Keeping mothers and babies in care to eliminate transmission of HIV

Nigel Livesley

Regional Director for South Asia, USAID Applying Science to Strengthen and Improve Health Systems (ASSIST) Project, University Research Co., LLC (URC)

My colleagues in Uganda are working with rural clinics to improve their capacity to prevent mother-to-child transmission of HIV.  Recently, we visited one rural clinic whose records showed that 177 exposed babies had been born in the clinic or had come there for care at some point in the past 18 months.  Yet only 9 had come back to the clinic in April 2013.

This means that we don’t know what happened to 168 (95%) of those mothers and babies.  We don’t know if the mothers are on antiretroviral drugs which are so important for maintaining the mother’s health and preventing the babies from being infected with HIV.  We don’t know if the babies are being breast fed properly to protect them from common bacterial infections and from HIV.  We don’t know if the babies are being assessed to see if they need ART or are receiving treatment.

There is a global movement to eliminate the transmission of HIV from mothers to babies.  We know what we need to do this – we need to identify HIV infected mothers and to use antiretroviral drugs to reduce the risk of transmission before and during delivery; we need to keep infected mothers and their babies in care and use antiretroviral drugs while the baby is being breast fed, we need to help mothers breastfeed their babies safely and we need to test the babies to identify those who are infected as early as possible. 

This is a limited number of interventions.  The problem is that we don’t know how to consistently delivery them to every mother and every baby.  Care after delivery is particularly bad.  The clinic we visited is pretty typical – mothers and babies are not in care and there is no data system to easily allow the clinic to identify who is in care and who is not.

The ASIST teams from Kenya, Mozambique, Tanzania and Uganda, working as part of the Partnership for HIV Free Survival, met in Uganda on June 6 and 7, 2013 to discuss how to help teams of health workers learn how to solve some of these problems with post-natal care.  Based on our discussions and the data from this and other clinics, the teams are going to start by helping clinics keep mothers and babies in care.   My future blogs will highlight some of the learning that the teams we support through the Partnership for HIV Free Survival generate about how to do this.

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