Devpro Resource Centre
PMTCT programme supports mothers living with HIV
|A health worker introduces the hospital's PMTCT programme to a group of pregnant women and counsels them to be tested for HIV at Manica District Hospital.|
Context and challenge: High HIV prevalence among adults, including pregnant women
The southern African country of Mozambique stretches along more than 2,500 kilometres of Indian Ocean coastline and shares borders with six other countries. Mozambique’s population is young, with the below-18 age cohort accounting for about half of the country’s 21 million inhabitants. Since the end of a 16-year civil war in 1992, the country has seen vibrant economic growth that has averaged 8 per cent between 1996 and 2006, one of the highest rates in Africa. During this period, according to the World Bank, almost 3 million people were brought out of extreme poverty. Still, the country ranks among the world’s 20 poorest. One of the greatest threats to Mozambique’s development is HIV and AIDS, and 58 percent of those infected are women.
In Mozambique, an estimated 90 babies are infected with HIV by their mothers every day. HIV-positive women can transmit the virus during pregnancy or delivery or through breastfeeding. Roughly half the infants who contract HIV from their mothers die before their second birthday, but these deaths are preventable. Antiretroviral prophylaxis given to a woman during pregnancy and delivery – and to her infant shortly following birth – has been shown to sharply reduce the likelihood of the mother passing HIV on to her baby, while also providing the mother with treatment.
With the Ministry of Health’s efforts, a significantly high proportion (85 per cent) of pregnant women in Mozambique do receive antenatal care at least once. This has been seen as a fruitful point of intervention for prevention of mother-to-child transmission (PMTCT) initiatives.
Action: Integrating PMTCT programmes with maternal and child health services
|© UNICEF Mozambique/2006/Pirozzi|
|Children receive antiretroviral treatment, care and psychological support from the highly trained staff at the Maputo Day Hospital.|
In 2002, the Ministry of Health launched the comprehensive National Programme on Prevention of Mother-to-Child Transmission of HIV. In a bid to ensure that the programme reaches the most pregnant women possible, it has been integrated with existing maternal and child health facilities and linked to other services, such as nutrition, paediatric treatment and malaria control. Mothers and children across the country are now being offered a holistic package of crucial health services, including HIV and AIDS prevention and treatment, and all PMTCT services are provided free of charge.
The Ministry of Health is assisted by a wide range of partners, including WHO, Centers for Disease Control and Prevention, USAID, Health Alliance International, the Elizabeth Glaser Pediatric AIDS Foundation, the International Center for AIDS Care and Treatment Programs, Population Services International and UNICEF, among others, in its efforts to scale up the national PMTCT programme. The Ministry of Health has initiated an ‘opt-out’ approach for HIV testing; that is, HIV testing is routinely offered to all pregnant women, rather than the ‘opt-in’ approach, in which a woman has to specifically say that she wants HIV testing. Studies have shown that the ‘opt-out’ approach increases rates of testing.
A pregnant woman who participates in the PMTCT programme at any maternal or child health centre can typically benefit from the following bundle of services:
- Pre-test counselling on HIV and AIDS transmission; antiretroviral therapy and post-test counselling on antiretroviral treatment options.
- A first rapid HIV test and a second confirmatory test, with results available in 10 minutes.
- Assessment of CD4 cell count for those pregnant women who test HIV-positive. For women with a CD4 count of less than 350 cells/mm3, antiretroviral therapy is initiated. Those with a higher CD4 count receive combination therapy for prophylaxis, consisting of a regimen of AZT in the 28th week of pregnancy and a single dose of Nevirapine during delivery. Babies born in hospitals receive the medicine as syrup within 24 hours of birth. Those brought from home get antiretroviral treatment no later than 72 hours after birth. Babies are also provided a short course of AZT.
- Psychosocial support and information is provided by Positive Mothers groups to all pregnant women and mothers with children under the age of 18 who are living with HIV.
- Safe and hygienic delivery is promoted at maternity wards. For home deliveries, traditional birth attendants have been trained to follow precautions.
- Those mothers who do not test HIV-positive receive information on the importance of exclusive breastfeeding.
While children undergo growth monitoring and receive vaccinations through the regular National Child Health Programme, those children exposed to HIV are given special care through a programme for at-risk children to address their nutritional needs and their higher risk of contracting infectious diseases. Infants are tested for HIV infection through a polymerase chain-reaction test when they are between four and six weeks old. While this test is currently only available on a small scale, the Ministry of Health is planning for its expansion. At 18 months, children receive an antibody test. Further antiretroviral treatment, as well as treatment for opportunistic diseases, is available at health facilities for women, their partners and children. Women and their partners also receive treatment for sexually transmitted illnesses.
Impact: Mozambique’s national PMTCT programme grows rapidly since inception
|© UNICEF Mozambique/Machiana|
|Mothers living with HIV and their children receive health care from trained nurses at Malahice Health Centre.|
Promoting the national PMTCT programme in precisely those places where pregnant women and young children already receive regular health services has proven to be an effective strategy. The PMTCT programme has also grown rapidly since its inception:
- The number of PMTCT sites across the country increased to 507 as of August 2008, up from 386 in 2007, 222 in 2006 and only 8 in 2002.
- The number of pregnant women receiving counselling and testing through PMTCT services increased from 4,641 in 2002 to 194,117 in 2006 and to 366,281 in 2007 – out of an average total estimated 800,000 pregnancies per year. More than 300,000 pregnant women were counselled and tested in the first eight months of 2008 alone – a significant increase from the previous year.
- The coverage of ARV prophylaxis for HIV-positive pregnant women rose from 0.2 per cent in 2002 to 8.3 per cent in 2006 and 29.7 per cent in 2007. During the first eight months of 2008, 39,265 HIV-positive pregnant women – or an estimated 38 per cent – received ARV prophylaxis.
Opportunities: Plans to expand PMTCT services to all health facilities in the country
The Ministry of Health aims to expand PMTCT services to all health facilities in the country with antenatal care and maternity wards, with the goal of reaching 700 facilities (or almost 90 per cent of all such facilities) by 2011.
1 December 2008
To learn more
UNICEF, Children and AIDS: Third Stocktaking Report 2008. | PDF
UNICEF, The State of Africa's Children 2008: Child survival. | PDF
UNICEF Mozambique Country Office | website
UNICEF, UNAIDS and WHO, Towards Universal Access: Scaling up priority HIV services for women and children in the health sector – Progress Report 2008. | PDF
WHO, Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants: Towards Universal Access – Recommendations for a public health approach, 2006 version. | PDF