In 2015, Nigeria recorded the 2nd largest HIV epidemic in the world and the largest number of new HIV infections among children globally. In 2016-2017, only 34.8 percent of Nigerian women were tested for HIV and knew their status. An infant born with HIV is less likely to die from from an AIDS related illness if given antiretroviral therapy (ART) within the first 12 weeks of life. But a challenge of preventing Mother-to-Child-Transmission of HIV in Nigeria is unavailability of well-equipped medical centres where pregnant mothers can be screened. The Director, Scientific and Medical Affairs for Africa, Abbott, Dr. Kuku Appiah, tells Victoria Ojeme how Abbott is addressing this problem. Excerpts:
In Nigeria currently, only 24 percent of babies born to HIV positive mothers are screened to know their status whereas in other countries, up to 70 – 80 percent of babies born to HIV positive mothers are screened.
Focus on newborns
So the m-PIMA HIV1/2 Detect introduced by Abbott is focused on newborns so that a baby born with HIV can start receiving treatment from birth. That makes a huge difference in their lifespan. Children born with HIV, without treatment more than half will die in the first year.
Focus is on newborns because we know the importance of the prevention of HIV transmission from mother to child and there is a time issue. Once a child is born to a woman that is living with HIV, it is important to know if that child is actually HIV positive because thinfected, but normal HIV screen tests do not work for a newborn.
m-PIMA HIV Detect concept
The m-PIMA is a point of care technology; it is a miniaturized form of laboratory system that is able to be used at the point of care without a central laboratory. The testing can be done within an hour and the result obtained.
This is an innovation in healthcare which has improved patient care specifically with m-PIMA to assist countries reach their goal for HIV elimination.
The box is portable and it has a battery so a healthcare worker can move around with it to test the women. It can also be used in a very remote clinic, even though women give birth at home there is a time when they will come with their babies in the first few weeks and if that device is present, the nurse doesn’t need a laboratory technician to operate it and give the result immediately after the test is conducted.
The whole point of this technology is geared towards people that are out of the hospital setting, not in the urban areas. One main challenge is that once a woman gives birth, if she has to come to the clinic and have the sample taken and that has to be sent to a central testing facility, she might not come back and get the result, but with the m-PIMA, point of care technology she will be able to get the result the same day and know before the leaves the clinic whether her child is HIV positive or not.
Currently Abbott manufacturers of one of the largest, most frequently used HIV test kits in Nigeria. It is called Determine Test and that is on the national testing algorithm for all Nigerians and it is procured in large numbers by the Nigerian government.
Apart from that, we have malaria test, syphilis test and we have other devices that are used in the laboratory in the health sector. Abbott is one of the largest companies globally. We introduced everything into the country based on the regulatory approval of the government. So we are engaged constantly with the Nigeria government to profile our port folio of products.
No baby should be born with HIV
For me, personally, I would not want any child to be born with HIV, I want every pregnant woman to be tested for HIV.
If the mother and newborn are HIV positive, I want each one of them to be on treatment and I don’t want this to be something that is only for people that are in urban areas or the wealthy.
I would want every child and every mother to have the same opportunity, that is where my belief aligns with the company’s belief, it’s for everybody. Nobody should be left behind.
Countries need to fast track their activities so that they would reach the target for 2030 because it is time bound time, it is time sensitive and so we have to constantly engage with the government to make sure that we can get our product and our message through to them.
Compliance with 90-90-90 objective
What has been set out byUNAIDS and which all countries have sign up to and it’s the strategic plan that is going to lead to elimination of AIDS, at least 90 percent of people who are living with HIV should know their status that include babies, mothers should know their status everybody who is at risk of being HIVpositive should know their status.
Of the people who have been tested and know their status and are HIV positive, then it is test and treat. Previously we had situation when you are diagnosed HIV positive you were told to come back but right now as you are diagnosed you start on Antiretroviral treatment.
So 90 percent of people who are HIV positive should be on treatment and the last 90 is to make sure the treatment is effective because if the treatment is effective and if people have undetectable viral load then the HIV will not be transmitted.
The person with undetectable viral load cannot transmit HIV, so if we want to stop HIV transmission, we have to make sure that at least 90 percent of people that are on treatment have got undetectable viral load.
“The m-PIMA HIV Detect is able tell us whether a newborn is HIV positive or not. If positive, treatment begins immediately, and if negative the mother must do all she can to ensure that the child does not become positive.
In terms of the third 90, Nigeria is only at 24 percent, so the gap is between 24 and 90. Other countries like Botswana and Namibia and the former Swaziland they have already achieved their all three 90’s; so there is a huge gap for Nigeria. And a third of all HIV positive infants are being born in Nigeria globally.
We are speaking to the government and other agencies that look at the HIV initiative. We don’t sell the device on an individual basis; we look to implementers that will buy the devices, anybody who is working on the HIV field is open to buy our technology and they will be the ones to use it in the different settings.
Internally displaces persons are very vulnerable, they are people that would need to be routinely tested and the women in those camps are also giving birth and they also require ARV, they require to know their status, so that definitely will be a good one to the relevant people.