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Whither Nigeria in elimination of mother-to-child HIV transmission?

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By Sola Ogundipe

LAST week , the World Health Organisation, WHO, validated Cuba as the first country on earth to eliminate Mother-to-Child-Transmision of HIV, eMTCT, and syphilis.  WHO Director-General. Dr Margaret Chan, who recognised that the elimination of transmission of a virus is one of the greatest public health achievements possible, described the feat as a major victory in the long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation.


•Stella Ibianujulu Ebelu (3rd right) with family. She is living with HIV but gave birth to five healthy, HIV-free children through the PMTCT initiative.
•Stella Ibianujulu Ebelu (3rd right) with family. She is living with HIV but gave birth to five healthy, HIV-free children through the PMTCT initiative.

Experts say what this translates into is that ending the AIDS epidemic is possible and Cuba is the first of many countries expected to seek validation that they have ended the HIV epidemic among their children.

As treatment for prevention of mother-to-child-transmission is not 100 percent effective, elimination of transmission is defined as a reduction of transmission to such a low level that it no longer constitutes a public health problem.
From the WHO perspective, the term “validation” is used to attest that a country has successfully met criteria (internationally set targets for validation) for eliminating MTCT of HIV and/or syphilis at a specific point in time, but countries are required to maintain ongoing programmes.

Progress in Nigeria Observers of the progress of the HIV response in Nigeria over the last decade or thereabouts are asking what lessons for the National AIDS Control Agency, NACA, and other Nigerian agencies tasked with the role of ensuring Nigeria meets the relevant criteria for validation as a country that has eliminated HIV transmission from mother-to-child?  In the view of the Director General of NACA, Prof. John Idoko, the lesson is quite clear.
Quoting the WHO report, Idoko reiterates: “Cuba’s success demonstrates that universal access and universal health coverage including Prevention and elimination of mother-to-child transmission of HIV, are feasible and key to success even against challenge as daunting as HIV.”
Further, Idoko stresse that the implications of the Cuban feat for eMTCT and syphylis prevention and control efforts for the rest of the world and Nigeria in particular, are that if countries put in the right strategies driven by science and evidence and fully fund the programmes, it is feasible to eliminate mother-to-child transmission of HIV and syphilis.
“A number of heavily burdened countries are already making significant progress. However, every country needs to be looked at differently in terms of the population, the cultural and social issues, the health infrastructure, the human resources available and the education and economy of the country.”
To reach the goals of total elimination, Idoko argues that process indicators show that more than 95 percent of pregnant women are attending antenatal care; more than 95 percent must know their HIV status and more than 95 percent HIV positive pregnant women are receiving antiretroviral drugs.
“One can therefore see why funding, the health and human infrastructure become most essential. Idoko asserts that Nigeria could hope to achieve elimination of mother-to-child transmission of HIV and syphilis and obtain a WHO/PAHO validation just like Cuba. “In the last five years, Nigeria has made significant progress in prevention of mother-to-child transmission of HIV, more so in the last three years that consciously we have used data and science to drive the PMTCT response.
“For example in 2012, there were 1410 PMTCT sites, 1.2 million pregnant women tested and collected their HIV test results and 40,000 HIV positive women received antiretroviral drugs compared to 2014 where there were 6,533 PMTCT sites, over three million pregnant women tested for HIV and collected results and 63,000 HIV positive pregnant women received antiretroviral drugs.”
As Nigeria moves towards option B+, even better results are expected in the elimination of mother-to-child HIV transmission. As for syphilis, the DG notes that even though routine testing is recommended in the various guidelines, the service is very poorly offered and the country needs to do better in this area.

“Nigeria needs to improve it’s health infrastructure to guarantee universal access to health and coverage. We need to fund health services adequately including MNCH, HIV, TB and malaria.  “We need to train and retain human resources for health and ensue our programmes are driven by science through operation research and implementation science.

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