By Sola Ogundipe, Chioma Obinna and Gabriel Olawale
Nigeria introduced efforts towards preventing mother-to-child transmission of HIV, several years ago, but despite significant progress in reducing new HIV infections among children, the country is not preventing or eliminating HIV infection in children fast enough.
Between 2010 and 2015, there was scale up of Prevention of Mother-To-Child transmission of HIV, PMTCT, sites in Nigeria from 675 to 7,265.
The PMTCT, and elimination of Mother-to-child Transmission, eMTCT, programmes, provide antiretroviral treatment, ART, to HIV-positive pregnant women to stop their infants from acquiring the virus.
During the period, more pregnant women received counselling and testing even as more HIV positive women were placed on treatment and antiretroviral drugs.
HIV elimination too slow
However, the reduction has not been fast enough to meet up with global targets towards elimination of new HIV infections among children.
Findings show that while Nigeria has advanced in HIV prevention and elimination, it is not on track to meet the Global Plan target of reducing mother-to-child transmission by 90 per cent.
Nigeria is also off track to meet the 2011 Global Plan towards the Elimination of New HIV Infections among Children, and Keeping their Mothers Alive, largely as a result of ignorance, stigma and discrimination, late diagnosis, denial, etc, which are fueling the epidemic in the country.
The Plan was launched to reduce the number of new HIV infections via mother-to-child transmission by 90 per cent by 2015.
The gaps in prevention strategies include high transmission rates among women of reproductive age (15-49), widespread unmet need for family planning, lack of access to antiretroviral medicines to prevent mother-to-child transmission, and high treatment drop-out rates among women who are pregnant and breastfeeding.
In 2016, UNAIDS with PEPFAR among others launched Start Free, Stay Free, AIDS Free – a framework calling for a worldwide sprint towards “super fast-track targets” to end AIDS among children, adolescents and young women by 2020.
A report by the National AIDS and STIs Control Programme, NASCP, shows that Nigeria currently ranks the 2nd largest HIV epidemic in the world (3.4 million). Nigeria also has the largest number of paediatric HIV cases in the world and there are 1.7 million HIV positive women and 380,000 children under15 years in the country.
According to the NASCP mother-to-child HIV transmission accounts for over 90 per cent of new HIV infections among children.
The body noted that HIV transmission rates without intervention rate between 15 and 45 per cent and that this rate can be reduced to less than five per cent with effective interventions in the periods of pregnancy, labour, delivery and breastfeeding.
Primarily, the interventions include ARV treatment for the mother and a short course of ARVs for the baby. Measures to prevent HIV transmission to the baby are also included.
Statistics from UNAIDS showed that in 2015, alone, an estimated 60 percent of new HIV infections in West and Central Africa occurred in Nigeria. Together with South Africa and Uganda, Nigeria accounts for almost half of all new HIV infections in sub-Saharan Africa every year.
Good Health Weekly gathered that HIV transmission may have become a localised epidemic in many states across the country. According to the National AIDS and Sexually Transmitted Infections Control Programme of the Federal Ministry of Health, NASCP, no less than 18 of the 36 states of the Federation have HIV positivity rates higher than the national average of 3.4 per cent.
From the findings, many more HIV positive pregnant women need to be accessing PMTCT services during antenatal care.
Key PMTCT indicators from the 2015 Annual report on HIV/AIDS Health Sector response in the country, show that 2,849,867 or 45.54 per cent out of an expected total of 6,258,277 pregnant women attended their first antenatal visits.
From the data, 2,780,170 pregnant women or 44.42 per cent out of an anticipated 177,993 were tested for HIV and received their results, out of which 75,855 (42.61 per cent) tested positive including those known to be previously positive.
Further, 53,677 (30.16 per cent) of the HIV-infected pregnant women received antiretroviral drugs to reduce risk of mother-to-child transmission (MTCT), while 27,486 (15.44 per cent) of HIV exposed infants received ARV prophylaxis for the PMTCT within the first six weeks of birth.
The absolute number of women that received ARV prophylaxis increased from 57,871 in 2013 to 63,350 but declined to 53,677 in 2015.
From the NASCP report, while 42.6 per cent of the estimated HIV positive pregnant women knew their HIV status in 2015, 70.8 per cent were placed on ARVs and 47.6 per cent gave birth in health facilities.
The report noted that 51.2 per cent of the babies born to HIV positive pregnant women that had PMTCT interventions, received the first dose of nevirapine and 29.6 per cent had DNA PCR done within two months of birth.
EMTCT targets: The National eMTCT targets 2015-2016, confirms that 20 per cent of all HIV positive women should have access to reliable HIV prevention interventions such as contraceptives; 70 per cent of all pregnant women and breastfeeding mothers should receive quality HIV testing, counselling and ARVs, while 55 per cent of all HIV-exposed infants are expected to be receiving ARV prophylaxis and 45 per cent all HIV-exposed infants recieving early infant diagnosis services by the end of 2016.
Participants at a recent meeting in Calabar Cross Rivers State, called for enhanced access to PMTCT services and increased number of pregnant women living with HIV to be initiated on lifelong antiretroviral medicines.
UNICEF meets JAPIN: The meeting, organised by UNICEF for the Journalists Alliance for PMTCT in Nigeria, JAPIN, in collaboration with the Child Rights Information Bureau, CRIB, of the Federal Ministry of Information, agreed that acceleration of treatment for all pregnant and breastfeeding women living with HIV is still needed to achieve elimination of new infections among children and halve HIV related deaths among pregnant women and new mothers.
In the view of UNICEF HIV/AIDS Specialist, Dr. Abiola Davies, HIV can be transmitted from an HIV-positive woman to her child during pregnancy, childbirth and breastfeeding.
“Mother-to-child transmission, MTCT, also known as vertical transmission accounts for the vast majority of new infections in children.”
Davies said without treatment, the likelihood of HIV passing from mother-to-child is 15-45 per cent, but ART and other effective interventions reduce the risk to below five per cent.
Davies noted that even though PMTCT is not 100 per cent effective, elimination of HIV is desirable as a reduction of transmission to low levels (below five per cent) that it no longer constitutes a public health problem.
According to the NASCP, it is expedient to ensure that the prevalence of HIV among children is reduced in line with global trends.
Emphasis should be on guidelines towards the global targets relating to PMTCT in reducing the number of new HIV infections among children to fewer than 40,000 by 2018 and fewer than 20,000 by 2020.
Calls were also made for commitment to ensure that 95 per cent of pregnant women living with HIV receive lifelong HIV treatment by 2018 while support for pregnant and breastfeeding women should be sustained.