Health experts urge African gov'ts to scale up preventive measures

by Daniel Ooko

NAIROBI, May 25 -- Health experts have called on nine African

governments to take urgent actions to expand and strengthen existing prevention

of mother-to-child transmission services for pregnant women, and increase the

treatment for infected mothers and children.

Speaking at a media briefing in Nairobi on key issues discussed and

consensus reached at the two-day Regional Expert Consultation, convened by the

UN Children's Fund (UNICEF), the UN Joint Programme on HIV/AIDS (UNAIDS) and the

World Health Organization, the experts said serious challenges remain to

increase coverage as well as improve the quality of services being provided.

"The HIV/AIDS epidemic continues to have a devastating impact on the health

of children and their mothers in this region, contributing to increased death

rates of both young children and their mothers as well as creating more

orphans," David Alnwick, UNICEF's Regional Adviser told journalists on Monday.

"It is critical at this juncture, when many countries are faced with

shrinking budgets and competing demands that we do not lose the momentum of what

needs to be done to create an AIDS free generation," the adviser said.

The experts made the call to the governments from nine countries in East

and Southern Africa, including South Africa, Kenya, Mozambique, Tanzania,

Zambia, Ethiopia, Malawi, Uganda and Swaziland, who last year accounted for half

of the global new HIV infections.

Experts agreed that these countries must reach 80 percent of all pregnant

women, mothers and their children with services, halve the number of mothers and

children lost to follow up, and double the number of HIV infected children on

ART treatment if it is to succeed in halting the spread of the virus.

The recommendations were made at the conclusion of regional consultation on

accelerating Prevention of Mother-to-Child Transmission (PMTCT) and Pediatric

Care and Treatment which ended in Nairobi over the weekend.

It brought together senior staff from ministries of health of the nine

countries along with experts from international and non-governmental agencies

that work in Eastern and Southern Africa region to review progress, identify

bottlenecks and agree on what needs to be done to address them.

After a decade of national programs to prevent the transmission of the HIV

virus from mother-to-child, great strides have been made. The price of the

medicines and diagnostic tests has dramatically fallen. More recently, all of

these countries have started to provide treatment to HIV infected children, as

well as anti-retroviral drug which potentially can keep mothers healthy and

prevent children becoming orphans.

Yet if global commitments are to be met including reaching the Universal

Access goal of ensuring 80 percent coverage of PMTCT by the end of 2010, reduce

50 percent of new pediatric infections as well as to more ambitious goals linked

to the Millennium Development Goals, by the end of 2015, much more needs to be

done.

A preliminary analysis by UNICEF of the best available data suggested that

two of the nine countries (South Africa and Tanzania) would be likely to meet

that goal based on their continued increased coverage in 2007 and 2008.

With the exception of Ethiopia, seven countries could possibly meet the

coverage goal with substantial increases in efforts, for some this would mean

increasing coverage by over a third this year, compared with 2007 and by a

quarter again in 2009.

Currently on average, PMTCT coverage for countries in East and Southern

Africa remains at around 50 percent.

There was an agreement amongst experts that serious challenges remain to

increase coverage as well as improve the quality of services being provided.

The experts said most countries are still struggling to expand treatment

and shift from single dose Nevirapine to more effective combination ARV

regimens.

Early infant diagnosis is still limited and the initiation of treatment for

children is often late, reducing their chances of survival.

"There is still not sufficient linkages with maternal and child health

systems as well as family planning and reproductive health services," the

experts recommended.

They said countries continued to face human resource constraints, with a

shortage of health care workers, as well as a lack of knowledge and skills.

A detailed set of recommendations were made, focusing mainly on relatively

low cost and straightforward actions that the governments could take before the

end of 2009 which would allow for substantial acceleration in 2010 and beyond.

Key among these recommendations were increased involvement of communities

and community members, especially women and mothers living with HIV/AIDS in

supporting local activities, reducing the workload of often overstretched health

workers, and helping increase both coverage and compliance with the full course

of treatment required.

They recommended strengthening data management, especially the impacts of

measurement mechanisms to better understand trends, identify bottlenecks.

The health experts also called on the governments to prioritize the

geographic areas/districts where prevalence rates are the highest so as to

intensity support and services where the need is greatest.