UNTIL the 1990s, the spread of HIV in Zimbabwe was regarded as a grave threat hanging over the lives of both infected mothers and their unborn babies whose chances of survival were almost non-existent.
BY PHILLIP CHIDAVAENZI
For nearly a decade, a macabre harvest of the lives of newly–born babies was witnessed, with some HIV-positive mothers opting for Caesarean section (C-section) operations to reduce the risk of their babies being infected during birth.
C-section, however, came with its own challenges as survival of either the mother or the child was not guaranteed.
But the introduction of the prevention-of-mother-to-child-transmission (PMTCT) regime in the country brought a new lease of life to newborns that made it possible for babies born to HIV-positive mothers to enjoy life free from the virus.
Its success has given rise to a whole new meaning to another “born-free generation”; a generation of children born to HIV-positive mothers free of the Aids virus.
Samantha Chibuwe (36) of Kuwadzana, Harare, is one such beneficiary of the “miraculous” programme. All her three children, including the one born last year after she had tested HIV-positive, are negative.
“My baby is a miracle,” she said in an interview. “When I discovered that I was HIV-positive while pregnant, I felt disappointed that my baby would not survive for long.”
When her doctor told her he was going to put her on the PMTCT treatment, she was weighed down by doubt, certain that this was like a futile attempt to breathe life into a corpse.
According to the Multiple Indicator Cluster Survey (MICS, 2014) final report released last month by ZimStat, mother-to-child transmission of HIV accounts for 90% of all new infections in children aged between zero and 14 years in Zimbabwe.
“It (MTCT) is the second major mode of transmission of the virus after sexual transmission, contributing overall to 7% of all HIV infections,” reads the report in part.
National PMTCT and paediatric HIV care and treatment co-ordinator in the Health ministry Angela Mushavi says there is need to intensify efforts to curb maternal infections as the country is lagging behind.
Mushavi is on record saying considering more HIV-positive women would continue giving birth, there was need to ensure they received all the care they deserved, noting that this could only be achieved through increasing resources, awareness and research.
“We experience a lack of tracking of mother-infant pairs in PMTCT and a slow scale-up of early treatment for HIV-positive infants. The procurement/supply chain management for PMTCT in the face of an under-resourced health care system is also difficult,” she explained.
Although PMTCT therapy has led to dramatic successes in preventing newborns from contracting HIV and helping to keep their mothers fit and well, Mushavi warns that HIV and Aids remains the leading cause of maternal mortality and was the underlying cause of death for most children below the age of five.
The National Aids Council (NAC) reports that the number of HIV-positive women giving birth to infected babies has been on the wane.
According to NAC Zimbabwe Aids Progress Report for 2014, the number of women receiving anti-retroviral (ARV) treatment to reduce the risk of mother-to-child transmission has been on the rise, from 22% in 2007 to 93% in 2013.
This had a knock–on effect on the number of infected children born to HIV-positive mothers, which decreased from 31% in 2009 to 9,61% in 2013.
“Zimbabwe adopted Option B+ in order to enable what it referred to as ‘the elimination agenda’. The recent national estimates reviewed that the mother-to-child transmission rate has reduced from 18% in 2011 to 9,61% in 2013,” says the report.
“High quality, comprehensive PMTCT services are currently provided in 95% of the 1 560 health facilities in Zimbabwe. PMTCT is one of the programmes that has achieved universal access (93% in 2013).”
The PMTCT programme in Zimbabwe was funded to the tune of $38 391 095 between 2013 and 2014 by a variety of local and international partners.
However, for HIV-positive women with birth complications, C-section remains the most viable option
Zimbabwe developed and adopted the national strategic plan for eliminating new HIV infections in children and keeping mothers and families alive (2011-2015). The elimination strategy aims to contribute to the attainment of Millennium Development Goals (MDGs) four (reduce child mortality), five (improve maternal health, and six (combat HIV and Aids, malaria and other diseases) by 2015.
Among the United Nations Population Fund (UNFPA)’s targets on the elimination of mother-to-child transmission is to ensure that it would be reduced to 5% by 2015, according to the fund’s strategic framework (2011-2015).
According to UNFPA, between 2009 and 2013 78% of pregnant women living with HIV received ARV treatment for PMTCT as part of the drive to eliminate paediatric HIV infection.
“Between 2009 and 2013, Zimbabwe has experienced one of the greatest declines; it was around 57%, in the number of new paediatric HIV infections,” said the fund in a report.
“Half of all HIV-exposed infants received an EID test and ARV therapy coverage was 27% among children 0-14 years of age.”
The report noted that PMTCT has been at the forefront of global HIV prevention activities since 1998, following the success of the short-course Zidovudine and single-dose Nevirapine clinical trials.
“These offered the promise of a relatively simple, low-cost intervention that could substantially reduce the risk of HIV transmission from mother to baby. Research and programme experience over the past 10 years has demonstrated newer and more effective ways to prevent new paediatric infections, particularly in high-burden, low-resource settings,” the report noted.
Where either the health of the mother or unborn baby was at risk through normal delivery, Caesarean section (C-section) has been successfully used to deliver HIV-negative babies. C-section is a measure of access to and use of a common obstetric intervention for averting maternal and neonatal deaths.
Although the best C-section rate is not known, in 2009 the World Health Organisation, Unicef and UNFPA set the minimum and maximum acceptable levels at 5% and 15%, respectively, which Zimbabwe adopted.
According to the findings of the MICS 2014 final report, 6% of women who delivered in the last two years had a C-section.
“C-sections were more likely to be performed on older women age 35 to 49 years (9,6%), on women with higher education (21,0%) and on women in the richest wealth quintile (15,4%),” says the report.
It also noted that the private sector (25,6%) surpassed the upper limit of 15% for deliveries by C-section.