-Scientists Highlight Ongoing Struggle Despite Progress
By Davis Buyondo
Masaka Region
The World Health Organisation’s latest report has indicated that Uganda registered a significant decrease in new infections among newborns. This is a commendable effort to combat the disproportionate impact of HIV on women. Out of the 1,400,000 million people living with HIV in the country, 860,000 are women, and 80,000 are children.
To decrease the incidence of HIV transmission to newborns, Uganda has implemented a comprehensive Prevention of Mother-to-Child Transmission (PMTCT) initiative.
The PMTCT program achieved a remarkable 77% reduction in HIV infections among newborns. The number dropped from 20,000 cases in 2010 to 5,900 cases in 2022.
This is attributed to a well-coordinated, multi-sectoral response and strong collaboration between the Government of Uganda, the WHO, the United Nations Children’s Fund, and the United States President’s Emergency Plan for AIDS Relief.
This program entails monitoring women of reproductive age who are either living with HIV or are at risk of acquiring it. The surveillance spans from their reproductive years through pregnancy and continues until the conclusion of the breastfeeding period.
The PMTCT program, implemented in over 3,600 health facilities nationwide, provides comprehensive antenatal care. Pregnant women are recommended to undergo testing for HIV, syphilis, and hepatitis B, allowing for early diagnosis and appropriate treatment to prevent disease transmission to their children.
According to Janet, a 29-year-old expectant mother living with HIV, diligently undergoes a comprehensive routine medical examination each month to monitor the progress of her pregnancy.
Already a mother of two, Janet first learned of her HIV-positive status in 2017 during her initial pregnancy. “When I received the news of being HIV positive six years ago during my first antenatal visit, I was devastated. I harboured fears that all my children would inherit the illness, starting with my unborn baby,” she recalls.
In line with WHO recommendations, pregnant women are advised to undergo testing for HIV, syphilis, and hepatitis B at least once during pregnancy, preferably in the first trimester, as an integral part of antenatal care. These crucial tests contribute to the early diagnosis of sexually transmitted infections, enabling timely access to proper treatment and preventing the transmission of diseases to their offspring.
In 2022, WHO introduced new guidelines stating the importance of checking the viral load of HIV-positive pregnant women every three months, reducing transmission risks. Blood tests, including the Point of Care for the HIV PCR test, have been introduced to expedite results, decreasing the turnaround time from one month to within 48 hours.
Dr. Kaggwa Mugagga, the HIV National Professional Officer at WHO Uganda, elaborates on these fresh guidelines, emphasizing that they advocate for more frequent monitoring of HIV-positive pregnant women.
The revised HIV management guidelines recommend that these women have their viral load checked every three months instead of the previous six-month interval. This adjustment, he said, aims to ensure a lower risk of transmission during pregnancy and beyond.
WHO’s Role in PMTCT Success
WHO, in collaboration with the Ugandan Ministry of Health, has developed training tools and materials, including a comprehensive HIV/AIDS care training package. This initiative aims to improve the implementation of the PMTCT program in health facilities across the country.
The PMTCT program has been expanded to encompass more than 3600 health facilities across the country. According to Dr. Linda Kisaakye Nabitaka, the HIV Focal Person at the Ministry of Health, the program is implemented nationwide, utilising tools endorsed by the WHO.
While celebrating the success of PMTCT in limiting new HIV infections among newborns, Dr. Yonas Tegegn Woldemariam, WHO Representative to Uganda, stressed the need to address factors contributing to new HIV infections, especially among adolescent girls and young women.
While global rates have remained constant, Uganda has demonstrated notable progress in reducing new vertical HIV infections. The country saw a reduction from 12.1% in 2015 to 6.8% in 2021, and early infant diagnosis (EID) increased from 44.5% to 74.5% during the same period, according to UNAIDS estimates.
However, despite these gains, mother-to-child transmission still accounts for up to 14% of all new HIV infections.
Medical Scientists Detect Stagnation
However, despite the 77% achievement, medical scientists say there is a stagnation. They say that from the time the PMTCT program started up to around 2021, there was a rapid decline.
According to Dr. Jonathan Kitonsa, a Medical Scientist at the Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine-Uganda, there has, however, been stagnation thereafter.
Kitonsa explains that similar trends have been identified across all districts in the greater Masaka region.
