Uganda adopts EMTCT intervention Option B+

Uganda has adopted a new policy called Option B+ for the elimination of mother to child transmission of HIV (EMTCT). According to the Ministry Of Health the new policy guidelines focus not only on eliminating HIV transmission mother to child, but also reducing mortality and morbidity among HIV positive women, and HIV exposed and infected infants. It was adopted from the WHO 2010 guidelines on use of ARVs in pregnant women irrespective of their CD4 count.

Option B+ has already been launched in some districts, prioritized according to HIV prevalence as well as prevention of mother to child transmission (PMTCT) population coverage. The national launch and campaign for EMTCT in Uganda was at Ntungamo District, Itojo Hospital grounds, under the theme ‘Stand Out, Participate, Protect and Have an HIV-Free Baby’.

The champion of this new intervention is the first lady of the Republic of Uganda Janet Museveni who advised couples to go together for HIV testing and for mothers to attend antenatal care four times and give birth in a health facility to guarantee that the baby is born HIV free.

According to the Minister of Health Christine Ondoa the results of the 2011 Uganda AIDS indicator survey indicate that 7.3 per cent of adults in Uganda are living with HIV and 0.6 per cent of children under age five are infected. About 1.3 million people are living with HIV, and an estimated 145,000 new infections are occurring each year. Of these, mother-to-child transmission contributes16,000 (11 per cent) of these new infections.

The Minister revealed that in 2012, 1.6 million pregnancies occurred and about 5.5 per cent of these expectant mothers were estimated to be living with HIV. This translated to 88,000 pregnant women whose babies were at risk of acquiring HIV. With an average transmission rate of 30 per cent, it was estimated that about 26,400 babies would get infected with HIV in 2012 alone through mother to child transmission without intervention. This explains the Ministry’s new effort through Option B+.
Option B+ differs from previous PMTCT policies in that all HIV pregnant women will be initiated on Option B+ irrespective of her CD4 count.

Members of People Living with HIV (PLHIV) Networks from Kigulu South Iganga District, shared experiences about their enrolment in previous PMTCT programmes (Option A and Option B) and welcomed the new guidelines under Option B+. Under previous programmes some of them still gave birth to HIV positive children and/or did not receive adequate information about PMTCT which resulted in poor adherence to treatment.
At the same time they noted that the Options A and B only sought to prevent the child from being infected, but now Option B+ will cater for the good health of the mother as well.

The challenge the participants foresaw in Option B+ was about adherence, because some mothers find it difficult to disclose their HIV sero status to their spouses and yet there is need for partner support to effectively promote Option B+. Therefore there is need for government to ensure that male involvement in PMTCT interventions are highly considered.

The Government’s elimination of mother to child transmission of HIV strategy involves reducing the risk of HIV transmission from an infected mother to her baby during pregnancy, labor, delivery and breastfeeding to less than 5 per cent nationally. It aims to reduce transmission of HIV from infected mothers to their children by 90 per cent by 2015.

In addition to reducing new infections in children, Option B+ offers some other benefits and these include:
•    Promotion of antiretroviral treatment for life for all HIV positive pregnant women
•    Reducing the number of orphans
•    Reducing transmission of HIV to the negative spouse in a discordant relationship
•    Improving adherence and treatment outcomes
•    Contributing towards achievement of MDG3, 4, 5 and 6

EMTCT services are provided in all hospitals, all health Centers IVs, most health center IIIs and 15 percent of health center IIs (these health centers are based rural community facilities that even those on a low income can access freely).

COMMENTS

WORDPRESS: 40
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    I can’t wait for us to have an HIV-free generation. I appeal to all mothers to test for HIV and those that turn positive to please adhere to ARVs and save our babies. This will make our dream of having an HIV-free generation a reality.

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    Ssenkirikimbe Williams 5 years

    TASO, the organisation I work for, has been implementing this and the main challenge is retention of those mothers who start treatment when they think it’s not yet time for them to start. I will be glad to hear from you.

