Preventing mother-to-child transmission of HIV in Swaziland
Sibongile Dlamini and her children Sipho (8 years) and Nomsa1 (2 years) live in the rural area of Sithobela in eastern Swaziland. Sibongile is HIV-positive. She was 28 weeks pregnant with Nomsa when she went for her first antenatal check-up. Like all women who go for antenatal care in Swaziland, she was offered counselling and testing for HIV. When Sibongile tested positive, she enrolled in the government programme for the prevention of mother-to-child transmission (PMTCT), where she got antiretroviral drugs to block transmission of the virus to her baby. She also had support from mothers2mothers (m2m), a civil society group that provides counselling to HIV-positive pregnant women enrolled in PMTCT programmes, helps them with disclosure, and works to eliminate stigma.
“When I went for antenatal care, I consented to be tested for HIV. To my surprise, I tested positive. It was not easy to accept that I am living with HIV. I cried a lot and I could not tell anyone for some time. I was started on PMTCT medication which I took faithfully and I delivered a baby girl who was also started on medication which I also administered religiously. She tested negative at 6 weeks and I was thrilled”, Sibongile related.
Prevention of mother-to-child transmission: a priority
Antenatal care is almost universally available in Swaziland, with 98% of pregnant women attending these services at least once. The rate of childbirths attended by skilled personnel in the country is also high, with 82% of women delivering in health facilities. Skilled birth attendance is important for the health of the mother and baby, especially when the mother is HIV-positive.
About 41% of pregnant women in Swaziland are infected with HIV, and they give birth to over 17 000 HIV-exposed infants each year. In response to this situation, the Government of Swaziland has made the prevention of mother-to-child transmission of HIV a top priority.
Launching the programme
Swaziland’s PMTCT programme was officially launched in 2003, with support from WHO, UNICEF, the Elizabeth Glaser Pediatric AIDS Foundation and other partners. At that time, and up to now, WHO’s country office has provided technical support to the Ministry of Health by adapting global guidelines to local needs, developing training materials, training health providers and strengthening systems for their supervision and mentoring, and working with communities to boost demand for services. From an initial three pilot sites in 2003, the national PMTCT programme grew to 150 sites by 2010.
Progress towards reducing transmission
Swaziland has made commendable progress in recent years. PMTCT services are integrated within maternal, newborn and child health services to ensure that they identify and care for as many HIV-positive women and children as possible. Based on WHO’s 2010 guidelines on the use of antiretrovirals for treating pregnant women and preventing HIV infection in infants, the country has made more effective drug regimens available that reduce the risk of mother-to-child transmission to less than 5%. In addition, all HIV-exposed infants are tested at six weeks of age.
Elimination the goal
“We are now aiming to eliminate HIV infections among children by 2015 and improve survival and health of their mothers”, said Dr Simon Zwane, Director of Health Services at the Swazi Ministry of Health.
With support from WHO and other partners, community-based activities are being rolled out in all regions of the country to improve awareness, access and uptake of maternal, newborn and child health services.
Mobilization activities include door-to-door visits to families to educate them about PMTCT, community dialogues, information distribution, and other HIV prevention services. This is especially important for reaching families in rural areas like Sithobela, as three-quarters of the Swazi population lives outside cities.
Provider-initiated HIV testing and counselling was introduced in Swaziland in 2006. Today, every woman who goes for antenatal care is encouraged to do a test for HIV early in her pregnancy and retest every two months, in line with WHO guidelines. Currently, more than 90% of pregnant women in public health facilities receive counselling and testing.
“WHO will continue to support the Ministry of Health to improve maternal, newborn and child health services, especially PMTCT’’ said Dr. Owen Kaluwa, the WHO Representative to Swaziland.
“I am really thankful to PMTCT and the M2M support groups because I now have a healthy, HIV-negative baby and I feel comfortable that I know my HIV status,” said Sibongile who continues to have access to free antiretroviral drugs and is happily raising Nomsa and Sipho.
1 Names have been changed.