Recent data compiled by UNICEF highlight the concerning reality, revealing a persistent 11% transmission rate from 2020 to 2022. The implications of this stagnation are far-reaching, warranting urgent attention from the global health community.
One major factor in this stagnation is the presence of untreated HIV expectant mothers. According to Kitonsa, pregnant women living with HIV or with a high viral load face an increased probability of transmitting the virus to their children.
The delayed antenatal care or lack of access to proper healthcare services during pregnancy further compounds the issue, leading to missed opportunities for HIV testing and necessary interventions.
He told this website that insufficient access to PMTCT Services also plays a crucial role in crippling the progress. “Comprehensive PMTCT programs, which include essential services such as HIV testing, counselling, administering antiretroviral therapy (ART), and safe delivery practices, have been identified as key factors in preventing transmission,” he said.
While breastfeeding offers essential nutrients and protection against infections, the scientist said it can also transmit HIV without proper precautions. Exclusive breastfeeding combined with ART treatment reduces the risk, but mixed feeding practices or breastfeeding without treatment can heighten transmission risk.
Maternal coinfections, including sexually transmitted infections (STIs) or tuberculosis, represent another risk factor, according to the scientist. Expectant mothers with concurrent infections may encounter an increased risk of transmitting HIV to their infants.
The ongoing OPTIMMS Trial at the MRC in Masaka focuses on optimising vaccine schedules to maximise infant protection against HIV. Dr. Kitonsa noted the contributions of technology, including highly effective antiretroviral therapy, safe delivery promotion, and early testing of newborns.
Traditional Practices And MTC Transmission
In a collaborative effort between Masaka District and Babies And Mothers Alive (BAMA), a joint study, conducted early this year, sheds light on the challenges surrounding HIV testing and treatment, particularly among men, and the resulting impact on the transmission of the virus from mothers to newborns.
The study reveals a critical lack of effective awareness, leading men to refrain from seeking HIV services and, consequently, not encouraging their wives or partners to do so.
The research emphasised the reluctance of men to undergo HIV testing and treatment, creating a concerning ripple effect. The hesitancy among men to engage with HIV services contributes to a lack of encouragement for their partners to seek crucial healthcare interventions.
This gap in awareness and participation poses a significant obstacle in the ongoing efforts to prevent mother-to-child transmission of HIV.
A noteworthy finding of the study points to the persistence of HIV-positive newborns born to mothers who choose to deliver with Traditional Birth Attendants (TBAs). These TBAs lack the necessary knowledge and training in the prevention of mother-to-child transmission, creating a high-risk environment for HIV transmission during childbirth.
Masaka District Health Officer (DHO), Dr. Faith Nakiyimba, highlighted the gravity of the situation, revealing that two newborns tested positive for HIV in January and February of this year.
Both cases were traced back to deliveries assisted by TBAs. Unlike health centres, TBAs do not conduct HIV tests or provide comprehensive antenatal services, contributing to the alarming prevalence of HIV-positive births.
Dr. Nakiyimba further stressed the urgent need for continuous public awareness campaigns to address these challenges. The lack of awareness among men regarding the importance of HIV testing and treatment, coupled with the reliance on TBAs for deliveries, has resulted in preventable cases of mother-to-child HIV transmission.
“Public awareness campaigns, tailored to reach both men and expectant mothers, are crucial in bridging the information gap. These campaigns should emphasise the significance of male involvement in HIV services, dispel myths and misconceptions, and promote informed decision-making during pregnancy and childbirth,” she said.
However, to mitigate the challenges identified in the study, Nakiyimba explained that a comprehensive approach is necessary. his includes targeted awareness programs, community engagement initiatives, and collaboration with local leaders to promote the importance of HIV testing and treatment for both men and women.
Additionally, efforts should be intensified to educate expectant mothers on the risks associated with relying on TBAs for childbirth and encourage them to seek professional healthcare services.
UNAIDS 2021 Spectrum
The UNAIDS 2021 Spectrum estimates reveal that Uganda witnessed 5,500 new cases of childhood HIV infections attributed to mother-to-child transmission. Notably, half of these infections occurred in infants born to mothers who discontinued HIV treatment during pregnancy and breastfeeding.
As outlined in the 2018–2023 Ugandan National Elimination Plan II, mother-to-child transmission of HIV constitutes 18 percent of all new infections in Uganda and stands as the predominant cause of infections among children.
END
English 