In a world where health developments continue to redefine possibilities, the elimination of mother-to-child transmission (MTCT) of HIV stands as one of the most remarkable achievements in public health.
This milestone not only saves lives, but also represents hope for a future free from the shadow of HIV. Mother-to-child transmission of HIV occurs during pregnancy, childbirth, or breastfeeding and without proper interventions. However, with effective measures such as antiretroviral therapy (ART), this rate can be reduced drastically.
Eswatini has made remarkable progress in the elimination of mother-to-child transmission (EMTCT) of HIV.
When the EMTCT programme started the country was around 20 per cent of mother to child transmission around 2002 which has now been reduced to 1.3 per cent which translates to about 80 children per year.
In recent years, the country has implemented a series of strategic initiatives aimed at tackling the high rates of HIV transmission from mothers to their children.
One of the key drivers of Eswatini’s progress is the robust implementation of prevention strategies that ensures that all pregnant and breastfeeding women living with HIV are on treatment and they are encouraged to adhere to their treatment to protect transmitting HIV to their children.
This approach not only improves the health of mothers, but also significantly reduces the risk of HIV transmission to the child.
Healthcare infrastructure improvements have also played a crucial role. The government, in collaboration with international partners, has enhanced healthcare facilities to provide comprehensive antenatal and postnatal care.
Increased access to maternal healthcare services means more women receive testing, counselling, and treatment during pregnancy, labour and breastfeeding.
According to the ministry of health, ART plays a pivotal role in reducing the viral load in pregnant women with HIV to undetectable levels, thereby significantly lowering the risk of transmission during pregnancy, labour and breastfeeding.
This medical development is complemented by implementations of strategies and health education campaigns aimed at early detection and treatment.
The first step that is encouraged by the ministry of health in prevention is early and routine HIV testing for all pregnant women.
Early detection enables healthcare providers to implement necessary interventions to reduce transmission risk.
Pregnant women found to be HIV-positive can begin antiretroviral therapy (ART), which is effective in lowering the viral load in their blood to undetectable levels, thereby significantly reducing the chance of passing the virus to their baby.
The ministry also encourages preventing mother-to-child transmission (MTCT) of HIV among HIV-negative pregnant women may seem unnecessary, but it remains an important aspect of comprehensive maternal health care and public health strategies.
Ensuring that HIV-negative pregnant women remain negative throughout their pregnancy is essential for the health and well-being of both the mother and the child. Here are some approaches and considerations in this regard. Apart from regular testing and taking precautionary measures, it is important for HIV negative women to engage male partners in HIV testing and counselling as it can help in identifying risks and ensuring both partners are aware of their HIV status, which can prevent new infections.
Tripple Elimination Campaign
In a drive to completely win this battle, the country has since embarked on a global initiative aimed at eliminating mother-to-child transmission (MTCT) of HIV, syphilis, and hepatitis B virus (HBV) through a coordinated, person-centred approach. The triple elimination campaign is a high priority for the health of women and children, given the elevated risk of transmission and the danger the infections pose to the immediate and life-long health of the woman and child.
Without any interventions, infants would have up to a 30 per cent risk of being infected with HIV, Syphilis and Hepatis B, and those who are infected have a 15–35 per cent chance of dying in the first year of life.
Infants born to mothers with syphilis have a high chance of adverse fetal outcomes, including early fetal death, stillbirth, neonatal death, preterm birth, low birthweight, and congenital infection.
For HBV, the risk of mother-to-child transmission can reach up to 90 per cent depending on the viral load. Additionally, chronic infection occurs in the majority (90 per cent) of infants infected by their mothers or before five years of age.
Chronic HBV infection can result in liver disease, cirrhosis (scarring), and cancer.
Eswatini has achieved very commendable results with respect to the UNAIDS 95 95 95 global targets; 98 per cent of pregnant women have a known HIV status, 98 per cent of HIV positive pregnant women were initiated on ART and 97 per cent of those who are on ART were virally suppressed by the end of 2022.
The country has made significant progress towards the virtual Elimination of mother-to-child transmission of HIV with a reduction of the final mother to Child Transmission rate, which has demonstrated the effectiveness of the PMTCT interventions
The ministry of health has now embarked on a countrywide campaign to educate and encourage all women of childbearing age as well as male partners to access PMTCT services in nearby health facilities. Through this campaign, the ministry of health is:
1.Encouraging every woman of childbearing age to access testing services for HIV, syphilis and HBV in antenatal care clinics.
2. Prompt treatment of all women who test positive to any of the three diseases which enhances prevention of transmission of the infection(s) to their children.
3. Encouraging early access of care by pregnant women, women should quickly access care immediately they start suspecting that they may be pregnant.
Early care is very critical for the success of the PMTCT interventions.
4. All pregnant women should plan to deliver at a health facility in order to encourage safe childbirth and early access to life saving services.
5. All men are encouraged to accompany their partners to the health facility for care to enhance decision making and continued support throughout pregnancy, delivery and childcare.
6. All infants and their mothers are to access care after birth on an ongoing basis according to the scheduled appointments.
7.Encouraging optimal infant feeding which includes exclusive breastfeeding for the first six months of life
8.Women who are already on Anti-retroviral treatment should adhere to their treatment in order to reduce the viral load to an undetectable level.
The journey towards completely eradicating mother-to-child transmission of HIV is one filled with promise.
As Eswatini strive for this goal, the vision of an AIDS-free generation comes closer to reality.
For countless mothers, it signals a future where their children can thrive, free from the threat of HIV.
