WHILE generation born free of HIV and AIDS is within the worlds reachNigeria is at a tipping point.Last year at the plenary session of the International AIDS conference in Austria, Nigeria was publicly named as one country dragging back on global gains on childrens access to ARV prophylaxiswhile countries like Botswana and South Africa had achieved 95 per cent and 73 per cent coverage, Nigeria had only a 10 per cent coverage.Today, paediatric HIV and AIDS is virtually a thing of the past almost everywhere in the world. Everywhere except Africaand the few other places left behind during a decade of progress in using antiretroviral medication to prevent maternal to child transmission of HIV (PMTCT).Every day, 1,000 Nigeria babies are born with HIV. The majority will not receive treatment. Without it, half will die before reaching their second birthdays.Professor John Idoko Director General National Agency for the Control of AIDS (NACA) does not agree with gloomy picture. He believes that the country is making steady progress.He said: We do not have figures for children as we do no routine surveys for children and we have not been able to track our PMTCT transmission reduction. But as you know pregnant women are the ones used for the national HIV surveillance, so the figures are actually for pregnant women,The PMTCT coverage at the end of last year is 32 per cent. This is the figure for pregnant women who tested. I do not have the figures for women who accessed prophylaxis,However, Prof Onyebuchi Chukwu minister of Health said: Well, certainly, we may not have done it properly in the past because it appears that we started from the top. I went to Teaching and Specialists hospitals and suddenly find that the foundation was not there. That is what we are trying to reverse now. The investment at the local government level, we now feel that the foundation needs to be strengthened. The Guardian investigations showed that early infant and maternal diagnosis have been a major problem in most health facilities across the country. The situation is worsened by poor health facilities in virtually all Primary health care centres, with testing kits not readily available. In fact, cases of false negative and positive results are abound, as most test kids are said to have expired.Besides, the awareness among mothers is still poor. The situation is not helped with scarcity of Antiretroviral drugs in some of the treatment centres.Idoko reacted: Early infant diagnosis is being expanded in phases and with the expansion of PMTCT interventions to comprehensive PHCs, EID will be expanded to these centres. The issue of testing kits is of concern but we are currently discussing with our partners particularly USG to see how we can expand the procurement. We will also use the WB funds to augment the GON funds that go to FMOH to see how we can procure more test kits. I am not sure if there are any expired test kits. I spoke with NASCP and they say actually that they do not have any expired test kits but I am of the opinion we should do better with distribution of test kits from the central medical stores,He continued: Again, I am not aware that there is scarcity of ARVs. What I know is there may be a problem of distribution of ARVs. As we communicate, I am aware FMOH has stocks of ARVs at the Central Medical stores. For the GF and PEPFAR programmes, there is no scarcity that I am aware of. Please give us specific examples so we can follow through,We are making efforts to mobilize mothers about accessing information and services on HIV and RH. We recently developed a strategic plan for women, girls and HIV which will soon be launched and we have funded women focused organisations like SWAAN, FOMWAN and ASWAN to carry our mobilization and we intend to expand this in the coming year, If the country is planning to eliminate HIV in Infants by 2015, it has not spelt out any agenda close to it. The National strategic framework discusses unrealistic reduction rates not based on evidence on the ground.But Idoko disagrees: He said: We have a robust strategic plan, we have a national PMTCT plan and we have updated our PMTCT guidelines in line with WHO 2010 guidelines. We are getting funds now from Global fund, World Bank, PEPFAR, Millennium Development Goals for PMTCT therefore we should make progress.We set a target of PMTCT coverage of 30 per cent by 2010, 50 per cent by 2011 and 90 per cent by 2015. The challenges will be funding after the initial two years and how well our decentralization to PHC and communities go, he added.Idoko said the country through the National Task Force on PMTCT/NASCP has just developed a national PMTCT plan and guidelines, which will direct the programs that will lead to the virtual elimination of MTCT by 2015. Specifically the objectives of the National Strategic Plan are: At least 80 per cent of all pregnant women have access to quality HIV testing and counselling by 2015.At least 80 per cent of all HIV positive pregnant women access more efficacious ARV prophylaxis by 2015.At least 80 per cent of all HIV exposed infants have access to ARV prophylaxis by 2015.At least 80 per cent of HIV positive pregnant women have access to quality infant feeding counselling.At least 80 per cent of all HIV exposed infants have access to early infant diagnosis services.DR Morenike Ukpong, a researcher insisted that the national strategic framework discusses unrealistic reduction rates not based on evidence.Dr Janet Kayita chief, Children and HIV/A IDS section UNICEF Nigeria said the key determinants for PMTCT programme success are the utilisation of ANC services as well as national scale up of programmes with associated decentralisation. Such decentralisation and scale up programmes, she argued must ensure depth of vertical