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    Dorothy Babirye 5 years

    At my facility where I work, many positive mothers who have love for their children have embraced the policy and they are happy and adhering to treatment.

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    Thank you very much for appreciating the work we do as Key Correspondents and for the encouraging comments.

    Thanks

    Sarah

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    kibet fred 5 years

    The biggest challange of Option b+ is idetifying the mothers and the perception health workers have towards scaling from the old version to this new current policy.

    Truely speaking how can we move to the new option when we have not fully evaluated the previous option? Let us first evaluate the other option before just rolling on to the new one, i’m worried we may double the effect of failure.

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    Janet 5 years

    The old options were evaluated and found to be wanting! We have reduced MTCT very minimally and because inititaing treatment with a low CD4 count means the viral load is already high thus a high probability of transmitting it! Treatment would also be inititaed late when the mother coukld already be weak thus a risk of increased mortality. Also given that mothers visit Antenatal first when the pregnancy is already advanced, the probability of having already infected the child is high.
    The change of policy is because of all that was discovered. However, this change should be tackled together with aggressive methods of scouting for pregnant mothers in the communities so that they are enrolled in PMTCT otherwise the very ambitious target set for 2015 will not be met!

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    Thank you very much for following the posts on Key Correspondents website and giving good comments
    Sarah

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    Christopher Abaho 5 years

    Mayanja Memorial Hosp.Foundation has already started to implement this strategy reaching to hard to reach areas through training/Orienting the change Agents of the community(VHTs) in S.Western Districts of Uganda in partisanship with STAR-SW,MOH,Health facilities and the local gorverment levels.”Hopes never dry”

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    Then that’s good to hear Christopher

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    Mudagu Elijah 4 years

    Am glad that almost all health Facilities in Jinja, have warmly welcomed the Option B plus Strategy. THank u Sarah for that work well done. Your the people that Uganda needs, be blessed.

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    Thank you very much and appreciating work done by Key Correspondents.

    Thank you Elijah

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    Mugoda francis -TASO Uganda. 4 years

    Together we can have zero new HIV infection,zero death to children in Uganda.
    However, disclosure and Adherence are big issues as intervention road blocks that need aggressive intervention in order to achieve the MDG 3,4,5,and 6.

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    TABO KENNETH GUFFU-JINJA NURSING UGANDA 4 years

    I appeal to all the mothers in Uganda to take HIV testing as their FIRST priority during pregnancy in order to lead a safer lives for themselves and their children and be able to plan for a better HIV free Uganda.

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    Exactly this is the idea behind why we are writing these articles

    Thank you very much Kenneth for your response

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    DR. NDIBAREMA .R. ELIAS 4 years

    EMTCT is the only way to go to eliminate HIV by 2015 to realize millennium development goal number 6

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    Senteza Robert Augustine 4 years

    Great Work.Eligible facilities in Kibaale District have embraced the policy and are optimistic about its implementation following the training of the critical staff to help in services provision and capacity building among other staffs to create a really informed and thus a functional team. Though with pessimism about sustained availability of logistics, there is a feeling that there will be ardent need for full scale public sensitisation on eMTCT and the crucial male involvement. Let us have positive attitude towards the policy as service providers they actively get involved in implementing the policy. Hope we shall be there.Aluta continua. Sarah &team, bravo.

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    thank you Robbert

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    Judy Mbithe 4 years

    I support the decision that Uganda has made to incorporate this into their medical system.
    Kenya is yet to follow suit soon.

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    irene 4 years

    Am public health specialist from TZ as we are about to initiate option B+ in our country , I would like to get your experience on retention and adherence to care for option B+ women from your program. Do you have any strategies in place to address this.

    • comment-avatar

      Thank you Irene, yes we have. i will let you know if at all i get you email address.

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    Betty 4 years

    Sarah, this a nice article. where exactly can one access EMTCT services in Kampala?. which hospitals/clinic?

