Poorly integrated maternal health services, a lack of human resources and a serious shortage of money for treatment mean the Democratic Republic of Congo (DRC) is unlikely to meet the global plan of eliminating mother-to-child transmission by 2015.
"It is a catastrophe. An HIV test during antenatal visits is not automatic - the information may be given but the tests may not be available, or the treatment may not be available," said Thérèse Kabale Omari, the director for Kinshasa Province of Femme Plus, an organization that works with women living with HIV in seven provinces of the DRC.
Only one laboratory in the country is equipped to carry out polymerase chain reaction tests for early infant diagnosis. "When an HIV-positive mother has a baby in [the southern province of] Kasai-Occidental, the centre must send the sample to Kinshasa, the capital of DRC. Getting results back can take weeks, and these women often don't live near the health centre," Omari said.
According to 2011 government statistics, just 5.6 percent of HIV-positive pregnant Congolese women receive ARVs to prevent transmission of HIV to their babies, but the official estimate puts the mother-to-child transmission rate at 36.8 percent.
A nationwide shortage of life-prolonging antiretroviral (ARV) drugs after the closure of some HIV projects and reduced funding for others means Omari is often forced to negotiate with doctors for HIV-positive women to be accepted in local treatment programmes. "I have to plead with them to prioritize pregnant women when someone dies or drops out off treatment," she said.
"If you help someone to find out their HIV status, then you should have a way to treat them if they test HIV-positive, but today we can't give women that assurance," Omari noted. Dr John Ditekemena, country director of the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), says while the DRC has strong policies and strategies for fighting HIV, and for the prevention of mother-to-child transmission (PMTCT), a severe lack of resources means they cannot be fully implemented.
"A main problem is coverage - many pregnant women who are tested will not return to the same facility for delivery. The DRC is a huge country with very limited resources - human resources, logistics, problems with the supply chain coordination - and the disastrous situation of the health infrastructure mean we won't be able to reach the goal of eliminating mother-to-child transmission by 2015," he said.
Femme Plus's Omari noted that 'free' treatment was rarely completely free. "For example, the HIV test may be free, but you have to pay for the patient card, for the syringe they use if you need some treatment, for transport - the costs add up and few women can afford them," she said.
Mariam, in her 20s, was diagnosed with HIV while she was pregnant a year ago, but has not started on ARVs because she cannot afford the US$15 it costs to get a CD4 test, which measures immune strength. She has since had her baby but the child has not been tested for HIV.
Mariam's husband travelled to the southeastern city of Lubumbashi shortly before she was diagnosed and has not returned. She suspects he has left her and their children for good. To make ends meet, she sells plastic bags of drinking water on the streets of Kinshasa, the capital, but the money she makes is barely enough to feed her family, let alone pay for health care.
"I have not been tested and I think I am getting sick because I have noticed an itchy rash all over my arms recently," she told IRIN/PlusNews. "I have two other children who are healthy but the baby gets sick often - I am worried."
|If you help someone to find out their HIV status, then you should have a way to treat them if they test HIV-positive, but today we can't give women that assurance|
Ramping up PMTCT
EGPAF and its partners, under a project known as Projet Intégré de VIH/SIDA au Congo - Integrated HIV/AIDS Project (ProVIC) - supported by the US President's Emergency Plan for AIDS Relief (PEPFAR), are assisting 24 maternal health facilities in five provinces of the DRC. Separately but also funded by PEPFAR, EGPAF is supporting 53 sites in Kinshasa and 17 in Lubumbashi as part of the "Malamu" project - meaning 'good' in the local Lingala language - to accelerate the pace of PMTCT in the DRC.
"The idea is to have a network of sites where women can receive the full package of PMTCT services, which will help improve coverage," said Ditekemena, adding that the project was working to build up other areas of PMTCT such as male involvement and counselling on infant feeding.
"If you invite 100 women to the antenatal clinic with their husbands, only 10 or 12 will show up - we are extending the hours of service to allow men to come in after work or at the weekend," he added. "Mother and infant follow-up is difficult if she is not counselled properly, especially if she does not have a support system around her - spouse, family, community."
The ProVIC project aims to see 50,000 pregnant women tested for HIV and get their results in 2012, while the Malamu project aims to test 30,000 women.
"Slowly, step by step, we can increase coverage and improve the quality of care,” said EGPAF's Ditekemena. “Perhaps by 2019 we will have eliminated mother-to-child HIV transmission in the DRC."