Saving babies from HIV infection

The new initiative will mobilise resources and generate political will to save young lives, leading to a generation of African children born free of HIV. It will use the existing infrastructure, human capacity and technical resources in the villages, to help rapidly expand family-and community-centred health services to stop new HIV infections among children.

The launch and signing of the new partnership between The Joint United Nations Programme on HIV/Aids (UNAIDS) and the Millennium Villages Project to keep babies from Africa and Uganda free of HIV provides a ray of hope despite Uganda’s increase in HIV incidence.

The initiative will help reduce HIV incidence in view of Uganda’s ‘modes of transmission’ study findings that showed 18 per cent of new infections as a result of Prevention of Mother to Child Transmission.

Uganda is one of the 14 countries to benefit. The villages, located in disadvantaged rural areas, are home to approximately 500,000 people. The partnership that was signed in September 2009 aims to help local governments create “Mother to child transmission-free zones” in 14 ‘Millennium Villages’ across nine African countries.

The new initiative will mobilise resources and generate political will to save young lives, leading to a generation of African children born free of HIV. It will use the existing infrastructure, human capacity and technical resources in the villages, to help rapidly expand family-and community-centred health services to stop new HIV infections among children.

The majority of children born with HIV each year are in sub-Saharan Africa, where services to prevent mother-to-child transmission in the region remain uneven.

Less than half of pregnant women living with HIV receive antiretroviral prophylaxis—essential to preventing newborns from contracting the virus, the situation is neither the best in Uganda. In contrast, in the whole of western Europe, there were fewer than 100 mother-to-child transmissions in 2007, whereas in sub-Saharan Africa, there were about 370,000.

Furthermore, Uganda has been unable to attain her target of reducing Mother to child transmission by 50 per cent by 2010 (i.e. from 30 per cent in 2000 to 15 per cent in 2010), though there is evidence from Africa which suggests that practical, locally appropriate and cost-effective clinical regimens can reduce HIV transmission from mothers to their children from current rates which are at around 45 per cent to as low as 1-2 per cent.

It’s hoped that this initiative will work on the bottlenecks that impend PMTCT and further strengthen HIV testing and counselling of pregnant women, the use of ARVs during and after delivery, and safe infant feeding practices that have seen developed countries reduce transmission of HIV to children fall from 25 per cent to between 1 per cent and 5 per cent in recent years.

The initiative will work with national and multilateral partners to strengthen, develop and promote safe, appropriate, and effective models that can be implemented across sub-Saharan Africa. Creating these zones free of mother-to-child transmission of HIV will inform national policies and enable the transfer of these practices for implementation wherever newborns are at risk for HIV.”

The Millennium Villages are a collaborative project of the Earth Institute, the Millennium Promise organisation, the UNDP, and an array of local governments. They operate a model primary health system and include education, nutrition and economic development.

The primary health systems include; free services at the point of care, trained professional community health workers, a network of adequately staffed primary clinics, access to a mobile communication network and emergency transport services to facilitate referrals and a local referral hospital to support second-tier care. The system houses a monitoring and evaluation platform that can readily assess the adequacy, uptake and impact of HIV testing and counselling and family centred HIV prevention services.

The initiative will bring together a multi-sectoral and science-based development and primary health care strategy, drawing on UNAIDS’ expertise in community and family centred prevention of mother to child transmission and greater involvement of people living with HIV, to help local governments create “transmission-free zones” in the Millennium Village sites and accelerate progress towards achieving the Millennium Development Goals (MDGs) by 2015.

Jotham Mubangizi, a Fellow with Makerere University School of Public Health-CDC HIV/Aids Fellowship Programme