A Mother’s perspective on integrating PMTCT of HIV with Maternal Newborn & Child Health Services

Felicia discovered she was HIV positive in 2013 during a provider initiated testing and counseling (PITC) session at DH Udi, Enugu state. All her hopes and aspirations for her unborn child became a misery. She could not help the incessant feelings of guilt as she realized the child in her womb could not only be infected, but die during pregnancy, delivery, or while breastfeeding as a consequence of mother-to-child transmission (MTCT). “I for remove the pikin because of fear”, she explained in Pidgin English.

The healthcare workers (HCWs) at Udi district hospital, a LOCATE comprehensive care and treatment supported (CCT) site in Enugu state informed her on the effectiveness of triple-antiretroviral (ARV) prophylaxis in preventing MTCT of HIV. This regimen which consist of 3 ARVs-Tenofovir (TDF), Lamivudine, and Efavirenz (Efv) maximally suppresses viral load, and can reduce the MTCT rate to as low as 2% even with exclusive breastfeeding up to 6 months of age.

Felicia’s hope came alive as she does not need to worry about stigma (from neighbors due to lack of breast feeding) and the cost for ARV, which could outweigh the average monthly income of most families in Nigeria (about $115); since the Center for Disease Control and prevention (CDC) through the LOCATE project, supports free provision of triple ARV regimen at Udi district hospital

The then parallel systems of HIV service provision and antenatal clinic (ANC) services meant that Felicia visits the hospital at least twice monthly. Her monthly visit to the ANC had a number of implications and she could not imagine going through such twice monthly:

  • The cost of transportation of about N800 ($5) monthly
  •  Long client waiting time of about 4 to 5 hours at the HIV clinic,
  •   She forfeits  an average of N320 ($2) from her soft drink and sachet (pure) water business for the day
  • Exhaustion coupled with the stress of pregnancy was daunting

As a result, Felicia maintained her ARV pick-ups at the expense of ANC. However, with the advent of the LOCATE project, the two services traditionally provided separately- Maternal Newborn and Child Health (MNCH) and prevention of mother-to-child transmission of HIV (PMTCT), were integrated. Consequently, Felicia has access to quality ANC as well as PMTCT services at ‘one stop shop’-the ANC.

As she narrates her story, she now spends about 30minutes to 1 hour monthly to access the two services at no extra cost! This eliminates exhaustion and affords her time to still sell soft drinks and sachet (pure) water for the day. She no longer feels like an ‘outcast’. Instead she feels more at home and a sense of wellness with other pregnant women at ANC. Expressing herself in pidgin English with a smile, she says, “I no get money to give una, but I deh ready to encourage other women. Abi you no see how I deh shine? I know say my pikin too, go shine when I born am!

Indeed, Felicia’s blessings are beyond the World Health Organization (WHO) target of PMTCT/MNCH integration aimed at ensuring appropriate follow up and therapeutic adherence (WHO 2009; WHO 2010).

 

7 month pregnant Felicia smiles as she counts her blessings