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Preventing mother-to-child transmission

© UNICEF/MOZA-01640/G.Pirozzi

Progress and challenges

In Mozambique, there are about 149,000 pregnant women living with HIV or AIDS and around 85 babies are infected with HIV by their mothers every day. HIV-positive women can transmit the virus during pregnancy, delivery or through breastfeeding.  

HIV may be transmitted when maternal blood enters the fetal circulation or by exposure to maternal mucosa and blood during labor and delivery.  

HIV can also be transmitted from a nursing mother to her infant. In developing countries, such as Mozambique, where women traditionally breastfeed for 18 to 24 months, there is an estimated risk of HIV transmission through breast milk of about 15 per cent.  

This risk can be reduced to a few percentages when breastfeeding is done exclusively, when the mother’s immune system is strong, when she has no breast problems and when she breastfeeds for 6 months only.  

In the counseling of HIV positive mothers, they are therefore advised to either breastfeed exclusively, or give exclusive replacement feeding, provided they can do so in a way that is acceptable, feasible, affordable, safe and sustainable.  

Preventable deaths

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.  

In 2002, the Ministry of Health launched a comprehensive national Programme on Prevention of Mother-to-Child Transmission of HIV (PMTCT).  

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 prevention and treatment, and all PMTCT services are provided free of charge.

© UNICEF Mozambique/E. Machiana

What is being done

The nationwide PMTCT programme has grown rapidly since its inception. The number of PMTCT sites across the country increased to 744 by October 2009, up from 500 in 2008, up from 386 in 2007, 222 in 2006 and only 8 in 2002.

As a result, 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 of 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 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 861 facilities – almost 90 per cent of all facilities – by 2011.

The way forward

Between 2010 and 2011, UNICEF will continue to support the Ministry of Health and other partners to scale up the PMTCT programme and improve the quality of services offered to pregnant women.

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 typically benefits from the following bundle of services:

  • Counselling and testing on HIV. Under the “opt out” approach, the HIV test is offered routinely to all pregnant women.

  • Referral of pregnant women who test HIV positive to a facility for a CD4 count test and initiation of antiretroviral therapy if she is found eligible.

  • Ongoing antenatal care and counseling.

  • Provision of ARVs according to updatesd national guidelines.

  • Promotion of delivery in a maternity ward, so that optimal care and prophylactic treatment for mother and child can be provided.

  • Postnatal counselling including counselling on infant feeding options. The guidelines recommend HIV- positive mothers to opt for exclusive replacement feeding if they can do this in a way that is acceptable, feasible, affordable, sustainable and safe.

  • If they do not meet these criteria, exclusive breastfeeding up to six months is strongly recommended, with early and rapid cessation at that age.

  • Referral and link up with a Positive Mothers Group, which is a support and information-sharing group within PMTCT centres. The groups are open to all pregnant women and mothers with children under the age of 18 who are living with HIV.

  • Referral of the child to regular follow-up consultations for high risk children. This programme includes routine health services like vaccinations and growth monitoring, as well as specific care for high-risk children, including the provision of cotrimoxazole for prophylaxis of opportunistic infections.

  • Early Infant Diagnosis, through polymerase-chain-reaction (PCR) test at the age of 4 to 6 weeks, is extremely important for prompt care of the HIV-exposed child. 

PCR test is currently only available at a small scale but the Ministry of Health is planning for its expansion. When not possible to test the child earlier, the child is tested through antibody testing at the age of 18 months.

 

 
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