Health programmes integrating services for the prevention of mother-to-child transmission (PMTCT) of HIV into regular maternal, newborn and child health (MNCH) clinics, rather than operating PMTCT services as stand-along programmes, are showing positive results in Kenya, experts say.
In western Kenya's rural district of Ndhiwa, where 17 out of 26 health facilities started to integrate PMTCT and MNCH in May 2010, mother-to-child HIV transmission has dropped from 11 percent to under four percent.
Traditionally, Kenya's public hospitals have managed HIV cases through Comprehensive Care Centres (CCC); women diagnosed with HIV in the regular MNCH clinics were referred to and then handled separately by the CCC.
"In 2010, transmission rates here were too high because mothers were dropping out of the comprehensive care centres. Many were either finding it too stigmatizing or were just bogged down by having to seek services at different points within a single health facility. As a result, children who would have been helped through an efficient system simply got infected with HIV or failed to get treatment," Justus Ojwang, Ndhiwa District AIDS and sexually transmitted infections coordinator, told IRIN/PlusNews.
"One of the ways to ensure that mother-to-child transmission can be eliminated is to have mothers come to health facilities both before and after delivery. But when you have a PMTCT programme that is isolated, many mothers tend to shy away and shun health facilities," he added.
The government is now moving towards the integration of HIV and other public health services, part of efforts to strengthen the overall health system.
Loss to follow-up
Kenya, which began implementing PMTCT programmes in 2002, has committed itself to the elimination of mother-to-child HIV transmission by 2015.
|One of the ways to ensure that mother-to-child transmission can be eliminated is to have mothers come to health facilities both before and after delivery. But when you have a PMTCT programme that is isolated, many mothers tend to shy away and shun health facilities|
Some 13,000 Kenyan children contract HIV annually; the country is among some 22 nations accounting for 90 percent of all pregnant women living with HIV. HIV accounts for 20 percent of maternal mortality in Kenya, according to the National AIDS and Sexually transmitted infections Control Programme (NASCOP).
Losing the participation of mothers and children after treatment initiation, known as “loss to follow-up”, remains one of the biggest challenges to the country’s efforts to end vertical transmission of HIV.
According to the Ministry of Health, only 63 percent of infants exposed to HIV receive ARV prophylaxis, and just 35 percent receive an HIV test six weeks after birth.
But the integration of care could improve these numbers. A September 2012 study published in the Journal of Acquired Immune Deficiency Syndromes, revealed that infants exposed to HIV were more likely to attend follow-up visits if they were enrolled in MNCH centres than if they attended CCCs. For infants enrolled within MNCH, 53.6 percent attended all the four recommended visits, compared to just 35 percent of those enrolled in CCCs.
"Other than reducing stigma, children who are enrolled in the MNCH model are able to get all vaccinations that they need in time, and it also saves mothers the agony of having to move from one place to another to get different services," John Ongech, head of research at the Elizabeth Glaser Paediatric AIDS Foundation, told IRIN/PlusNews.
Ongech says that although integration had worked well in poor districts with limited health personnel and infrastructure, "this doesn't give an excuse not to invest in [additional] health system strengthening".