How facility delivered 1,200 HIV negative babies in 3 years

“Every month, we make 40 to 60 deliveries. Out of that, 10 per cent (the equivalent of between 5 and 10 babies) are born negative by HIV positive mothers,” Mr Joseph Otto, the in-charge of Patongo Health Centre III, said.

In May, for example, five HIV negative babies were delivered by mothers living at the facility.
Mr Otto attributes the success to massive sensitisation and awareness creation that the facility embarked on four years ago under the Prevention of Mother to Child Transmission programme (PMTCT).

PMTCT, also known as prevention of vertical transmission, refers to interventions to prevent transmission of the virus from a mother to her infant during pregnancy, labour, delivery, or breast feeding. Approximately one-third of children born to mothers living with HIV will acquire the virus in the absence of preventive measures.

Mr Otto says once a pregnant mother arrives at the facility, they are offered health education, counselling on nutrition and viral load assessment.
The mothers also join family support groups where HIV positive mothers share their experiences.

“We have records of all our village health teams (VHTs) and the traditional birth attendants whom we have trained to identify, manage and refer all pregnant mothers to the health facility from where they would deliver,” he said.

According to Mr Otto, the VHTs and the traditional birth attendants have been issued booklets to record details of all pregnant mothers within Patongo Town Council and the neighbouring areas to enable follow-ups by health workers every month.

Patongo Health Centre III has the biggest number of HIV positive patients enrolled on ARVs within the district.
The facility serves between 2,800 and 3,500 HIV positive patients every month excluding HIV positive mothers who are accessing care under PMTCT.

Whereas only four non-suppressive (where the level of the virus in their blood is not going down) mothers were registered in 2019 due to non-adherence, the facility has registered only a single case of infant mortality since 2014.

By 2018, nearly 1.4 million Ugandans lived with HIV while the percentage of exposed infants tested for HIV before eight weeks of age stood at 45 per cent, according to a World Health Organisation report.
In the same year, 93 per cent of pregnant women living with HIV accessed ARVs to prevent transmission of the virus to their babies and 17,000 new HIV infections were prevented among new-borns.

Without treatment, the likelihood of the virus transmission from mother-to-child is 15 to 45 per cent. However, antiretroviral treatment (ART) and other interventions can reduce this risk to below 5 per cent.

Inadequate drugs
Mr Otto added that whereas the facility has been able to score a great percentage in the PMTCT, it is still facing challenges of limited supply of ARVs for the mothers “On normal occasions, we receive Niverapine dozes for only five patients for two months yet averagely we have 45 mothers a month. We have to borrow from neighbouring facilities that have excess drugs,” Mr Otto said.

Neighbouring health facilities that receive the excess ARV drugs for mothers from National Medical Stores and have bailed out Patongo Health Centre III include Lira-palwo, Lira-Kato, Lukole and Aadilang Health Centre III. The above health centres have a fewer patients on enrolment.

But Mr Linos Ngompek, Agago Resident District Commissioner who is also the chairman of the district HIV/Aids committee, says government should find ways of closing the persistent testing and treatment gaps.

“To end HIV/AIDS as a public health threat in the district, the government needs to improve its HIV testing and treatment response to match the needs of this vulnerable population,” Mr Ngompek added.
When Daily Monitor visited the facility last week, a theatre and a new admission unit were being established, while the expansion of the staff quarters was also ongoing.

Dr Emmanuel Otto, the Agago District health officer, said the big number of patients accessing health services at the facility makes drugs to deplete quickly once supplied by NMS since it is the only major facility in the area.

We are working hand-in-hand with the Ministry of Health to ensure that the facility is upgraded. We believe that all the challenges such as low ARV drugs stock, limited beds, and personnel, will be addressed once the facility is upgraded to a health centre IV,” he said.
He added: “We have received a letter from the Health ministry okaying the upgrade and Shs300m was recently disbursed to facilitate the facelift for the facility.”

PMTCT services
Access to PMTCT services is critical in the elimination of vertical transmission of HIV. Several countries, including Uganda, have made remarkable progress towards the elimination of vertical transmission of HIV.
A 2018 report by BMC Research Notes on the utilisation of PMTCT services among pregnant women in HIV care in Uganda, indicated a high uptake of the programme.

Of the 299 women sampled during the research, 127 (42.5 per cent) reported at least one pregnancy within 24 months; 61 women (48.0 per cent) delivered a live child. Of the 55 who had a live birth at the first pregnancy, 49 (95.9 per cent) delivered at a health facility while 54 (98.2 per cent) received ARVs during pregnancy.
Of the 37.9 million people living with HIV globally by the end of 2018 (WHO), 79 per cent had undergone testing, 62 per cent received treatment.

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