Masvingo records success in Elimination of Mother to Child Transmission (eMTCT) – Target, Accelerate and Sustain Program (TASQC) reaching out to pregnant women.

Picture 1: Shelter Pangure and family

Worldwide there are over 1.7 million children (0-15 years) living with HIV. According to UNAIDS, in 2020, 150 000 new infections were among children. Mother-to-child transmission (MTCT) of HIV accounts for 9% of all new infections globally. In Zimbabwe, the MTCT rate is at 8.9%. To eliminate MTCT of HIV, the Ministry of Health and Child Care has developed the Elimination of Mother to Child Transmission Plan (2018-2022) which aims to have a MTCT Rate of less than 5%, and reduction of new infection among children to less than 250 / 100,000 live births.

With support from PEPFAR through USAID Zimbabwe, JF Kapnek Zimbabwe in partnership with OPHID (Organisation for Public Health Interventions and Development) is implementing the Target, Accelerate and Sustain Quality Care for HIV epidemic control (TASQC) program in 4 provinces.  OPHID is a technical partner of the Ministry of Health and Child Care. The program also works in partnership Zimbabwe National Network of people living with HIV ZNNP+ with an aim to contribute to the achievement and sustainability of HIV epidemic control in Zimbabwe.

In Masvingo the TASQC program supports MOHCC to implement the eMTCT plan aimed on making sure pregnant and breastfeeding women (PBFW) are on ART and virally supressed thus reducing the chances of transmission of HIV to the child. During the pregnancy and breastfeeding period, women receive more intensive viral load monitoring than the ‘general population’. For women already on ART they get a viral load done when they book and if the load comes back target not detectable or with a viral load of less than 50 copies/ml they are virologically suppressed and they get the viral load test done every 6 months until they stop breastfeeding when they go back to the general population period of getting a viral load annually.

For women newly diagnosed in antenatal care and starting antiretroviral therapy (ART) they get their first viral load at 3 months after initiation (as opposed to 6 months in the general population), then at 6 months after initiation and then every 6 months until the end of the breastfeeding period if they are virally suppressed. For those who have a high viral load (greater than 50 copies/ml) they get intensified counselling sessions, and the viral load is repeated in one month from receipt of results. All this is done to ensure any episodes of a high viral load are quickly identified as these put the baby at risk of acquiring the HIV infection. Mothers who are virally suppressed can not transmit the virus to their unborn or breastfeeding babies, a message summarised as undetectable= untransmissible (U=U).

In Masvingo province during FY22Q1 and Q2 in the 6 districts supported by JF Kapnek Zimbabwe, the ART coverage among pregnant women was 99% and the viral suppression rate among PBFW was at 97%. The positivity rate for exposed infants in FY22Q2 was 2%.

The eMTCT programme requires mothers and their babies to receive antenatal and postnatal services during pregnancy and breastfeeding and have access to antiretroviral treatment (ART). They are encouraged to deliver in hospital so that adequate measures can be implemented to reduce the risk of transmission to the infant. These include ensuring that the woman’s ‘waters’ have not ruptured for too long before she delivers and use of caesarean delivery. After delivery mothers are encouraged to breastfeed their infants irrespective of their HIV positive status and to give the child only breastmilk until at least 6 months when they can then introduce solid foods. They are encouraged to continue breastfeeding up to 24 months of age and beyond. Early introduction of other foods is associated with a higher possibility of the baby being infected. In mothers who do not want to breastfeed education is provided on the safe preparation and administration of supplements. The effectiveness of ART is monitored during pregnancy by checking the viral load (the amount of virus in an infected mother’s blood) as previously described. Babies are tested for HIV at birth, 6 weeks, 9 months and at 18 months or 3 months after cessation of breastfeeding whichever is later. All babies are put on HIV preventive treatment for the first 6 to 12 weeks and on cotrimoxazole preventive therapy until the mother stops breastfeeding.

The journey of Shelter – one of the beneficiaries of the eMTCT Shelter Pangure from Masvingo District.

Shelter is a 38-year-old mother of 5 children and lives in Victoria Range in the city of Masvingo. To sustain a living both Shelter and her husband are vendors. Shelter has been on ART for 14 years. At the time she was tested Shelter had one child and she was 5 months pregnant. So, she was enrolled for PMTCT in September 2008. She gave birth in January 2009. The baby was given 10mg of Nevirapine syrup and Zidovudine once daily. When the baby was 6 weeks to 12 weeks, he got prophylaxis -20mg of Nevirapine once daily. Shelter exclusively breastfed the baby for 6 months and introduced complementary feeding thereafter. The baby tested HIV negative at 24 months old.

Shelter got pregnant again in 2013 when both she and her husband were on ARV Treatment, and they were adherent to their therapy. By then viral load monitoring was not being routinely done in the ART program. Throughout the pregnancy, both parents continued to take their ARVs, and Shelter attended the required antenatal visits. Shelter then gave birth to another baby boy at Masvingo General Hospital in November 2013.

Shelter breastfed her child for 9 months, and this child got their prophylaxis and was tested for HIV according the MOHCC algorithm at birth, 6 weeks, 9 months and at weaning. After weaning from breastmilk, the baby then tested negative. From this evidence of effectiveness of eMTCT, Shelter got pregnant again in 2017 and the baby tested HIV Negative after being weaned from breastmilk. In December 2021, Shelter had another baby boy, he tested HIV Negative at birth and 6 weeks and now awaits another test at 9 months and after being weaned from breastfeeding.

When asked what measures she took to ensure that she gives birth to HIV negative children, Shelter said,

“I listened to the teachings that the nurses taught us, and I took my medication on time. I had my viral load constantly checked and made sure the babies got their medication and practiced exclusive breastfeeding for 6 months”.

Sister Junica Maturure a registered general nurse and Midwife at the provincial hospital was happy about the successful elimination of MTCT. She said Shelter was just one of the many cases of how successful the programme has been. Of the 2 401 women were booked for antenatal care in Masvingo District in Quarter 2 of programme year, 144 knew their HIV positive status while 61 were newly tested and initiated on ART. For these 144 women, they are receiving the same services as Shelter and through the committed efforts of health care workers like Sister Maturure, we continue to strive towards the goals of the Zimbabwe eMTCT strategy. That is having a MTCT rate of less than 5%, and reduction of new infection among children to less than 250 / 100,000 live births.

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