WHAT is the prevention of mother-to-child transmission of HIV, and why is it still important in Nigeria?
Prevention of mother-to-child transmission of HIV, or PMTCT, is a set of interventions aimed at preventing HIV transmission from an HIV-positive mother to her baby during pregnancy, labour, delivery, and breastfeeding. Once we understand this, the key question becomes: what exactly are we preventing? Without these interventions, a woman has up to a 45 per cent risk of transmitting HIV to her unborn child. However, the good news is that with proper intervention, this risk can be reduced to less than 2 per cent. A significant number of infections can be prevented. It’s important to note that infants who acquire HIV from their mothers have less than a 50 per cent chance of celebrating their second birthday. It’s a killer disease.
It is critically important that the government continues to prioritize PMTCT and focus on it so we can reach a point where mother-to-child transmission of HIV is no longer a public health issue. This is essential if we are to achieve an HIV-free generation by 2030. Nigeria alone contributes 22,000 new infections annually. This is alarming, making Nigeria one of the countries with the highest rates of mother-to-child HIV transmission. To be effective, PMTCT services must be made available across communities so that pregnant women can access care and achieve viral suppression. When HIV-positive pregnant women take their medication, their viral load drops significantly, and once it becomes undetectable, the risk of transmission to the unborn child is almost eliminated. As the saying goes, U = U – Undetectable equals Untransmittable.
What is CDC doing to support Nigeria’s efforts to prevent mother-to-child transmission of HIV, and why is this support important?
The U.S. Centres for Disease Control and Prevention has been at the forefront of efforts to prevent mother-to-child transmission in Nigeria. We provide both technical and financial support to the government to enable an effective response. Our support includes the procurement of ARVs and ensuring they are available in supported hospitals. CDC currently supports 1,204 health facilities across 18 states. Out of the 2,410 total PMTCT centres in Nigeria, CDC supports nearly 50 per cent through our implementing partners.
We offer a range of services, including HIV testing, which is the first step in prevention. We’ve also built the capacity of healthcare workers to provide ethical and safe PMTCT services to women in need. We provide essential supplies and support policy development to ensure services meet international standards. We also offer infrastructural support to health facilities, including basic tools such as weighing scales for adults and children, as well as monitoring tools to track women enrolled in the programme over time. Since women may have repeated pregnancies in the course of their reproductive years, we ensure continuity of care by tracking their progress across visits.
Is CDC’s support making a difference in closing the gaps in Nigeria’s PMTCT programme?
What challenges remain, and how can Through our partners, CDC provides extensive data management support, from field-level data collection to digital documentation. We’ve also introduced electronic platforms to transition from paper-based systems to digital records. We conduct periodic evaluations to assess impact. For example, between September 30, 2023, and October 1, 2024, we screened about 20,000 HIV-exposed infants. Only 19 tested positive, representing less than 1 per cent, compared to the 45 per cent risk without intervention. This means we averted HIV infection in nearly 9,000 infants – a clear indicator of our impact. Those give us feedback on what’s happening in the field and help us to address issues that may impede women from accessing services.
However, challenges remain. One major issue is access to services. According to the NDHS 2024, only 63 per cent of women attend ANC at least once during pregnancy. The remaining 37 per cent seek care elsewhere at traditional birth attendants or faith homes or even deliver at home or in the bush. These women significantly contribute to maternal and infant mortality over time. To address this, we’ve taken services to them in the community. One strategy is the Baby Shower Initiative, which brings HIV services to faith-based gatherings where pregnant women gather to care for their pregnancy and provide HIV services along with it.
How can communities and key stakeholders help women-especially those who are pregnant or planning to have children-access PMTCT services?
Ownership is critical, and it starts at the community level. There are key players within every community, and any public health intervention or program that lacks community context is likely to fail. Our programmes have adopted strategies that prioritise community involvement. We begin with community leaders, engaging them as advocates. They help mobilize and sensitise the community about the benefits of PMTCT and the importance of women taking ownership of their health. These leaders encourage women to attend antenatal clinics rather than deliver at home or in informal settings. Beyond leaders, we also involve local community members in designing programs that are tailored to the specific needs of each community. What is acceptable in one community may not be in another, so we ensure our training curricula and delivery programs are culturally sensitive and context specific.
Pregnant women themselves are vital members of the community and should also serve as advocates. They can share information about PMTCT with other women, whether pregnant or raising children, and guide them on where to seek help. We also identify and train community members who can serve as mobilisers and peer educators, helping women access services.
The government plays a crucial role in policy development and revision, creating an enabling environment for women to access care. In some cases, challenges like security issues or natural disasters, like the flooding in Rivers State, can hinder access. In such instances, government support has enabled us to reach affected communities, even across floodwaters, to continue service delivery.