    • comment-avatar

      All government hospitals, this system has started working i.e Kawempe health center IV, Mulago referral hospital and other Kampala government hospitals Other wise thank you Betty for the appreciation and for reading articles that are posted on KC website

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    stephen 4 years

    If we do not empower and educate our medical service provide, it remains a paradox that after all these well intentioned and costly but free services, MTCT is still high. What is it that these mothers look for that can not be provided at Health facilities? Is this a cultural, social, economic or scientific dilemma?

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    Thank you Stephen

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    Dominic Lomurechu 4 years

    It should be a joint effort by every body to ensure that all pregnant mothers are tested for HIV in our Health facilities so that all our children in uganda are born HIV free for better uganda

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    zungu grace jesca 4 years

    Thanks so much for this information we need more on the results so far,thanks to NGO like STRIDES and PREFA for the suport in this srugle please continue
    we wait for more up date
    Zungu kangulumira health centre iv (BSN)

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    am making a follow up on this issue and very soon i will update you, other wise thank you Grace for your comment

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    Eunice Omaset 4 years

    To increase on efficiency of EMTCT community awareness need to be emphasized especially in the rural areas given that greater percentage of the population live there and most have no access to media like TV, news papers and radio that usually provide this information.The same rural population constitute the larger proportion of the national poor; hence can’t afford dry cells for radios and they are also illiterate to extract any thing from news paper, fliers nor billboards that are usually used. Need for unique approach to reach every one in all corners of the country with the information.

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    In Uganda they have the Health Village Teams and the People Living with HIV Networks at every parish
    or community level who work at the ground and they have at least done the best for the EMTCT because both parents have managed to understand the issue of protecting the unborn child from HIV. Thank you Eunice for your comment.

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    korobe fontiano 4 years

    We are privileged with this move, there is still much to be done on the side of sensitization at rural levels about Hospital delivery.

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    Tibamanya Timothy 3 years

    1. i would like to know how many districts are implementing this program so far?
    2. what is our target by the year 2015?
    3. have you tried to find out if there has been any barrier to this program since its initiation?
    thanks very much ,hoping for a reply soon.

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    Tibamanya Timothy 3 years

    also i cama across a publication of a focus group discussion that looked at understanding perspectives of pregnant women on option b+ conducted in uganda and malawi. am requeting if you have a copy send me one on ma email and i read (ttibamanya@gmail.com) thank you.

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    sarah kamya 3 years

    sarah this is a nice comment but there is achallange of mothers who refuse to take drugs who opt to go for prayers.
    others do not adhere.

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    tibamanya 3 years

    sara i wd like to inquire from you if option b+ has been evaluated so far and if so i wd like to read thru da document and be uptodate with the programm since am one of the people implementing the program bt in health facility,thanks.

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    Dear Readers of my article i would like to thank you for all the comments, corrections and concerns, here is the link for the success of OPTION B+

    This is the latest “HIV and AIDS UGANDA COUNTRY PROGRESS REPORT 2013 revised 31st March 2014” and released in August 2014 kindly follow the Link and down load it. i will send it to your personal emails if i happen to have them. I would like to Thank my Editor Sarah Oughton for the support and all the KCs thanks

    http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2014countries/UGA_narrative_report_2014.pdf

    Thank you

    Sarah

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    Kibirige Leonard 3 years

    I Have Found This Information Very Helpful Am Updated My Knowledge.

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    Grace 2 years

    The trend of reduction of MTCT is really positive and as a country, Option B+ is working.
    However, it meets some challenges especially in the rural areas like;

    1. Poor retention due to long distances from facilities and lack of aggressive male involvement.
    2. Poor male involvement also affects the test and treat strategy since some mothers deny ART with excuse of first informing their spouses and return for ART.
    3. Some mothers still don’t have the MCH seeking behaviours so they only report late after delivery with TBAs.