transmission (MTCT) prevention services and increase in level of comprehensive services.For Nigeria, poor penetration of services with poor service uptake perpetual, added to poor linkages for long term follow up are said to be responsible factors for this dismal performance.Elimination of MTCT is a global goal as this contributes 90 per cent of new paediatric infections.Indeed different countries have identified various effective strategies at addressing MTCT.For instance in South Africa, early assessment of transmission is done in immunisation clinics. This strategy has resulted in the reduction of MTCT transmission of HIV infection from 24 percent in 2000 to 7 per cent in 2008.Also, based on the WHO guideline, pregnant women start ART at 350 CD4 count and to continue so as to ensure ART coverage during breastfeeding period. This, The Guardian gathered has helped to reduce HIV transmission from mother to child during breastfeeding.Kayita posited: We have the power to prevent mother to child transmission of HIV everywhere, and it is time we used that power to save hundreds of thousands of lives in Africa. The time has come to recognize that because we can virtually eliminate paediatric HIV and AIDS, we must.Kayita explained that the focus should be in scaling up cost-effective initiatives to ensure that clinics are properly staffed and supplied, so that more women and newborns are tested early and receive ARV treatment in time to prevent transmission of HIVChukwu added: We are thinking that NGOs for instance, can participate. If we register our Traditional Birth Attendants (TBAs) assist them to be taking deliveries and reward them with training incentives.They will help in testing women for HIV/AIDS during Antenatal care and refer those that are positive, to facilities where they can get all the Preventions of Mother to Child Transmission (PMTCT) services.But you know there is a gap. For instance, we used to have the figures that said that as at 2008 (it has improved now); only about 15 per cent of pregnant women have access to PMTCT services. Yet, as at that time, skilled people took 35 per cent of all deliveries and the simple question was that since 35 per cent had the advantage of having skilled health personnel to take their delivery, how come only 15 per cent had access There is some disconnect here. And people tried to explain to me that even though deliveries were by skilled hands but they were taken at home. So, why did the same skilled hands not test people at home That is what I mean by strengthening the health system, he stated.Ukpong added that additional funding is also needed to expand access to quality care, treatment and support for women and children living with HIV. And, without question, we must invest in innovative ways of reaching the poorest and most vulnerable women and families, Kayita explained that a successful prevention of mother to child transmission, begins with the offering of HIV test and proceeds through posttest counseling to drug adherence and beyond.She added that most programmatic failures are common along this path, with each health facility facing its own mix of challenges in maximizing service coverage.Last month Kenya became the first country to begin distributing the Mother Baby Pack, take-home boxes that contain all the drugs needed to protect the health of one mother and her infanteven mothers who live in remote locations far from clinics.This promising initiative was developed by UNICEF, WHO, UNITAID and other partners. Soon, Cameroon, Lesotho and Zambia will also begin distribution of the Mother Baby Packs to accelerate their own PMTCT efforts.Researchers have also shown that a six-month drug regiment cuts HIV risk for breastfeeding infants.Indeed, giving breastfeeding infants of HIV-positive mothers a daily dose of the antiretroviral drug Nevirapine for six months was said to have halved the risk of HIV transmission to the infants at age 6 months compared with giving infants the drug daily for six weeks.According to preliminary clinical trial data presented at the 18th Conference on Retroviruses and Opportunistic Infections (CROI) held in Boston, United States in March, the longer Nevirapine regimen achieved a 75 per cent reduction in HIV transmission risk through breast milk for the infants of HIV-positive mothers with higher T-cell counts who had not yet begun treatment for HIV.Extended breastfeeding reduces infant mortality in places that lack safe, clean water by protecting babies from common childhood diseases because breast milk contains protective antibodies from the mother that formula feeding does not provide, says Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, which funds the trial.These findings show that giving the infants of HIV-positive mothers an antiretroviral drug daily for the full duration of breast feeding safely minimizes the threat of HIV transmission through breast milk while preserving the health benefits of extended breastfeeding.The new findings apply to mothers and infants in developing nations, where infectious diseases such as gastroenteritis and pneumonia often pose a life-threatening risk to very young children.While the world must intensify efforts and funding to address all causes of maternal and child mortality, indications of a flagging commitment to scaling up of HIV services are particularly concerning, given that HIV prevention and treatment services have demonstrated a tangible impact on maternal and child mortality and morbidity in many hyper endemic countries in Africa.Highly effective programmes for preventing mother-to-child transmission of HIV (PMTCT) exist already, requiring no specific breakthrough work or research that is not already there.
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