In Lesotho, reaching all pregnant women with health services to eliminate paediatric HIV infections
By Malume Mohale
PHELINDABA, Lesotho, 30 May 2012 – Thato* and her husband Thabang Peli* are both living with HIV. They are healthy, thanks to the antiretroviral therapy that they take regularly. And thanks to preventative therapies, both of their sons, ages 5 years and 9 months, were born free from the virus.
Support for pregnant women living with HIV
When Thato was pregnant with her first child, her mother-in-law Mathabang Peli* insisted that she visit the antenatal clinic. It was during an antenatal consultation, with her mother-in-law by her side, that Thato learned her HIV status.
“I always accompany my daughter-in-law to the clinic and sit with her when nurses give mother-and-child talks,” said Ms. Peli.
Thato began a course of medications and services designed to prevent the mother-to-child transmission of HIV (PMTCT). Ms. Peli supported her, ensuring that she took her medications on time. “I know that if they deliver healthy babies, our family lineage will be kept alive,” Ms. Peli said.
Thato’s pregnancies were also made easy by Matlohang Qhobela, a community health worker with Mothers2Mothers, an NGO that assists HIV-positive mothers. Ms. Qhobela is responsible for organizing support groups to teach HIV pregnant women important life skills, such as whether and how to disclose one’s HIV status to partners and families.
“There are cases where women sometimes have to hide their HIV status and medication from partners and family for fear of being perceived negatively,” Ms. Qhobela said.
Reducing mother-to-child transmission
In Lesotho, HIV transmission from mother to child is the second most common mode of transmission, after heterosexual sex. A 2009 Lesotho Sentinel survey reveals that an estimated 27.7 per cent of pregnant women attending antenatal clinics are already infected with HIV. According to the Ministry of Health and Social Welfare, of the 55,000 infants born in Lesotho each year, 15,235 are born to HIV-positive mothers, and, in the absence of any interventions to prevent mother-to-child transmission, an estimated 6,094 new paediatric HIV infections would occur each year.
Like Thato, many women in Lesotho first find out about their HIV status during pregnancy,¬ reflecting a lack of comprehensive knowledge about HIV and low usage of testing services. To address this, public health strategies in Lesotho are focusing on improving the health of HIV-positive mothers and reducing transmission of the virus to their children during pregnancy, labour, delivery and breastfeeding. These services also provide an opportunity to implement integrated, high-quality, family-centred approaches to HIV/AIDS prevention and treatment, which focus not only on the mother but also on the infant and the entire family.
Care for all pregnant women
One such approach is ‘Mofao’, also known as ‘Mother-Baby Packs’, which are packages of antiretroviral treatments and antibiotics that keep HIV-positive mothers and their babies healthy. Women receiving this package leave the clinic with clear instruction on which drugs to take, when to take them, and which ones to give to their babies after birth. It is with ‘Mofao’ that mothers like Thato have been able to keep their babies HIV-free.
With support from UNICEF, the package has recently been improved to aid all pregnant women, regardless of HIV status. The contents are now packaged in three colour-coded boxes, and are distributed to all pregnant women attending antenatal care clinics in the country. HIV-positive pregnant women receive the package containing antiretroviral treatments, while HIV-negative pregnant women receive the package containing micronutrients and vitamin A tablets. Since January 2011, about 40,000 ‘Mofao’ kits have been distributed in public health facilities that provide PMTCT services.
According to UNICEF Health Officer Blandinah Motaung, the ‘Mofao’ packages are particularly critical for women who have difficulty returning to the antenatal clinics. “The first visit is the most important period for appropriate PMTCT interventions. With 91.8 per cent of women attending ANC at least once, while 71 per cent attend four times, ‘Mofao’ is a strategy to avail PMTCT medications to a greater proportion of mothers – even to those disadvantaged by difficult terrain or living in hard-to-reach areas,” Ms. Motaung said.
*Names changed to protect identities