Preventing Mother-To-Child Transmission Of HIV – Ghana’s Response

Charity Owusu Baluo in 2002 was told she was HIV positive when a test conducted on her revealed she had the HIV virus in her blood.

“It was after the death of my late husband that I found out my status,” she said.

Charity, after days of doubt, finally started treating her HIV condition with herbs till she was told about antiretroviral drugs and she started taking them. Charity was also introduced to an HIV support group in 2005.

“This helped me to overcome my fear and doubt about the sickness because they showed me love and helped me to cope with my condition,” she stated.

Charity had the opportunity to remarry after some years and so disclosed her HIV status to her husband-to-be.

“When I told him I was HIV positive even before getting married, he did not believe me so we went to the hospital and the test was done on both of us. He was negative and I was still positive,” she added.

“The nurse counselled us about how to live together with the sickness and having a family,” she said.

Charity became pregnant after five years of marriage and was put on the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme.

“In my case, I never doubted what the nurses told me. I overcame the doubt and fear so I was ready for a child with the help of the support group; and now I have two children—a boy and a girl,” she revealed with a sense of satisfaction.

Charity's story is one of the successes of the Prevention of Mother-to-Child HIV Transmission programme in Ghana.

The Ghana AIDS Commission (GAC), for the past thirteen years, has been implementing the prevention of mother-to-child transmission of HIV through early detection at the antenatal care stage and initiating HIV prevention treatment.

The PMTCT Programme
Mother-to-Child Transmission of HIV (MTCT) occurs during pregnancy, at the time of labour and delivery, or after birth while breastfeeding the infant.

In the absence of any interventions for prevention, the HIV transmission rate from infected mothers to their babies is estimated to range between 15 and 30%, but could be as high as 45% depending on the duration of breastfeeding.

Nevertheless, this mode of transmission is currently responsible for virtually all new infections among children, thus significantly contributing towards infant morbidity and mortality.

This makes the comprehensive Prevention of Mother-to-Child Transmission of HIV (PMTCT) a key issue in eliminating HIV in Ghana and the world.

The focus of Ghana's PMTCT programme is for pregnant women not to contract HIV in the first place. But if they do, then the programme ensures that they do not pass the infection on to their unborn babies.

Dr Nii Akwei Addo, former Programme Manager, National AIDS Control Programme, disclosed that the PMTCT programme started in 2003 with HIV positive women in labour receiving one tablet and then an HIV positive baby receiving one month of antiretroviral medication.

In 2007 the programme received a boost when a better option of combining two tablets for an HIV positive pregnant woman of 28 weeks of pregnancy and then one week medication for the baby was introduced.

Then in 2010, the World Health Organisation (WHO) changed the arrangement to enable every HIV positive pregnant woman receive prophylaxis to prevent transmission from mother to child.

“So the woman takes this because of her child not herself.  She starts at about 14 weeks and takes it throughout pregnancy, delivery and continues for one year minimum after delivery.

“The aim is to substantially reduce transmission to the child and if you take this medication as advised, then the probability of you passing on the virus to your child is drastically reduced,” he added.

Dr Mrs Emilia Taye, Obstetrician and Gynaecologist at the Korle Bu Teaching Hospital, said there are strategies used by health officials to reduce or even prevent unborn children from contracting the sickness from their mothers, thanks to the new WHO standard.

According to her, pregnant women who visit health facilities are counselled on the sickness and tested.

“When she is found to have HIV she is offered antiretrovirals as treatment, depending on her eligibility for treatment, or prophylaxis to reduce the viral load so she does not transmit the sickness to the unborn child,” she added.

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Dr Taye indicated that during delivery, interventions are put in place so that the baby does not come into contact with the mother's infected fluids.

The mothers are then counselled on breastfeeding their babies due to their health condition.

Dr Taye said breastfeeding is a challenge to most HIV positive mothers because of the fear that they might transfer their sickness to their children.

HIV & Infant Feeding Policy
The Ghana Health Service, Ministry of Health and the Ghana AIDS Commission have however established a policy to address this issue based on findings that the amount of HIV virus is drastically reduced when the mother is put on antiretroviral drugs during pregnancy.

The policy requires that HIV mothers who have been put on the drugs should, after delivery, exclusively breastfeed their babies until they are six months old and then they can add complementary foods till they are one year old.

Mrs Veronica Gomez, Breastfeeding Programme Manager, Ghana Health Service (GHS), stated that the policy also takes into consideration mothers who do not want to breastfeed at all because of their health condition.

These mothers, she added, go through counselling on the options they will have to use to feed their babies including affordability of the breast milk substitute, hygienic and safe preparation of the formula and its acceptability to the whole family.

National Response Progress
Dr Angela El-Adas, Director General of the Ghana AIDS Commission, also noted that the reduction in new infections among children is among the most remarkable successes in the country's HIV/ AIDS response.

The number of client counselling and testing as part of ANC services increased from 257,466 in 2008 to 381,874 in 2009 and from 520,900 in 2010 to 627,180 in 2011, according to the Country Response Progress Report for 2013.

The number of positive PMTCT clients receiving ART was 4,991 in 2008 but decreased to 3,643 in 2009 and rose again from 57 to 5,845 in 2010 and to 8,057 in 2011. There was however a fall to 7,781 in 2012.

The percentage of HIV infected pregnant women who received antiretroviral drugs to reduce the risk of mother-to-child transmission increased from 38.1% in 2008 to 70% in 2012.

Dr El-Adas said the gains made so far do not only have to be sustained but doubled. She added that although stakeholders of the national response may hold divergent views on a couple of issues, but all agree that “no child in Ghana today should be born HIV positive.”

Way Forward  
Dr El-Adas said last year marked a milestone in the national HIV response as the country came close to implementing the five-year comprehensive strategic plan for HIV/ AIDS.

She said the work has been evaluated and findings form part of the evidence that is helping the country develop a new national strategic plan for the next five years.

“We will not stop in our quest for the highest quality of services in order to avert new infections both among children and adults,” she added.

She however agreed that stakeholders have not done so well in assuring every infected child of effective comprehensive treatment as a UNICEF report indicates that only one out of five children with HIV has access to treatment.

“Therefore we shall extend our efforts and facilities to achieve our goal in the next five years,” she pledged, adding, “We will focus our efforts and resources in serving our children and ensuring that they enjoy the same if not better services from other populations to secure the future of Ghana.”

Side Barr >>>>>>>
In the past decade, Ghana's efforts at managing and containing the epidemic have yielded positive results and have been recognised worldwide.

Ghana is among eight African countries in the 2014 UNAIDS Gap Report to have new infections among children decline by more than 50 percent.

HIV prevalence among adults has declined consistently from 3.6% in 2003 to 1.3% in 2013. Treatment coverage for persons living with HIV also increased from 30.5% in 2009 to 63% in 2013.

However, new infections among young people have increased, with the prevalence rising from 1.3% in 2013 to 1.8% in 2014.

By Jamila Akweley Okertchiri