Our efforts to reach zero tolerance of PMTCT in the FCT– Dr Mohammed

How far has the FCT gone in integrating PMTCT services in the PHCs?Our concern in Nigeria today is reducing HIV. PMTCT is our major concern because Nigeria constitutes only two percent of the general population of the world but it contributes about 30 per cent of mother to child transmission of HIV. It’s a big […]

How far has the FCT gone in integrating PMTCT services in the PHCs?
Our concern in Nigeria today is reducing HIV. PMTCT is our major concern because Nigeria constitutes only two percent of the general population of the world but it contributes about 30 per cent of mother to child transmission of HIV. It’s a big concern to the federal government. So more than anything we want to make sure that the child at least is not infected with the disease.
What we and our partners in the FCT administration are doing is to make sure that we scale up the intervention to about 40 PHCs and some of our partners like IHVN and others are coming to support us.
We’ve trained some people with the help of UNICEF and The World Bank to make sure that they have the knowledge and the required information to carry out the work.
Training is quite important. Some of them may not necessarily be doctors and the whole world is going towards integration. If you are only offering one service like taking care of only malaria; it becomes a practical problem. We want everything to be in one place; all the staff there should know how to give services for PMTCT. They can even go for outreach services; to the community, and find out those who are pregnant, they can even screen some of them with the knowledge they have acquired from the training on HIV testing and counselling.
 
Any plans to scale up and how many PHCs will benefit?
About 25 are almost ready now. We still have one or two logistics issues as it relates to staff; some are MSS staff trained by World Bank while others trained by UNICEF. We trained all of them and we gave them equipments to use including data tools and kit.
Its very important to train people on HIV/AIDS issues due to the stigma and discrimination attached to the disease.

How do you go about the prevention of mother to child transmission of HIV/AIDS?
If we want to talk about PMTCT which is a key factor in reducing our HIV prevalence, what we used to do before is screening before pregnancy, during pregnancy and after breast feeding.
If the woman is living with the virus HIV, then you have to start her on some drugs; ART. Make sure she takes the drugs regularly so that her child will not be infected. During delivery, it is not now compulsory but before we used to carry out elective Caesarean session so as to reduce the risk of transmitting  the virus from mother to child but now since the woman is on drugs and the child would also be given lluborapin 2.5 milligram per kg body weight, the rate of transmission is reduced.
If she continues taking the drugs, and the child continues taking the drugs, the mother can continue breastfeeding that child for 12 good months before she stops.
Meanwhile, the former method we were using was breastfeeding options. But it’s different from this one. It actually failed until 2012 when the guideline for the PMTCT was revised.
Now, what they were doing before is that if a woman has HIV, we disallow her from breastfeeding the baby because the highest level of transmission is 13 per cent level of transmission through breastfeeding. So we give her breastfeeding options like formula milk. But we found out that it was not working.
The baby tends to have diarrhoea and contact diseases all the way, including infection. So we had decided on the second option which is wet nursing.

Are there other options?
Another alternative is to allow another woman, who is HIV negative and could be a relation to be paid to breastfeed the child. But this carried a lot of stigma. So this also failed.
Another method is that a woman on anti retroviral can do exclusive breast feeding for six months and the child would be given drugs at birth, then the breastfeeding would stop and  the baby fed  with formula after six months.
 So many children were infected with HIV. So it also failed. The next one was what you will call, sperm washing. When you have a case of a sero discordant couple where either one of them is positive but in this case, the father, what is done especially in the western world is to carry out sperm washing.
They wash the sperm and remove everything around it and put it into the woman. So in this case, you don’t need to do anything again because the woman is negative. It’s another sophisticated method which is now being carried out in Nigeria.
We realised that all these things are not possible and the federal government sat down with the stakeholders and our partners and looked at the method again to look for what is possible?
The breastfeeding has more usefulness. It is the first immunization of a child and is highly nutritive for the child. So breast milk is very key in the development of a child. It gives him intelligence quotient. It even helps the government in reducing poverty because the woman does not need to buy anything since it is from God.
But most women do not want to breastfeed their babies. In the FCT last demographic survey, the rate of women breast feeding is 9 per cent while in neighbouring countries, its 13 per cent. We are doing another National Demographic Health Survey (NDHS) now.
So the new nutrition guideline is for the HIV positive mother to breastfeed the child. The HIV positive mother will be on anti retroviral drugs including the child for 12 months when she stops breastfeeding.
You will find out that the children are better off in Nigeria today. They are not at risk at all because if the child is on drugs, the mother is on drugs, the risk is minimal.
 We have different donors doing several things .World Bank will come and say it wants to tackle HIV, Global Fund will say malaria and tuberculosis. This is not good in medical practice. Integration is the answer. What we are doing now is to have what we call supportive supervision to find out whether its going well or not.
This is exactly what we are doing in the FCT to find out whether the integration is going to work well or not because in most of the primary health care centres, the drugs are not available, the staff are not there.