Non Adherence To HIV Treatment Risks eMTCT

Nigeria is responsible for 12.4 percent of the global burden of HIV infected children with an estimated number of 267,000 living with the virus, says 2017 Joint United Nations Programme on HIV/AIDS, (UNAIDS) report.

The report also states that Nigeria has the second largest burden of Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome, (HIV/AIDS) and also contributes the largest proportion of new vertically acquired HIV infection among children.

With 95 percent of the National HIV response driven by donor partners, inclusive of Prevention From Mother To Child Transmission of HIV, (PMTCT), and pediatric treatment services, it is important that mothers adhere to treatment in order to eliminate Mother To Child Transmission Of HIV, (eMTCT).

To curb Mother To Child Transmission of HIV, (MTCT),
drugs adherence requires 95 percent to achieve viral suppression. By viral suppression, the HIV virus looses its ability to transmit to another person.

However, Nigeria is still committed to the Goal of eMTCT by 2020, hence has initiated strategies to reduce the impact.

One of such strategy according to the Assistant Director and Head of PMTCT of the National AIDS And STIs Control Programme, (NASCP), Federal Ministry of Health, Dr. Ijaodola Olugbenga includes; ensuring that at least 90 percent of HIV infected women have access to comprehensive prevention of mother to child transmission of HIV services including anti retroviral drugs, (ARVs), during pregnancy, labour, delivery and breastfeeding period.

Dr Olugbenga however said that a list of comprehensive intervention package to PMTCT includes; HIV Testing Services, (HTS), Provider Initiated Testing and Counselling, (PITC), Infant Feeding Counseling, family planning counselling and services, ARV and Cotrimoxazole prophylaxis for mother -infant pairs, early infant diagnosis and linkage to treatment.

Others includes; screening of all pregnant women for hepatitis, syphillis and other Sexually Transmitted Infection, (STIs), screening of the mother for cervical cancer as well as eligibility assessment for lifelong anti retroviral therapy.

Currently, there are core activities to ensuring that women living with HIV do not have babies with the virus, Olugbenga added that these activities are geared towards women give birth to HIV free babies.

He said the on going activities includes; routine HIV testing services for all pregnant women attending ante natal care, labour and postnatal with appropriate documentation.

He added that there is “initiation of all newly identified positive pregnant women on Anti Retroviral Therapy, (ART) with referral to adult ART clinic after PMTCT. Appropriate classification of HIV Exposed Infant, (HEI) risk and initiation on recommended ARV prophylaxis -viral load for all pregnant women 32 to 36 weeks gestational age.

“Testing of all HEI at two months, two-18 months using early infant diagnosis and rapid test at 18 months. Documented referral of all HIV positive infants to pediatric ART.”

In a 2017 Maternal PMTCT Cascade presented by Dr Olugbenga at a media dialogue, organised by the Child Right Information Bureau, (CRIB), Federal Ministry of Information with support from United Nations Children’s Fund, (UNICEF) held in Calabar, Cross River State, pointed out that 165,474 are estimated mothers needing PMTCT.

While 64,811 are number of women tested HIV positive (old and new in ANC), 50,890 are number of HIV positive mothers on ART, 24,026 are number of HIV positive mothers who delivered at the health facility booked and unbooked.

However, Olugbenga said the report also states that in 2017, it was estimated that the number of children aged 0 to14 living with HIV was put at 221,729, children currently on ART 54,167, children with viral load test result 10,464, children with viral load suppression 4,699.

He said NASCP has put up some strategy focused on saving children from HIV as follows; increase ANC uptake and improving facility based delivery, increase HIV testing coverage among pregnant women, provision of ARVs for the positive pregnant women during delivery and breastfeeding period.

“Increase Dried Blood Spot, (DBS) and early infant diagnosis testing coverage, improving the pediatric ART management, coordination and harmonization of efforts, improving data harvesting and management.”

However, there are limitations in carrying out these ongoing strategic efforts as well as full implementation of these plans, Olugbenga revealed that; there is inadequate proportion for HIV program in National and State budget, dwindling support from partners, socio- economic challenges, poor health seeking behavior, culture, myths, misconceptions, stigmatization.

He said there are laudable plans to sustain the efforts thus far by partners and such plans are; sustaining the drive, improve collaboration, more granular level effort to identify priority States, LGAs, wards that can achieve eMTCT with minimal efforts.

To ensure effective integration of PMTCT in the Maternal and Newborn Child Health, (MNCH) platform, high level advocacy for eMTCT and pediatric ART as well as resource mobilization.

Earlier in his speech, the Deputy Director and Head, Child Rights Information Bureau, Mr Olumide Osanyinpeju, expressed worry over the large number of children in the country at risk of contacting the HIV from their mother adding that proactive measures should be taken by all stakeholders to save the children from the imminent danger.

Osanyinpeju however said that the Federal Government is working relentlessly with relevant stakeholders to achieve an HIV/AIDS free nation, stressing that journalists should champion the course of the realisation of the rights of children to live free from the disease.

In his words, “it is worthy to note that it has been a difficult task propagating that children reserve the rights to issues affecting them, the right to live free from diseases, HIV/AIDS in focus. May we not lose sight of the fact that a large number of Nigerian children are still at risk of this infection, a host of them living in our communities under emergencies and insurgencies.

“We must understand that the deprivation of the foregoing is an infringement on the rights of a child. There is need for all to rise up against this menace as routine transmission may leave life-long scars that may affect the child emotionally and psychologically.

“As you know, government alone cannot fight this cause, hence, the need to collaborate with Agencies, Non Governmental Organizations and other line partners and Organizations to advocate on how best to address the issue.

“We need the media to start making the Nigerian people think in the interest of the Nigerian child, to tackle the low level of awareness that exists amongst our people towards the realisation of the health needs of children within the framework of child’s right, and obtaining the desired support from government and institutions,” Osanyinpeju added.

He encourage the media to work diligently and develop clear messages that will sensitize and inspire the Nigerian people and use stories, reports to create massive awareness as well as enlighten the people, duty bearers, and indeed all levels of government on the need for prevention and elimination of Mother To Child Transmission of HIV.

Osanyinpeju also urged journalists to mainstream the issue so as to increase the knowledge among spouses, partners and family members, as well as addressing HIV-related stigma and deep gender inequalities in decision making.

“By so doing, it will go a long way in realizing the objective of UNICEF at advancing Children’s rights and enhancing their well being. We must work in line with the United Nations General Assembly Resolution to intensify global efforts to eliminate this menace.”

In a recent report released by the Ag.Director, Research Monitoring and Evaluation Directorate, National Agency for the Control of HIV/AIDS, (NACA), Mr Greg Ashefor states that “based on our data, only 1, 090,233 persons (747, 853 females and 342, 380 males) are currently on HIV treatment in Nigeria as at June 2018.”

These number, he said includes all persons on treatment programmes supported by the President’s Emergency Plan For AIDS Relief, (PEPFAR), which is a United States government initiative to address the global HIV/AIDS epidemic and help save the lives of those living with the disease, primarily in Africa, adding that Global Fund, and the Federal Government has also contributed greatly.

He revealed that the Federal Government programme covers 62, 120 persons on treatment, with 44,116 persons in Taraba and 17,904 persons in Abia.