Ugandan health workers strive to improve pediatric HIV services

By Irene Nabusoba | April 30, 2013

Participants break into groups to create strategies to get more children into pediatric HIV and EID services in their districts.

EGPAF

In an effort to encourage more women to take advantage of pediatric HIV prevention, care, and treatment services, the Elizabeth Glaser Pediatric AIDS Foundation’s USAID-funded Strengthening TB and AIDS Response in SW Uganda (STAR SW) project, working with the Ministry of Health (MOH), organized a regional pediatric HIV and Early Infant Diagnosis (EID) stakeholders’ conference earlier this month at Lake View Hotel in Mbarara in western Uganda.

The meeting which attracted over 70 health workers – including district health officers, health center managers (known as “in-charges”), doctors, and midwives – aimed to identify gaps and challenges in EID of HIV, pediatric care, and treatment for children living with HIV.

With funding from the United States, EGPAF’s STAR SW project is supporting the MOH National AIDS Control Program to increase access to a broad range of comprehensive, high quality HIV/AIDS and tuberculosis (TB) services for children, women, and families in 13 districts in southwestern Uganda, covering over 200 health care facilities.

Dr. Mary Namubiru, director of clinical services for EGPAF, called for “creativity” in getting more children into pediatric HIV services, focusing her attention on EID, which often serves as a key entry point for care and treatment of children under five years of age.

“We should strengthen the ‘Know Your Child’s Status’ campaigns to increase community awareness of benefits of (the) pediatric HIV/AIDS diagnosis, care, and treatment,” Namubiru said. “And let’s test every mother (before she gives birth), offer preventive services, and for those children that (become) HIV positive after delivery, we should not lose them.”

Dr. Peter Elyanu, Ugandan national coordinator of pediatric and adolescent HIV care, noted that though mothers are expected to visit clinics for prevention of mother-to-child transmission (PMTCT) services to protect their babies from infection, the stigma of HIV is causing many women to shun such treatment.

“As of June 2012, only 68 percent of positive pregnant women (in Uganda) received ARVs for PMTCT, and only 38 percent of their babies were returned for (preventative antiretroviral (ARV) treatment) after birth.”

According to the World Health Organization, about 35 percent of HIV-infected pregnant women will transmit HIV to their infants if they are not diagnosed or treated. But key interventions can reduce mother-to-child transmission of HIV to less than 5 percent. These interventions include routine HIV testing and counseling of all pregnant women; providing antiretroviral drugs (ARVs) to all HIV-positive women during pregnancy, birth, and after delivery; preventive therapy with ARVs for infants born to HIV-positive mothers; and safe infant feeding to minimize transmission via breastfeeding.

However, Dr. Elyanu said that he regretted that while only 4 percent of children who received the full cascade of PMTCT interventions were infected with HIV in 2002, a staggering 12 percent of children who received partial treatment and 35 percent of children who received no treatment were infected with HIV.

“The package must be complete, and mothers must seek the PMTCT services,” Dr. Elyanu said.

During the conference, Ntungamo district health officer Dr. Richard Bakamuturaki said that women are afraid to disclose their HIV status with their husbands and next of kin, impacting the numbers of children enrolled in pediatric HIV prevention and EID services in the name of “keeping face.”

“Mothers give us wrong addresses (for) fear of health workers and village health care teams following them up in their homes,” Dr. Bakamuturaki said. “For many, when they test HIV positive, they do not disclose their status to their husbands. “

“They even rub codes off their health cards that indicate their HIV serostatus, hampering follow-up of exposed infants for appropriate diagnosis and care,” Bakamuturaki added.

Dr. Ibrahim Kirunda, director of quality improvement for STAR SW, urged health workers to pay attention to the overall quality of pediatric HIV care services in health facilities through strengthening counseling services, actively implementing patient follow-up; building laboratory capacity and improving the transportation of blood samples and results; and supporting continuous on-site mentorships for health workers.

“It’s important that we integrate pediatric HIV services into all ‘adults-only’ ART clinics and existing maternal, newborn and child health programs,“ Dr. Kirunda said. “We should also integrate EID into child days and immunization outreaches; and strengthen active follow-up through documentation, phone calls, and home visits with consenting mothers.”

Irene Nabusoba is Communications and Outreach Officer for the Foundation, based in Uganda.