Late antenatal booking increases HIV transmission to babies —Experts
It was the nurse on duty that recognised her and probed why she was not back at Agbogbon Primary Health Care Centre to collect ARV medications for her three-month-old baby.
Sulia Waheed, the 21-year-old mother, had brought her baby for immunisation. She had been delivered of the baby at this health facility under a false name and address. Only Sulia’s mother knows she has HIV, so coming back to access HIV treatment for herself and her baby proved difficult.
No doubt, access to ARV services for prevention of HIV from mother to child has improved, but mothers who register late for antenatal care or have difficulty disclosing their HIV status remain a challenge to Nigeria attaining zero HIV transmission from mother to child.
Currently, Nigeria has a high number of new HIV infections among children. According to the 2016 National HIV Strategy for Adolescents and Young people, mother to child transmission of HIV accounts for 90 per cent of HIV infections in children.
In addition, the 2018 Nigeria HIV/AIDS Indicator and Impart Survey (NAIIS) puts the prevalence of HIV among children below 14 years at 0.2 per cent.
More than 90 per cent of the world’s children living with HIV get infected through the transmission of HIV from an HIV-infected woman to her child during pregnancy, labour, delivery or breastfeeding. It constitutes the third most common route of HIV transmission globally.
Also, the survey stated that among women who self-reported knowing their HIV status, only 1.4 per cent self-reported testing HIV positive during pregnancy.
In addition, among women who gave birth since January 1, 2015, almost four out of five women attended at least one antenatal care visit during their last pregnancy and only four out of five self-reported knowing their HIV status during pregnancy.
Although attendance at antenatal care by pregnant women has improved, experts in a new study pointed out that late registration for antenatal care also increases HIV transmission to babies. They advocated that early registration for antenatal care to ensure the elimination of mother to child transmission of HIV.
In a prospective cross-sectional study conducted among apparently healthy pregnant women at Port Harcourt, researchers found a high incidence of mother-to-child transmission of HIV in those HIV-positive mothers who registered late for antenatal care.
The 2018 study entitled ‘Incidence of Vertical-Transmission of HIV and Its Correlation with Maternal Gestational Age at Antenatal Booking in Port-Harcourt, Nigeria’ was published in the Journal of Advances in Medicine and Medical Research. It involved Fiekumo Igbida Buseri, Evelyn Mgbeoma Eze and Ngowari Golden.
In this study, all antenatal attendees and their HIV-exposed newborns were screened for HIV infection at the University of Port-Harcourt Teaching Hospital (UPTH) and Braithwaite Memorial Specialist Hospital (BMSH), Port Harcourt between April 2016 and May 2017.
The HIV-positive antenatal attendees were placed on daily single-dose triple antiretroviral regimen (efavirenz, lamivudine, tenofovir, 600/300/300mg tablet) with multivitamins from the first day of booking.
The HIV-exposed babies (babies born to HIV-positive pregnant women) were placed on 5ml daily single-dose triple antiretroviral chemoprophylaxis on the first day of delivery and continued until blood collection at six weeks for HIV diagnosis.
They found 4.34 per cent overall prevalence of HIV-1 infection among the antenatal attendees and 7.57 per cent incidence of mother-to-child transmission.
Also, a high incidence of mother-to-child HIV transmission was recorded among those HIV-positive mothers who registered late for antenatal care.
Ideally, pregnant women should enter antenatal care, which includes early diagnosis and management of pregnancy-associated disorders, within the first 10 to 12 weeks of pregnancy.
While there was no mother-to-child transmission of HIV among the attendees who booked at the first trimester, they recorded 35.7 per cent and 64.3 per cent among those that registered for antenatal care and commenced ARV at second and third trimesters respectively.
According to the World Health Organisation (WHO), HIV-exposed or infected babies without intervention are much more prone to a rapid rate of disease progression as well as up to 50 per cent chance of dying before their second birthday.
Notwithstanding, Mrs Folakemi Ayanmo, LACA manager, Ibadan South East Local government, linked cases of mother-to-child HIV transmission to low perception to the risk, nonchalant attitude towards preventive measures, the naivety of being infected and poverty in the community.
Dr Mosunmola Fasana, a medical officer of health, said without breaking common taboos around antenatal care in the community to ensure early booking for antenatal care, including early diagnosis and management of pregnancy-associated disorders, including prevention of mother to child HIV transmission, may be difficult.
Dr Fasanu added that “they know that they have to pay for some specific tests each time they come, so many of them will postpone the antenatal care visit. They do not see the importance of that checkup to their health and the health of their baby.
”They really need to understand the implication of HIV and why they need to be on treatment. They see it as another germ that over time will go. So we have had some HIV cases that should not have occurred at delivery.”
Mrs Bukky Alabi, Oyo State coordinator of Network of People Living with HIV and AIDS in Nigeria (NEPHWAN), however,stated that antenatal care should be free at all levels to ensure that it becomes an entry point for prevention of mother-to-child HIV infection.
She added that poor attitude of health workers also prevents many pregnant women from coming for antenatal care because stigma and discrimination is still an issue.
“Even among healthcare workers, if one of their colleagues is HIV-positive, they do not treat them fairly even when it comes to pregnancy care,” she added.
Dr Olukayode Ogunkunle, Project manager, Oyo State Agency for the Control of AIDS, however, assured that there is no local government area in the state that does not have at least one prevention of mother to child transmission of HIV centre presently, where if they tested HIV-positive, they can access treatment.
He added, “They may not deliver at the centre where they are given the HIV drugs, but we ensure that they are taking their medications. When they take their medications, they will be virally suppressed and the chances of transmitting the virus to the baby during delivery will be very minimal.
“No woman will want her baby to get HIV. So if they are properly counselled and informed, they will not run away. They will want to do all that is possible to make sure that their babies come out HIV-negative.”
Moreover, Dr Olubunmi Akande, Oyo State HIV desk officer, said that without HIV testing during antenatal care, it is not possible to ensure that steps are taken to prevent a mother transmitting the infection to her child.
She assured that ARV is safe for a woman to take in pregnancy, adding, “she must use it every day as stipulated. Then she must come for her regular antenatal visit and follow up on her ART to ensure that she will be virally suppressed.”