV can be passed from mother-to-child
- Inadequate access to ARV therapy or prophylaxis
- HIV testing and counselling during ANC, labour and delivery and postpartum
- Provision of ARV drugs to mother and infant
- Safer delivery practices
- Safe infant feeding information, counselling and support
- Treatment or appropriate referrals to comprehensive treatment, care and social support for mothers and families
- Universal Access
- Addressing retrogressive cultural practices that promote MTCT
CINCO works to mitigate risk factors associated with MTCT. It is critical that pregnant women with HIV get the best possible ANC and postpartum care. Comprehensive Approach to Preventing HIV Infection in Infants and Young Children is important to significantly reduce MTCT and achieve targets. PMTCT must be viewed as a comprehensive public health approach and focuses on women with HIV and their partners, children and families as well as parents-to-be whose HIV status is unknown or who have tested HIV-negative. This should also cover STIs screening. Having STIs increases the risk of HIV infection and HIV infection tends to make a STI more severe and less responsive to conventional treatment. Early diagnosis and treatment of STIs can reduce incidence of HIV in general population by about 40%.
A comprehensive approach is needed to prevent HIV infection in infants, young children. The four elements of the comprehensive approach to PMTCT are:
- Primary prevention involving sexually active women and men
- Prevention of unintended pregnancies among women infected with HIV
- Prevention of HIV transmission from women with HIV to their infants
- Provision of treatment, care and support to women with HIV, their infants and families
Effective PMTCT programmes should provide access to interventions that can significantly reduce the rate of MTCT. Risk of transmission to the infant is highest when the mother’s viral load is high. Maternal and Child Health (MCH) services, especially ANC care, are an entry point into the range of services required to meet the needs of HIV-infected women and their families, and includes family planning services.
CINCO encourages promotion of the 4 Cs to enhance MCH in HIV control, thus:
- Compliance to treatment
- Contact tracing, counseling and treatment
- Condom use
Male involvement is significant to the success of every PMTCT intervention!
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