World Health Organisation (WHO) and Uganda Ministry of Health (MOH) recommend Nevirapine (NVP) Prophylaxis at birth for all HIV Exposed Infants (HEIs). However, at TASO-Mbale, only 50% (5/10) of the HEIs had received the NVP within 72 hours of birth. A follow up revealed that whereas mothers were receiving antenatal care services at TASO Mbale, when it came to delivery, they went to public or private health facilities that lacked NVP supplies. This is common for most health facilities that provide antiretroviral therapy but lack maternal and child health care services like delivery.
With a new initiative from TASO Mbale, one of the UPMB USAID-Local Service Delivery for HIV and AIDS Activity (LSDA) supported facilities, the team came up with an innovation to prepare mothers with NVP for their new born babies. “We looked at several interventions which included; cohorting mothers by age of pregnancy and Expected Delivery Date for tracking purposes; routine health talks about benefits of elimination of Mother to Child Transmission (eMTCT). The team at the clinic started updating mothers’ physical addresses and phone contacts regularly”, says the ART clinic in charge. Expectant clients were scheduled for a clinic appointment and given NVP at last antenatal care (ANC) visit and advised to pack it with the ‘Mama-Kit’ (a set of materials given to a pregnant woman to for use during the delivery process). It is a requirement that all expectant mothers are supposed to have in preparation for delivery). A reminder phone call was made around the expected date of delivery to confirm delivery and initiation of the NVP. Through these interventions:
“We managed to increase NVP uptake at birth from the initial 50% to 100%. We have also learnt that regular phone follow-ups create a good ‘doctor-client’ relationship, and also help us book the HEIs for the timely 1st PCR and consequent Viral Load and PCRs tests”, says the clinic in-charge.
Namono Rose is one of our clients who has been through the eMTCT four times. We interacted with her to explore her experience.
“I am called Namono Rose, 33 years old from Mbale district. I am a mother of four and I separated with the father of my children in 2021.
I have been a client at TASO-Mbale since 2010. Before I found out that I was HIV positive, I was sickly but I thought it were signs of early pregnancy since I had just got married to my ex-husband. I went to the nearest clinic, where I took an HIV test which turned out negative. But I continued feeling unwell. Because of the HIV awareness campaigns by TASO over the radios and community drama exhibitions, I convinced myself to go to the AIDs Information Center to take a second test since it was near home. Unfortunately, the results showed that I was HIV positive. I was referred to TASO-Mbale, where I was counseled, and initiated on co-trimoxazole therapy since my CD4 was still very good. I convinced my husband to test too, and he was also positive. We were counseled and educated about safe parenthood since we were both still young and had never had children.
I had a child in 2012, I decided not to breastfeed her due to the fear of passing on the virus to her despite all the counselling I had received. I went on to have other three children whom I breastfeed till one year. I had now proved that I can have HIV negative children after the first child.
My fourth baby is nine months old. Before the birth of this baby, I was enrolled into a special project by my “musawo” clinician and counselor who told me that they were monitoring my pregnancy till birth. I went through routine counseling and other PMTCT programmes. But this time, I was given the NVP syrup at my last Clinic visit. I was showed how it should be given, how I should pack it in my antenatal bag, together with the ‘mama-kit’. After delivery, I called the ‘musawo’, and I informed her that I had given birth, and she was happy for me. She asked me to come to the hospital when the baby is one month old, which I did. A test was done and she was negative. I continued coming to the hospital to monitor my baby’s health and growth. At nine months, another test was done and she is still negative.
I have learnt that attending ANCs, delivering at the health facility, not sharing sharp instruments, are very important if you want to have HIV negative babies.”
Preparing expectant mothers with NVP syrup for their newborns is vital in reducing the risk of exposure since they are able to administer the drug within time regardless of where they have delivered from. This intervention is helpful for ART clinics that provide antenatal care services for pregnant mothers on ART but do not support delivery.