30 year old Jessica (not real names) is a single mother of a 4 year old gal, and a 2 year old boy. She grew up in the hills near Kabale, in what she calls a “proper christian home with strict parents.” The second of 5 children, Jessica lives with her mother, having lost her father as early as 1990. The 5th wife of her husband, Jessica conceived within the first year of her marriage, only getting knowledge of her HIV status in her 1st trimester. Jessica lost no time in getting into ART Care and Therapy.
In 2009, having been exposed to PMTCT services, Jessica delivered her first born daughter, HIV Negative. Excited at the possibility, Jessica knew she could hold onto her dream of having a family, and in 2011, Jessica delivered her second child, HIV Negative. Jessica is one of hundreds of thousands of women who have seen the fruits of the intervention to prevent the transmission of HIV virus from a mother to her unborn child.
When my organization, the Elizabeth Glaser Pediatric AIDS Foundation started to implement the USAID funded STAR-SW, there were only 100 accredited sites to offer PMTCT services in 13 districts in the South Western region of Uganda. Today, there are over 220 PMTCT accredited sites.
Today, the problem of health workforce is not in the numbers, rather in their technical capacity to support fully the elimination of mother to child transmission of HIV (eMTCT). And whether this capacity is well harnessed and managed so that every mother who comes to the facility will find a competently equipped health worker to attend to them. Where the numbers remain wanting, Peer educators have been used to stop gap non-technical areas, so that the few health workers present could be utilized maximally. There are many facilities that could use peer educators, in some cases, needing upto 6 in the HIV/ART Clinic.
For health workers to be present, without the logistics they need to perform their work is disheartening. eMTCT programs are premised on the presence of HIV Test kits, the presence of ARVs pre and post-delivery, both for mother and baby. Incidentally, mothers can be initiated on ART Care without the presence of complex and expensive equipment in a state of the art laboratory. But whenever a facility does not have these essentials, then the consistency of the intervention is greatly undermined. The question of logistics has a flip side, whether a health center is an accredited site to receive and offer PMTCT services. While I understand the dynamics of this, I also realize that the size of pandemic that HIV is, that we should indeed consider to have this intervention at the nearest health facility to a mother who we would not like to deliver at home, unattended to, and who will inadvertently pass the HIV virus to her unborn child.
South Western Uganda communities also have taught me an important lesson – that when men are not involved in the seeking of eMTCT services, then we do not have a sustainable intervention. Men are key, and in some cases kings. But men have escorted their pregnant partners to the facility only to sit under a tree for 2 or 3 hours, unattended to and completely detached from the details of an ANC visit. Indeed, some health workers do not know what to do for men, other than HCT for which couple testing is rewarded with a certificate. There must be, on offer, a package suited towards men that will give them a sense of belonging and connection to the health care of their HIV positive partner, beyond HCT. Here, is opportunity for innovation.
Often, when HIV positive mothers leave the facility, they go into a stigmatized community and some of them are lost to care and treatment at the facility. We need to continue to take a detailed look at the linkages between the facilities and the communities. The use of peer educators could be a terrific solution for this. For example, staff at Ntungamo district’s Itojo Hospital have devised a plan, to assign each peer between 5-6 mothers who live in the same neighbourhood as they do. They will check on them at home, and ensure that they remain plugged into Care and Treatment; and in some cases serve as treatment buddies.
But we can do so much more with community leaders – parish chiefs, religious leaders, sub-county chiefs, model men, opinion leaders – they can all help to shape a dialogue, at community level that will stem so many negative attitudes and cause us to
To date, we have seen over 2 million mothers access and receive PMTCT services, but we cannot remain complacent, the next mother in line is equally as important as the one we have served. And we are going to need all hands on deck, Men, trained health workers, adequate supplies, and a conducive environment. Together, we can bring about an HIV Free generation, together, we can eliminate mother to child transmission of HIV.