Surviving HIV in Mozambique
Every day in Mozambique, 100 children are born HIV-positive. Many don’t survive to adulthood, largely because their HIV status is not identified until they have become very sick, by which time it is often too late to save their lives. On average, a child born with HIV begins life-saving antiretroviral treatment between five and nine years of age.
The situation is set to dramatically change with the uptake of a new test that helps increase the chances of survival among HIV-positive infants by 75 per cent. Early infant diagnosis testing uses highly effective technology to screen an infant’s DNA, allowing an HIV-positive child to be diagnosed as early as six weeks – and to receive treatment immediately. This differs from traditional testing, which can only be administered once a child is 18 months old, when there is no longer any trace of the mother’s antibodies in the child's blood.
“I lost my first child a few days after he was born and my second child three months after birth,” says Mariana*, a young mother in the maternity ward at the Malahice Health Centre. It is just a day since Carlos* – her third child –came into the world. “This is why I agreed to take the HIV test,” she says smiling at her son with a hopeful look.
When HIV-positive mothers like Mariana pass on the virus, it is often unwittingly during pregnancy, delivery or breastfeeding. Mariana is now part of a UNICEF-supported Prevention of Mother-to-Child Transmission (PMTCT) program. This involves antiretroviral therapy (ART) for her and special medicines for Carlos. “Now I’m in the program, and I have been following all the recommendations that the nurses have been giving me to help Carlos from becoming infected. I am hopeful that at least this son will survive.” In six weeks time, Carlos could be screened using the early infant diagnosis test, and if needed begin treatment right away.
In tandem with efforts to expand early infant diagnosis, UNICEF is collaborating with Mozambique’s Ministry of Health to scale up PMTCT programs. One key initiative is the establishment of PMTCT sites like the Malahice Health Centre, where a comprehensive package of services is housed under one roof to provide:
• Routine HIV testing and counselling for pregnant women
•Antiretroviral therapy for HIV-positive women and preventive treatment during
pregnancy and delivery
• Medicines for newborns within 24 hours of birth
• Psychosocial support, family planning and information on nutrition and infant feeding to reduce the risk of transmission during breastfeeding
• Close monitoring of babies born to HIVpositive mothers
As a result of the expansion of services, the number of health centres offering PMTCT services to pregnant women had increased to 504 by June 2008, up from only eight in 2002. More than 235,000 pregnant women received counselling and testing by the middle of 2008, a dramatic jump from some 4,500 accessing these services in 2002.
While many PMTCT sites in Mozambique, as well as treatment sites, are now collecting blood for rapid testing through early infant diagnosis, only two labs in the country perform the tests. The HIV testing equipment is highly effective but also costly, and greater resources are required to expand this technology to other labs. A key challenge for UNICEF and its partners is to help increase this testing capacity and improve the turnaround of results from early infant diagnosis to ensure that every child who requires treatment can access it without delay.