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Catherine Murombedzi
BABIES born to HIV-positive mothers are said to have been exposed to the HIV virus either in the womb, at birth or during breastfeeding. The babies need to be screened for the virus six weeks after birth.All babies born to HIV-positive mothers are therefore given Nevirapine syrup as a measure to combat the virus.
A special test is used to check if the baby did not get the HIV virus vertically from the mother.
They do not use the rapid HIV test used for adults but a thorough test meant for babies. Baby is pricked on the big toe and a blood sample put on a blotting paper. They have to use this dry blood sample (DBS) as it takes time to send the sample to the national laboratory.
The test is only done in Harare at Harare Central Hospital laboratory. This test is called DNA PCR as they have to be sure that the antibodies they pick in the sample do belong to the mother. Were they to use a rapid HIV test, it would give a false result as it could pick antibodies from the mother and thereby present a positive result when in fact the baby is HIV negative.
Since all dry blood samples are sent to Harare, it takes between three weeks and four weeks for the sample to be clarified, under normal circumstances. This is so if the sample was sent from a centre in Harare or Marondera urban.
If the sample has been sent from, say, a clinic down in Mbire, Mashonaland Central, the sample is sent to the district hospital where other samples from the district are compiled and then sent to Harare.
Depending on the mode of transport, this is where the delay is normally found. This is the case nationally with most outlying health centres where the turn-around time for DBS is between two to three months.
Take it that a baby gets ill, in the interim it would be fatal before the baby’s results are back, which is sad. Therefore all exposed babies need to be screened before they are ill and six weeks is ideal. In the past babies were tested at 18 months but with the advent of technology they can now be tested earlier.
Results from the national laboratory can be posted to a different location if two clinics carry the same name. This has been the case at times for samples for Mapanzure Clinic in Gutu being sent to Mapanzure in Zvishavane. The wrongly sent results have to be rerouted thereby causing a further delay.
The delay in sending and receiving DBS will be a thing of the past now as Elizabeth Glaser Paediatric Aids Foundation (EGPAF) has offered to pay courier services for the speedy movement of DBS to and from.
Dr Tsitsi Mutasa-Apollo, who is the deputy director STI/HIV in the Ministry of Health and Child Care, revealed this recently on the sidelines of an HIV capacity building workshop organised by National Aids Council for editors in Chinhoyi.
“It’s true the turn-around time for dry blood samples nationally was worrisome and in some instances it took two to three months for the results to be received at a centre. This is now a thing of the past and I am glad to say that our partners EGPAF have offered to pay courier service charges to Fedex. So Fedex now collects from all places they can reach and it has seen the turnaround time down to 3 weeks. The challenge still remains in the hard to reach areas in remote areas. In such areas we have to use motorbikes to district hospitals from where Fedex then picks up for delivery to Harare,” said Dr Mutasa-Apollo.
Dr Mutasa-Apollo said mobile phones have been provided to centres where there is network coverage and this has seen results being dispatched electronically.
“In areas where there is mobile phone coverage, mobile phones and airtime have been provided and the national lab sends the results by SMS, which is faster,” she said.
The National Aids Council statistics show that national coverage in paediatric ART is still far from pleasing as it stands at 46 percent.
“We are not doing very well in paediatric ART. We are far from reaching universal access. For adults ART coverage is at 80 percent while for children it is 46 percent,” Mr Amon Mpofu, NAC monitoring and evaluation director said.
“We have to scale up on paediatric ART. We have over 1200 sites offering ART and all these are capacitated by the Ministry of Health and our partners as we co-ordinate the national response. There should be no reason why paediatric ART lags behind that of adults,” he said.
I recently spoke to a number of HIV-positive mothers who had given birth in the last year and they expressed mixed feelings all bordering on fear.
An HIV+ mother can safely breastfeed exclusively for six months without giving the baby water or any other solids. Solids like porridge bruise the baby’s gut lining. Therefore giving a baby such foods is not recommended since milk is a complete food for babies under the age of six months.
There have been concerns from HIV-positive mothers who have not breastfed their babies for fear of infecting them. If one can afford to buy milk formula and ensure bottles are clean and sterile, then they can opt for formula.
The danger is that formula is expensive and as one fails to keep pace with the demands by the baby, a mother is tempted to add more water.
This can lead to upset tummy leading to running stomach.
The first mother said she did not breastfeed at all from day one baby was born as she could not take the risk.
“During pregnancy I had stocked up milk formula to last me six months, but in reality it lasted four months and I had to buy more when the milk ran out. I could not risk breastfeeding as I had been told that the baby had a 10 percent chance of getting infected from breast milk. My husband had to forgo a bottle or two and that way we managed but it was difficult,” said the mother who requested anonymity and lives in Tafara, Harare.
The second mother who lives in Msasa Park said that she was afraid that formula would be incorrectly mixed hence she breastfed as she had done with her other children.
“My worst fear was not the expense but to have my baby getting ill from a watery formula or getting sick from dirty bottles so I breastfed. I had baby tested for HIV three times during the duration of one year and am glad that my baby is clear.
“I stopped breastfeeding when my baby turned one year. I am glad that the last DNA PCR result remained HIV negative. I have been on medication since I found out that I was HIV positive and that was at ante-natal clinic when I was two months pregnant. I am now on anti-retroviral medication for life. My baby has since stopped taking
Nevirapine syrup because there is no need. God has been good and has answered my prayers,” said the mother in her 30s.
A baby aged a month can use a 250g tin of formula in a week and the intake rises as the baby grows. Such a tin, depending on brand, costs anything from US$6 to US$9. By the time a baby is four months a 250g tin lasts 2 days and the cost becomes heavy on the pocket. A mother will therefore be forced to introduce baby to solids prematurely. The Zimbabwe Government therefore realises these shortcomings and encourages mothers to breastfeed. Breast milk is readily available, always has correct temperature and is sterile. Breast milk has all the nutrients required for baby’s growth for the first six months of life. A breast-fed baby can ward off a host of illness as a mother’s milk acts as an immunity booster.
Vice-President Joice Mujuru last year launched Option B+. This entails putting a mother on ARVs for her own good and as a precautionary measure to protect the baby from getting infection from the mother.
In the past the mother got a single dose of Nevirapine which was meant for the baby’s protection only. The mother took the tablet when labour kicked off.
The country has taken a better route now where both mother and baby need medication. An HIV-positive pregnant mother therefore takes a triple medication combination for her own health and also as a means to lower the risk of passing on the virus to the baby.
With the DBS turn-around time now less than a month, all exposed babies have a chance of survival if their mothers take them for screening on the prescribed times.
No baby should be born with the HIV virus and the national vision is to see less than 5 percent of all babies born with the virus by 2015. It’s only 2 months to the target date and all pregnant mothers are encouraged to get tested for HIV. Testing is the entry point to ART and if any pregnant mother is found to be HIV positive irrespective of their CD4 count, they are commenced on ART for their own good and to protect the baby from possible infection.
Let no fear grip an HIV-positive mother who is pregnant. There are now intervention measures to have baby born clear of the HI V virus.
Online Reporter