Can Ndhiwa eliminate new pediatric HIV infections?

At the Oridi Dispensary in Ndhiwa, this poster helps healthcare workers track prevention of mother-to-child transmission (PMTCT) efforts.

EGPAF

Located on the south shore of Lake Victoria in Homa Bay District, the region of Ndhiwa could be among the first high HIV-burden districts in Kenya to eliminate mother-to-child transmission of HIV.

The region’s average mother-to-child HIV transmission rates have decreased precipitously in recent years, falling from a high of 10 percent in 2010 to 4 percent in 2012. This incredible advance comes as a result of an aggressive program supported by EGPAF to to decentralize HIV services and make them available at all public health facilities in the district as part of a suite of maternal, neonatal, and child health (MNCH) services.

“When we first suggested this idea to health officials in the district, it sounded crazy and was met with some resistance,” Dave Muthama, Deputy Director of the PAMOJA project, said.“(But) today, we are grateful – health officials, including healthcare workers, are the greatest champions of the program.”

PAMOJA is a five-year Centers for Disease Control and Prevention (CDC)-funded project to increase the availability and use of high-quality comprehensive HIV prevention, care, and treatment services while building the capacity of health care workers to provide these offerings. EGPAF is implementing the program in the three districts of Nyanza, including Ndhiwa.

Until 2010, only Homa Bay District Hospital provided HIV services in the expansive Homa Bay district. Other facilities offered limited services, providing HIV testing, counseling, and preventive antiretroviral drugs only given during pregnancy and the breastfeeding period to prevent infants from contracting HIV. Pregnant women and others in need of lifelong antiretroviral therapy (ART) were referred to district hospitals, a day’s journey through rough terrain and nonexistent roads for most patients.

Most women who transmit HIV to their infants also need ART for their own health. They compose 20 percent of pregnant women living with HIV, but are responsible for unknowingly transmitting 80 percent of new HIV infections to infants. In high HIV-burden areas like Ndhiwa, the number of HIV-positive pregnant women who need ART for their own health could be as much as 40 percent of all HIV-positive pregnant women.

EGPAF’s efforts to support the Ministry of Health (MOH) and achieve the elimination of pediatric HIV began in 2010 by building the capacity of Ndhiwa District Hospital, making it a central ART site and supply center for other public health facilities in the district.

Health workers were trained on how to manage adolescents and adult illnesses, equipping them with the skills and knowledge needed to provide HIV services.

Laboratory diagnostics services used to determine the extent of HIV infection are not available in all health facilities, but EGPAF and the MOH-pioneered laboratory networks are helping to make diagnostic services more accessible to people in rural communities. Instead of sending patients to facilities with laboratories, healthcare workers collect samples from clients and send them to established referral laboratories that have the requisite equipment and technical staff.

Since the roll-out of HIV services in all public health facilities in Ndhiwa District, the proportion of HIV-positive pregnant women receiving care increased from 39 percent in December 2010 to 100 percent as of December 2012. The number of pregnant women on ART increased from 11 percent in December 2010 to 100 percent in December 2012. In addition, the district registered a higher number of women staying on ART treatment.

Among the facilities that have contributed to the drastic reduction of new HIV infections in Ndhiwa is Oridi Dispensary, which began providing one-stop HIV services, including tuberculosis management, in 2011. The dispensary is located about 25 miles away from the district hospital, in a remote area where public transport is unavailable. Within a year and half of offering HIV services, 120 HIV-infected pregnant mothers were enrolled in a HIV care and treatment program through Oridi Dispensary. 74 mothers had their babies declared free of HIV after turning 18 months of age, and 67 mothers had their babies tested for HIV at 6 weeks and 9 months; only one infant tested positive for HIV.

“We explain to all pregnant women the importance of doing an HIV test, and (we) hold on to the positive ones from pregnancy until after their children are 18 months old,” said Helen Awuor, head nurse at Oridi Dispensary. Helen was recognized as Nurse of the Year in 2011 by the National Nurses Association of Kenya for her HIV integration efforts.

A recent EGPAF-Kenya study comparing services for follow-up of HIV exposed infants – published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS) in September of 2012 – and the results from Ndhiwa offer hope that new HIV infections among children can be eliminated by using MNCH service models.” Elimination” is defined by the United Nations as reducing mother-to-child transmission to less than 5 percent. Every day, more than 900 children around the world are infected with HIV.


Eric Kilongi is Senior Communications Officer for the Foundation, based in Africa.