Prevention of mother-to-child HIV transmission (PMTCT)

"CIDRZ created one of the earliest successful prevention of mother to child transmission programs in sub-Saharan Africa...Coupling the research and provision of services is unique and has placed CIDRZ in an appropriate respected leadership position." -- Catherine M. Wilfert, MD, Scientific Director, Elizabeth Glaser Pediatric AIDS Foundation

Scope of problem

Approximately one in five pregnant women in Zambia are infected with HIV. In the absence of intervention, over 30,000 babies would contract HIV from their mothers each year. This risk can be reduced with relatively simple interventions.

Background of mother-to-child transmission of HIV

Not all babies born to infected mothers become infected themselves, but many do. HIV can be transmitted from mother to baby during pregnancy (5%-10%), during labor and delivery (10 -20%), or during breastfeeding (~15%). About 40% of HIV-infected mothers in Zambia will transmit the virus to their babies if there is no intervention available. However this can be reduced substantially with antiretroviral drugs. The simplest intervention used in Zambia is “single dose nevirapine,” a regimen of one tablet of the antiretroviral drug, nevirapine, to the mother at the time of labor onset and one dose to the baby after delivery. This can reduce mother-to-child transmission by nearly half. Other, more complex regimens, such as 3-drug combination therapy, also known as highly active antiretroviral therapy (HAART), during pregnancy can reduce transmission rates to two percent or less.

CIDRZ supports the Zambian Ministry of Health PMTCT programs

The support that CIDRZ gives helps to ensure that all pregnant women are provided HIV testing and counseling as part of routine antenatal care. HIV-infected mothers are offered anti retroviral drugs to prevent perinatal transmission. Single-dose nevirapine, is used in sites located in rural areas. In Lusaka, the capital city of Zambia, the government clinics have begun offering a regimen of “nevirapine-boosted AZT,” which uses the antiretroviral drug zidovudine (also called “AZT”) from 36 weeks of pregnancy. Mothers on this regimen still take nevirapine in labor and the baby receives single dose of nevirapine in addition to a week long course of zidovudine. This regimen is more effective than single dose nevirapine. HIV-infected mothers are also receiving CD4 counts to determine if they have more advanced HIV disease and are eligible for highly active antiretroviral therapy (HAART), sometimes called the ‘triple cocktail.’  Mothers who receive HAART can reduce their chances of giving HIV to their babies to almost nil. New studies are also showing that HAART taken.

Testing babies for HIV

Studies have shown that the earlier a baby can be diagnosed with HIV, the better he or she does. CIDRZ is supporting testing of infants as early as six weeks of age for HIV using polymerase chain reaction (PCR). Those babies born to HIV infected mothers are also given cotrimoxazole, beginning at 6 weeks of age to prevent serious lung infections associated with HIV. This is given for the first year of life to all babies whose mothers were HIV infected whether the babies are HIV infected or not.

Support of Antenatal Care

Good antenatal care is very important for both the mother’s health during pregnancy as well as for a safe delivery. CIDRZ supports:

1. Ministry of Health Districts to train health care providers on the PMTCT minimum package of care that has been developed by the World Health Organization
2. Buying back-up supplies when supplies run out such as syphilis test kits, and specimen bottles for blood tests
3. Renovations of old government clinic structures and procurement of clinic furniture
4. Procurement of medical equipment e.g. centrifuges and blood pressure machines and refrigerators
5. Procurement of computers and printers

Use of peer educators; lay counselors; and trained traditional birth attendants

Peer educators are patients or community workers who have either gone through the PMTCT program or have an indepth knowledge of the program and live in the communities which are supported by the health centers. CIDRZ supports the use of peer educators because in many of the health facilities there are very few trained staff and little assistance in counseling; education and other tasks can be delegated to support staff such as peer educators; lay counselors and trained traditional birth attendants.

Income generating activities

Part of the holistic view that CIDRZ has towards health involves income generating activities.Some of the income generating activities supported by CIDRZ include the provision of small loans to a group of peer educators at one clinic. The peers have started a variety of small businesses including sewing and raising chickens.

Visitors

CIDRZ supported PMTCT programs have had many famous visitors. Some of our visitors include:

• Stephen Lewis
• Graca Machel
• Oprah Winfrey
• Matt Damon
• Bill Clinton
• Naomi Watts

Community outreach activities

Community awareness of what is being offered at their nearest health clinic is very important. Since many clinics or small health posts in rural areas don’t have ways of broadcasting their services, we support community awareness through drama, door to door education, as well as church meetings.

Support for PMTCT activities continues to expand, with technical assistance and financial support currently provided to almost 200 Zambian Government sites in 12 districts and 3 provinces. CIDRZ has supported training of 852 nurses in the national PMTCT package.

Since 2001, CIDRZ has supported the Zambian Government in delivering PMTCT services to more than 450,000 women in Zambia to date.