EGPAF Helped Me Be Sure That My Child Is HIV-free
In 2007, Fatuma Mohamed, a young woman living near Tanzania’s southern coast, fell in love. She and her partner wanted to experience the joy of raising a child together—but they are both living with HIV, so they were unsure about their prospects. In the previous year, Fatuma’s 5-month-old baby had passed away after being seriously ill. The child may have died from an AIDS-related cause, but Fatuma could not be sure because neither she nor the child had been tested for HIV. But now she was aware of her HIV-positive status, and she was overwhelmed by the fear of transmitting the virus to her baby when she became pregnant.
To quell her anxiety, Fatuma and her partner visited the Kitumbikwela Dispensary, their local health clinic in Tanzania’s Lindi District. They spoke with a counselor who assured them that Fatuma had an excellent chance of delivering an HIV-free baby if she adhered to prevention of mother-to-child transmission of HIV (PMTCT) services, which are available for free at the dispensary. Relieved, Fatuma and her partner decided to go ahead.
Soon after conceiving, Fatuma started antiretroviral therapy, designed to prevent HIV transmission to the child. Fatuma followed all recommendations given by the nurses and counselors, and she safely delivered a son, Hassan. After delivery, Fatuma decided to breastfeed, which she knew would be safe for the baby if she followed PMTCT protocols. When Hassan was 1 month old, Fatuma took him to the dispensary to submit a dried blood sample to test for HIV. The result was negative. Fatuma repeated the test when Hassan was 9 months old, and, once again, the result was negative. This was repeated when Hassan was 18 months old, with the same result, and he was certified as being HIV-free.
“I cried with joy,” says Fatuma. “I was so happy for myself and my child. Both I and my son are healthy and productive. He is now 8 years old. I have a sense that Hassan and I will live longer to achieve our goals.”
The clinical experience of Fatuma and Hassan illustrates the success of the multilevel approach that the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) is taking with the Tanzania Ministry of Health to improve early infant diagnosis of HIV.
In Tanzania, pregnant or breastfeeding women who test positive for HIV are registered in Lifelong Antiretroviral Therapy for Pregnant or Lactating Women (LLAPLA). At the site level, the health record of women enrolled in LLAPLA is paired with that of their HIV-exposed infants to ensure that the children are tested—and treated if necessary. Through integrated management of childhood illness, children who test positive are linked to community- or home-based health care programs.
EGPAF and the Tanzania Ministry of Health work with regional and community health management teams to monitor numbers of dried blood spot kits to minimize stock-outs. The teams also track transportation and check in with laboratories to ensure that the samples are tested in a timely manner. Key to this effort has been orienting medical attendants to identify HIV-exposed infants and collect data to include for reproductive and child health cards. Working with laboratory staff, EGPAF generates quarterly reports on the dried blood spot samples received, processed, and sent back to sites.
As a result of these efforts, the registration of HIV-exposed infants increased from 56 percent to 82 percent. Improvements were highest at sites with greater numbers of women enrolled in LLAPLA. Lifelong treatment has provided the frame for better monitoring of family health.