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Rumbidzayi Zinyuke
Health Buzz
Every year, Zimbabwe reports about 3 650 new HIV infections among children.
According to information from the Ministry of Health and Child Care, these children acquire HIV from their mothers.
While the country has made significant progress in identifying HIV positive people and initiating them on antiretroviral treatment (ART), the number of new infections continues to be worryingly high, particularly among children.
The main drivers of these new infections are mothers who do not receive antiretroviral treatment either during the pregnancy or the breastfeeding period, or those who start antiretroviral treatment but they do not continue, while others acquire a new infection during pregnancy or breastfeeding.
Out of the 1,3 million people living with HIV in the country, 74 587 are children below the age of 14.
With more than 50 000 pregnant women in need of prevention of mother to child transmission (PMTCT), the country is yet to achieve that. This is why the MTCT rate remains high at 8,1 percent.
Unfortunately, children are acquiring more than just HIV, but also viral hepatitis as well as syphilis.
Last week, members of the Zimbabwe national validation committee on the Elimination of Mother to Child Transmission of HIV, Syphilis and Hepatitis B met in Kadoma to discuss the progress that the country was making in this regard.
During the discussions, it was apparent that as a country, there is more that should be done to eliminate vertical transmission of not only HIV, but syphilis and hepatitis B.
National PMTCT and paediatric HIV care and treatment coordinator in the Ministry of Health and Child Care Dr Angela Mushavi noted that if all 50 000 mothers who need ART are initiated on treatment, if those who are on ART are encouraged to adhere to treatment and if all pregnant women are tested early and retested before delivery and during breastfeeding, the number of children acquiring HIV would proportionately decline.
But for this to happen, the country also needs to take into consideration the young girls who are getting pregnant early.
“In our programme, we are seeing a phenomenon of pregnancies in young girls and it is increasing. The teenage pregnancy study showed teenage pregnancies of 22 percent. And that is worrisome. That age group is a very high risk age group. Adolescent girls and young women, they are mothers in our ANC. We are seeing them. So we need to prevent new HIV infections and scale up interventions such as pre-exposure prophylaxis.
If this happens, Zimbabwe would definitely make progress towards the triple Elimination of Mother to Child Transmission of HIV, syphilis and hepatitis B.
The Triple EMTCT is a global initiative that focuses on improving health outcomes for mothers and children by addressing HIV, syphilis, and hepatitis B virus.
The WHO has set global standards for prevention, care, and treatment for pregnant women and children, integrating PMTCT into maternal and child health services.
In this regard, Zimbabwe has since developed a national EMTCT plan (2023-2026).
The plan targets to attain the Gold Tier on the Path to Elimination by 2026 and this involves reducing the MTCT rate to less than 5 percent, reduction of new paediatric HIV and congenital syphilis cases to below 250 per 100 000 live births as well as reduction of the hepatitis B surface antigen (HBsAg) prevalence among children aged five years and below to 0,1 percent or less.
“For syphilis testing, we have introduced the HIV-syphilis combo test, and we have actually seen syphilis testing rates going up. When you give benzathine penicillin, and the mother receives treatment before 30 days of delivery, you can actually prevent congenital syphilis altogether. Obviously, the mother should continue on treatment and receive three doses of full treatment for herself, but even one dose of benzathine penicillin given to the mother early in the pregnancy is sufficient to prevent congenital syphilis,” said Dr Mushavi.
For the elimination of hepatitis B, Zimbabwe will soon introduce a universal Hepatitis B vaccine for new-born babies to prevent the transmission of the viral infection from mothers to their babies.
This will be used to complement the ongoing treatment of hepatitis B among pregnant women who test positive for viral hepatitis, using single formulation Tenofovir.
Although the country is still working towards validation, stakeholders have said it is possible for the county to achieve its targets.
The WHO put together four key pillars aimed at ensuring that countries attain validation for EMTCT. Among these was the need to focus on all women and girls of childbearing age, whether not pregnant, or breastfeeding.
It also places focus on counselling, care, support and linkages to, or provision of Sexual Reproductive Health (SRH) care for women and girls living with HIV, HBV and or seropositive for syphilis.
The third and fourth pillars focus on the prevention of MTCT to infants of pregnant and breastfeeding women and girls living with HIV, HBV and seropositive for syphilis as well as testing, treatment, care (including immunisation and well-child care) and support for exposed infants, infected children, household contacts and partners of women and girls living with HIV, HBV and or seropositive for syphilis.
UNAIDS country director Ms Jane Kalweo said it was possible for Zimbabwe to end AIDS in children.
“We remain focused on closing gaps in children and this means we remain focused on the present, which requires resources, strong policies and programming, and political support. The 2020 Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) did not include children; therefore, there is no population-level surveillance data to provide better estimates,” she said.
While the data remains vague, Ms Kalweo said there are strategies that can be implemented to get the correct information on paediatric HIV. These included strengthening case based surveillance to pick children living with HIV as a result of MTCT.
But this needs to be supported with interventions that target women before, during and after pregnancy.
Because we cannot focus on treatment and elimination without speaking of prevention.
United Nations Population Fund country director Ms Miranda Tabifor said the UNFPA was keenly working with the Government towards creating linkages to the prevention agenda for the elimination of HIV, hepatitis B and transmission of HIV.
“So we look at the linkages and how our support can come in. We have done a lot with the Government looking at the pre-pregnancy, during pregnancy and after that, in that chain of the life cycle of a mother. What we do is to make sure that we provide sexual and reproductive health commodities and we have invested a lot in that. In the last couple of years, more than US$25 million has been invested for SRH commodities. Talk about comprehensive sexual education, giving them the right information to make informed choices as to what they are doing. And we also work and support the Government in terms of innovation. Then we look at community engagement, UNFPA is engaging the communities, working with traditional leaders, and we are in the process of actually launching a big campaign of ‘Not In My Village’, where we are going to be addressing teenage pregnancy in Zimbabwe,” she said.
These and many other interventions are coming together to protect the next generation of Zimbabwe.
Imagine a Zimbabwe where children are born free from these debilitating diseases. These initiatives safeguard the health of infants, preventing them from suffering the consequences of infections they did not choose. It gives them a fighting chance at a healthy life, free from illness and stigma.
By eliminating the transmission of HIV, Hepatitis B and Syphilis from mothers to children, the country can create a healthier population, a stronger workforce, reduced strain on healthcare systems, and a brighter economic future for Zimbabwe.
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