When should pregnant women living with HIV start antiretroviral treatment, and why is early treatment important?
In the early days of HIV programmes, there were strict criteria for determining who should start medication. Today, science has shown the benefits of early initiation of treatment. This is why we now follow the ‘Test and Start’ approach: as soon as a pregnant woman tests positive for HIV, it is important she starts medication immediately, unless there is a medical contraindication. Starting treatment early helps prevent frequent illness. Without treatment, HIV weakens the immune system over time, leading to opportunistic infections and progression to AIDS.
Early treatment helps prevent complications such as tuberculosis, oral thrush, Kaposi’s sarcoma, and organ damage. It also reduces the risk of transmission to partners and babies, as it leads to viral suppression. When a person’s viral load becomes undetectable, it means the virus is still present but cannot be transmitted. This is the basis of the message: U = U – Undetectable equals Untransmittable. At the community level, early identification and treatment help stop transmission. At the individual level, it ensures people stay healthy and live longer, fuller lives.
What steps can women take to protect themselves and their babies from HIV during pregnancy and childbirth?
Women of reproductive age and especially pregnant women should get tested for HIV during every pregnancy with appropriate counselling. If a woman tests positive, then steps need to be taken; she needs to commence ART – antiretroviral therapy – immediately. Women living with HIV should discuss family planning options with their healthcare provider and partner. Unplanned pregnancies should be avoided to ensure proper care and monitoring. Pregnant women should attend antenatal clinics and avoid delivering at home or in the bush or on the farm. Regular viral load testing is essential to monitor treatment effectiveness. After delivery, babies should be brought in for early infant diagnosis to ensure timely intervention if needed.
After birth, the baby also needs to have some medications, which we call ARVs, to prevent HIV transmission. These medications are essential in ensuring the baby remains HIV-free. We take further steps to ensure the baby is protected until they reach what is called a ‘final outcome’, the point at which the baby can be officially discharged and declared HIV-negative. All 1,204 health facilities we support offer free services from start to finish.
There are specific times when medications should be taken, and it’s important for mothers to adhere to the schedule and attend hospital visits for monitoring, including viral load testing. This helps track progress and detects any issues early. If they experience any side effects-such as rashes or vomiting-they should report to the hospital immediately. Healthcare workers can help them manage these effects and stay on treatment.
What can be done to help pregnant and breastfeeding women stay in care and stick to their HIV treatment?
Healthcare workers need to be very sensitive to the needs of these women, be empathetic with their condition, and non-judgmental in their approach. Once they come into the service, they should ensure that the correct testing is done, which is free. If they are HIV-positive, they should commence medication as early as possible, and they should adhere to their medications. There are times when the medications should be taken; they should stick to it, and they should come into the hospital for monitoring by way of giving their blood for viral load monitoring so that healthcare workers can monitor their progress.
Joining a support group is also highly beneficial. These groups consist of women living with HIV who have gone through pregnancy and PMTCT. Sharing experiences helps reduce stigma, provide emotional support, and encourage consistent clinic attendance and adherence to treatment. After delivery, it’s crucial that the baby receives appropriate follow-up care. Once the baby is discharged, the mother must continue her HIV treatment for life. As of now, HIV treatment is lifelong, even after childbirth. Having a baby does not mean the mother is cured. She must return to the facility where she began treatment to continue receiving care.
Fortunately, treatment has become simpler. Instead of taking multiple pills, most patients now take a single fixed-dose combination tablet that contains three drugs. This makes adherence easier and improves quality of life. These medications are also safe and effective.
How can PMTCT services be better integrated into maternal and child health care to improve outcomes for mothers and babies?
We aim to make the programme as simple and sustainable as possible so that the government can take full ownership. On the policy side, we’ve worked to ensure that HIV services are integrated with maternal, newborn, and child health (MNCH) services. This means that at HIV service points, MNCH services should also be available, and at MNCH service points, HIV services should be provided.
This policy integration already exists within the government framework. Beyond policy, we ensure that healthcare workers are trained and capable of delivering integrated services. We also ensure that commodity supplies are available at all service points. A major achievement has been the integration of HIV services into the Maternal, Newborn, and Child Health Week, which takes place twice a year. During this week, mothers and children under five receive a range of healthcare services at the community level. Now, HIV testing is part of this package. As healthcare workers go into communities, they not only provide general health services but also offer HIV testing and linkage to care for those who test positive.
Our approach brings together policy, technical support, and service delivery. We are breaking down silos and building a comprehensive, community-centred system that ensures no woman or child is left behind.