Yale doctor: We can eliminate mother-to-child HIV

Eliminating mother-to-child transmission of Human Immunodeficiency Virus (HIV) in Ghana is possible by 2015 if the right mechanisms are put in place to reduce increased viral burden and placental disruption.

According to Dr. Elijah Paintsil (Assistant Professor of Pediatrics, Yale School of Medicine, New Haven, Connecticut), since pediatric HIV infection is acquired primarily through mother to child transmission, it is important to recognize that without antiretroviral interventions, infection rate will continue to grow as underscored by a trend that shows there is 20-25 percent transmission level in formula-fed infants, but increases to 40 percent with prolonged breastfeeding.

Healthcare professionals believe the greatest burden of HIV infection in women and their children is disproportionately borne by developing countries, especially in sub-Saharan Africa. Breastfeeding is a major health-promoting factor for infants and children, but in this region, as in others, the risk of mother-to-child transmission (MTCT) of HIV by this route is challenging traditional practices and health policies.

Presenting a paper titled “Elimination of Mother to Child Transmission of HIV in Ghana by 2015: Myth or Reality” at the 11th Anniversary Conference of Ghana Physicians & Surgeons Foundation in Atlanta on April 20, 2013, Dr. Paintsil said with over 2 million of the global 2.1 million HIV-infected children living in sub-Saharan Africa, governments need to do more to reverse rate of transmission, and Ghana is no exception.

Elijah Paintsil opined that breastfeeding is the cornerstone of infant survival in many resource-limited countries; however, it is associated with high rate of HIV transmission. Paintsil explained that even though there has been major progress in prevention of mother-to-child transmission in developing countries in the past 7 years, Ghana could still achieve appreciable outcomes by developing interventions that allow safe breastfeeding due to its critical role in reducing rate of infection.

Dr. Paintsil said there has been great progress in the global effort to prevent mother-to-child HIV infection, but it is imperative countries transform science into policy and practice, adding that “in Ghana this process has not come easy, but it is possible to reduce the number of new child HIV infections by 90 percent, and mother-to-child transmission to 5 percent by 2015”.

Analyzing a sample of communities in Ghana with regard to “HIV prevalence by site”, Dr. Paintsil said Adibo (0.0- the lowest), Bawku & Jirapa (1.0), (Kumasi & Akim Oda (1.8), Eikwe & Takoradi (2.0), Hohoe & Amansie West (3.0), Obuasi (4.2), Agromanya (8.8), and Cape-Coast (9.6 – the highest) provide the basis for adopting a holistic approach to reducing the rate of transmission.

Dr. Paintsil said Ghana, Angola, Botswana, Burundi, Cameroon, Chad, Cote d’Ivoire, Democratic Republic of Congo, Ethiopia, India, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Swaziland, Uganda, Tanzania, Zambia and Zimababwe have the highest estimated pregnant women living with HIV globally, hence the need to intensify better management of treatment and prophylaxis.

In the case of Ghana, Dr. Paintsil recommended that treatment for women should include (triple ARVs starting as soon as diagnosed, and continued for life), and prophylaxis using (triple ARVs starting as early as 14 weeks gestation and continued intrapartum and through childbirth if not breastfeeding or until 1 week after cessation of all breastfeeding), and that regardless of CD4 count, there should be (triple ARVs starting as soon as diagnosed, and continued for life. For infants, he recommends the use of (daily NVP or AZT from birth through age 4-6 weeks regardless of infant feeding method).

Paintsil said even though these treatment options would be expensive, Ghana stands to gain because they improve quality of life for both mother and child, leading to drastic reduction in the rate of transmissions.

Dr. Paintsil posit that HIV transmission policies should not exist in a vacuum, suggesting that public health decisions on them should be part of a broader country HIV programming, leveraging synergies, linkages and integration of care.

“The health of women is paramount, hence country ownership of their care requires shared responsibility through public-private partnership, not only in monetary terms, but developing infrastructure and service delivery, Paintsil added.