As the world marks yet another Aids day, experts say the elimination of Mother-to-Child Transmission is one of the silver bullets that will end disease.
This year’s theme being ‘Know Your Status’, HIV experts are emphatic that knowing the status of HIV-exposed infants will be particularly key in reducing new infections. HIV-exposed infants are those whose mothers are HIV positive.
Statistics by the Joint United Nations Programme on HIV-Aids (UNAids) indicate that Kenya, alongside South Africa, Nigeria and Mozambique are the four countries with the highest HIV burden in Africa.
Despite the many steps in the right direction towards eliminating mother to child transmission also known as vertical transmission, the country is reeling from a setback.
According to the director of Medical Services Dr Jackson Kioko, “In 2015, 16 children acquired HIV through mother-to-child transmission on a daily basis. This was still a reduction compared to the 66 who were getting infected daily in 2009.”
The National Aids and STI Control Programme now paints a much more dire picture, as statistics show an increase in vertical transmission from 8.3 per cent in 2015 to the current 11.5 per cent. Further, HIV-related deaths among children remain high at 14 per cent.
Dr Lucy Matu says it is within this context that experts and stakeholders in paediatric Aids are making haste to seal the loopholes that are frustrating efforts to reduce vertical transmission to zero.
Matu, the director of programmes at the Elizabeth Glaser Pediatric Aids Foundation, says despite the startling statistics, there is hope.
This hope is in the Point-of-Care Early Infant Diagnosis testing that seeks to increase the number of HIV-exposed infants tested and initiated on antiretroviral treatment if found to be positive.
Matu says point-of-care testing is a breakthrough technology that facilitates timely decisionmaking on steps to take for HIV-infected infants or those found to be negative but are still exposed to the virus from a HIV-positivemother.
“Early infant HIV diagnosis is important to identifying HIV-positive infants as early possible, and to immediately initiate them on treatment. This increases survival of infected infants, and by doing so, reduces child mortality,” she expounds.
For those found to be negative, mothers are counselled on how to prevent transmission to the child throughout the breastfeeding period.
EGPAF’s Jared Onsase in Kisumu affirms that knowing the status of an infant and in the shortest time possible is key. Onsase is a monitoring and evaluation officer for the Point-of-Care early infant testing programme.
“One of the many challenges in preventing mother-to-child transmission has been the long periods it takes for the mother or caregiver to know the status of their infants,” he says.
The point-of care testing is reducing the period it takes for HIV exposed infant’s status to be communicated to the mother, as well as the time it takes for the infant to be put on treatment if found HIV positive.
“We have had instances where a baby dies from HIV complications before their status is communicated to their mothers or caregivers, because it took too long to process their blood samples,” he says.
Onsase says as of August last year, the point-of-care test has been made available and accessible in nine counties. These include Homa Bay, Busia, Bungoma, Kakamega, Vihiga, Siaya, Nyamira, Migori and Turkana. Plans are under way to make it accessible across the 47 counties.
“Early infant diagnosis has been decentralising by placing the testing equipment closer to the patients,” he says.
The equipment is placed in a high-volume county or subcounty referral hospital, and at the same time, it serves the health facilities that are near this health facility. This increases the number of mothers with access to the earlytesting services.
Nonetheless, Matu says this is a major improvement, since two to three years ago, the test could only be taken in the eight national referral laboratories.
“It meant that blood samples would be collected and sent to the referral laboratories, and this could take 90 days or more, especially in far-flung counties, such as Turkana,” she says.
This delay, HIV experts say, meant that if an infant was HIV-positive, it would take even longer for them to access the ART treatment and care they needed, which would then drastically reduce their chances of survival.
Experts caution that during those early days after the virus has entered the body, it multiplies very fast, necessitating the need for early detection and treatment.
Matu confirms that due to advances in technology, it is now possible to know the status of an infant at six weeks.
While it is still not possible to test infants at birth, the HIV expert explained that the availability of Point-of-Care testing has made it possible for infants to be tested at six weeks and for the results to be communicated to the mother on the same day the test is taken, or within seven days.
Whereas the goal is to reduce vertical transmission to less than five percent by 2019, elimination of vertical transmission by 2021 is the ultimate goal.
“Even where one child is infected, this one baby is still 100 per cent to the family,” Matu said.