A small step for St Albert’s . .

29 Nov, 2015 - 00:11 0 Views
A small step for St Albert’s . .

The Sunday Mail

How a study at a rural hospital changed the course of HIV in Zimbabwe

Sharon Kavhu recently in Centenary
In the late ‘90s, hundreds and thousands of people died of HIV and Aids as many had no guts to go for testing and counselling.
People had no hope after testing positive. The virus was stigmatised; it was a disgrace to be seen going for HIV testing and counselling, particularly in remote areas.
And infected women almost always passed on the virus to their newborns.
It was only in 2000 when the light started showing in the narrow tunnel as a group of Italian donors and doctors initiated a testing and counselling programme for pregnant mothers at St Albert’s Hospital in rural Muzarabani, Mashonaland Central.
“Initially, the doctors from Italy trained a team of three medical personnel, myself as a counsellor and two other nurses. The two nurses were trained on HIV testing and how to initiate pregnant mothers on anti-retroviral treatment for preventing mother-to-child transmission,” said Itai Wankie, a nurse at St Albert’s Hospital.
Sr Wankie witnessed the first case of prevention of mother-to-child HIV transmission (PMTCT) at St Albert’s.
She recalled: “Many mothers were scared to get tested because of the issue of stigma and discrimination within our community. Others had to consult their husbands first before getting tested and many husbands shunned the programme. However, there were a few who were brave enough to come forth and participate in the programme. For instance, a local mother who was our first successful PMTCT case, Mrs X.”
She said when PMTCT began, pregnant mothers living with HIV were given a single dose of Nevirapine at the onset of labour, and another to the baby after delivery.
“The dose of Nevirapine for the mother was 200 milligrams which is equivalent to one tablet at the onset of labour, or at least two hours prior to a Caesarean section.
“We were forbidden to give mothers the dose during delivery because if the dose is too close to delivery time, there won’t be adequate levels of nevirapine in the mother for placental transfer to the infant,” Sr Wankie said.
“In our first case, we did everything like we were trained. When Mrs X was in labour, she incurred some complications which led her to be put in the caesarean section. She was given the nevirapine dose two hours before she was operated.
“Her son was delivered safely and he was given a single dose to maximise the duration of adequate nevirapine in his blood levels. Under normal circumstances, the infant should be given the dose between 48 and 72 hours after birth and for Mrs X, her son was given after 54 hours,” she narrated.
She said the PMTCT programme was officially launched by the donors at the hospital in 2001 and handed over to Health Ministry in 2005.
Ms Safina Magodhi (39), who was one of the first successful cases of PMTCT at the hospital and probably in Zimbabwe, said: “I was one of the first pregnant mothers to have the courage to go and be tested for HIV at the hospital.
“Some of the pregnant women which I came with for anti-natal care registration kept running away from the initiative. I remember vividly one of the women warning me against getting tested saying ‘these white people are too clever, they want to take our clean blood and replace it with monkey’s blood for their rituals’.
“My decision to get tested was influenced by the information I was told during the pre-HIV testing counselling. The nurses told me the advantages of knowing my HIV status and how the knowledge can protect my unborn child from contracting the virus.
“Although Aids was still deadly and scary during that time, I made the decision for my child because he had nothing to do with my condition.
“In fact, I was the one who made a stupid decision to stay married to a man who was promiscuous and married four more wives after me in the name of religion. I was tested HIV-positive when I was seven months pregnant. It was hard for me to accept it for the first few days but, through counselling I eventually managed to live with it.”
She said the counselling sessions motivated her to participate in the PMTCT programme for the sake of her unborn child.
The nurses told her to constantly visit the clinic for check-ups.
“After birth, my son’s blood samples were taken to national laboratories for an examination to see whether or not the virus had been transmitted to him,” said Ms Magodhi.
“The happiest moment of my life was when the results were out, 18 months later and it was established he was HIV-free.”
Since Nevirapine was first proven to be efficient for PMTCT in the HIVNET 012 trial in Uganda between 1997 and 1999, hundreds of thousands of babies have been saved.
The study found that a single dose of Nevirapine given to the mother at the onset of labour and to the baby after delivery roughly halved the rate of HIV transmission.
In Zimbabwe, the single Nevirapine dose method was centralised after 2000 and it was modified to Option B+ in 2013.
Option B+ is the current PMTCT methods which protects both the mother and the infant.
Once a pregnant woman is tested HIV-positive, she is initiated on a three-in-one drug combination for life.

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