Two steps forward, three backward

IT is either she is coughing, suffering from a headache or she is down with a running stomach. Sometimes it is oral thrush.

Chido Mabhachi (not her real name), a Grade Three pupil in Harare, whose parents died from Aids-related illnesses, lives with retarded growth. It is a life of battling all kinds of opportunistic infections. Mabhachi always wonders why she is different from other children her age. She tends to ask herself why she is always sad, sickly and not hyper-active like children of her age — and this only serves to make her sadder.

A vicious cycle for any child if ever there was one. She shies away from her peers. Not that most of the other kids want to be her friends. She is too different for their tastes. Mabhachi and many other children living with HIV face this kind of existence on a daily basis.

In Zimbabwe, of the 77 000 children living with HIV and Aids, 11 000 are not on treatment. Many a time, expectant mothers shy away from seeking health services either out of ignorance, lack of money or fear of knowing their HIV status.

Though it is not mandatory in Zimbabwe, all expectant mothers are encouraged to have an HIV test upon knowing they are pregnant as a measure to lower mother-to-child HIV transmission. Late pregnancy bookings have also been cited as a major obstacle in implementing this.

National co-ordinator of the Health and Child Care Ministry’s PMTCT and Paediatric ART programmes, Dr Angela Mushavi, says: “Though there has been a slight improvement in pregnant women registering their pregnancies in the first trimester, we are still concerned with expectant mothers coming in late. As a result, many children born to parents living with HIV are being exposed to the virus.”

The global target is to reduce new HIV infections in children to less than five percent. A recent survey indicated that as of 2016, Zimbabwe stood at 5,2 percent. A leading cause of child mortality in Zimbabwe is HIV/Aids, which contributes to about 21 percent of deaths.

Approximately two-thirds of childhood deaths occur during infancy, with more than a third occurring in the first month of life. Organisation for Public Health Interventions and Development Trust chief of party Ms Patricia Mbetu says late bookings remain an obstacle to PMTCT.

“While committed to a goal of zero new HIV infections among children by 2018 and improved survival of mothers, children and families in the context of HIV, Zimbabwe hasn’t yet reached the elimination of mother to child transmission from an estimated 9,2 percent in 2013 to less than five percent by 2018. “With each year there have been some improvements as more women book early. However, this remains a challenge that needs to be addressed.”

Not so long ago, the perception was a mother infected with HIV could not give birth to an HIV-free baby, and she could not breastfeed for the first 18 months. Probable false answers lingered in people’s minds for far too long. Yes, HIV can be passed on from a mother to her baby during pregnancy, during delivery or whilst breastfeeding.

Without any intervention, the chances that a baby born to an HIV positive mother will be infected are 15-30 percent without breastfeeding, and 25-45 percent with breastfeeding. But PMTCT interventions can reduce likelihood to less than five percent.

Dr Mushavi says, “There is great need to increase the number of children with HIV on treatment to cover more than 85 percent. We can then deal with the 21 percent mortality rate that is attributable to HIV.” Zimbabwe’s PMTCT programme began in 2009, using World Health Organisation guidelines of single dose nevirapine (Option A).

Updated guidelines recommended moving from Option A to provision of triple ARV drugs to all infected pregnant and breastfeeding women in the ante-natal clinic setting (Option B), or continuing therapy for life regardless of the CD4 count (Option B+). Most clinics offer HIV testing but there are reports of slow return of laboratory results.

“HIV tests for children are processed at a central laboratory which means that all tests are processed centrally and this has resulted in backlogs and delays as the samples are transported to the lab, and results to the clinic and eventually to the mother,” explains Dr Mushavi. “A significant number of children are tested for HIV but clinics face challenges as the mothers often do not return to collect the results.”

With support from partners, Government wants to achieve 50 percent reduction of HIV-related deaths in children under the age of five, and 90 percent reduction of new HIV infections among children from an estimated 15 000 infections in 2009 to 1 500.

“While the number of children tested for HIV is relatively high, there is a need to ensure that all HIV-positive children should be initiated on treatment,” says Dr Mushavi. “Effective antiretroviral treatment for children is required- otherwise half of these children would have died before their second birthday.”

Recent reports from clinics in Harare suggest that some women are collecting and then dumping nevirapine treatment for their children because they fear that partners and/or family members will find out.
Low capacity and confidence in healthcare workers to initiate, counsel and treat children living with HIV has been cited as another setback.

“There is a need to improve counselling services for children and resources to support children on treatment,” adds Dr Mushavi. Ms Mbetu says home deliveries among some religious groups also pose a headache.

OPHID is leading the Families and Communities for the Elimination of pediatric HIV (FACE-paediatric HIV) programme to strengthen quality and coverage of healthcare services for children, as well as strengthen community structures and support systems.

And male involvement will be key to success. Nationwide, male involvement in PMTCT programmes stands at less than 30 percent. “The failure to target men in health programmes for women and children have weakened the impact of interventions since men can significantly influence their partners’ reproductive health resources,” laments Dr Mushavi.

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