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Mentor mothers key in elimination of mother-child HIV transmission

24-year-old *Lucy* looks anxious and disturbed.

She cuddles her eighteen months old baby on a bench at Kiambu Level Five Hospital, as she awaits to be attended to.

A doctor walks in and ushers her, and the baby, to a clinic.

After a few minutes, the mother comes out wearing a big smile - the baby has just tested HIV negative.

Tears of joy drip her eyes.

“I grew up with pain and tears being HIV positive. But today, the HIV status of my daughter has wiped the tears. I am overwhelmed by joy,” narrates Lucy, a resident of Waginge village, Gatundu in Kiambu County.

The 18-month-old is Lucy’s secondborn. Her five-year firstborn also tested HIV negative.

The status of the young ones has brought hope to a young couple, of raising a generation.

Lucy acquired the virus at birth.

The virus swept both her parents and two elder siblings.

Lucy learnt about her HIV status from her aged grandmother, who was strict about having her take ARTs.

“I did not understand why I was always taking medicine, yet I wasn't sick, and I was not allowed to travel, unlike my cousins who were always out of home.

So someday on a chilly evening, my grandmother approached me with a heavy heart and disclosed I was her son’s only surviving child after his entire family died of AIDS,” recalls the young adult.

The news left Lucy in despair, but with counselling, she began living a positive life.

Though she kept the status dear to her heart, the young adult experienced ‘self-stigma’ more so at school, and would isolate herself from other learners.

“Imagine being in a class, only to hear a teacher say during a lesson -HIV is a very dangerous disease. It kills, yet you have the virus! This traumatised me so much, and I knew it was only a matter of time to die,” she recalls.

After her primary education, she joined high school and immediately decided to get married at 19 years.

“I knew it was a matter of time for AIDS to swallow me as it swept my entire family. So I wanted to give birth to leave behind a generation,” says Lucy.

In preparation for the baby, she suppressed her viral load by adhering to HIV treatment.

She also enrolled for ANC after conceiving.

At the clinic, the young mother was assigned a mentor mother (HIV HIV-positive mother with an HIV-negative child).

The mentor mother walked her through the pregnancy journey by ensuring she attended all ANC clinics, ate a balanced diet, suppressed her viral load, and delivered at a hospital.

After delivery, the baby was given prophylaxis and put on nevirapine (drugs that prevent transmission of HIV from mother to child).

At six weeks, he was introduced to Septrin which prevents opportunistic infections, drugs which he will do until he stops breastfeeding.

The baby tested HIV negative at six, 12 and 18 months, and is living negative.

With a smile, she says she is happily raising her two children and is hoping to see them grow into productive adults.

Lucy applauds the role of mentor mother, saying, she took her through each step of ensuring her babies were born negative.

“I had fears that I could infect my baby with the virus, but I am happy, several tests reveal they are all negative,” says Lucy.

Lucy represents hundreds of HIV-positive women able to deliver HIV-negative babies as Kenya walks the journey of eliminating mother-child transmission, using mentor mothers.

Anne Githige, technical officer for Prevention of mother to child Transmission at Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) observes the need to have all women attend ANC to end child transmission

Linking women to mentor mothers, she adds, is key to identifying gaps in mother-child transmission to help come up with solutions.

Mentor mothers work under the LVCT program and ensure each of the pregnant women is tested, and those who turn positive are put on treatment.

However, she regrets that during the journey, a number of babies turn HIV positive for various reasons namely late ANC visits by the mother, some present during delivery whereas some fail to suppress their viral load and interrupt treatment.

“It is worrying that some women only learn about their HIV status when they present for delivery, making it hard to stop transmitting it to the babies,” says Githige.

Through mentor mothers, Kiambu has reduced mother-child transmission which stands at 5. 5 per cent mother-child transmission against 8.6 per cent nationally.

Siaya is the only county in Kenya, that has attained WHO set a target of below 5 per cent mother-child transmission.

The Standard visited Mutitoni Level Five Hospital in Machakos, and met Mary Wanjiku Njeri, a mentor mother who has been sensitising pregnant women about HIV.

At the clinic, every pregnant woman undergoes HIV tests, and those found positive are counselled and put on treatment.

The HIV-positive mothers are then assigned a mentor mother who guides them on pregnancy care, and care of newborns to prevent transmission of the virus.

The mentor mother ensures pregnant women adhere to treatment and deliver in the hospital.

They also ensure the babies test for the virus at six weeks, 12 months and at two years.

Njeri further follows up on HIV testing of babies at six weeks, 12 months and two years.

Babies who turn positive are put on long-life treatment.

“HIV-positive mothers can give birth to negative babies if they are supported and shown best practices to eliminate transmission.

However, it is worrying that stigma makes the majority not attend clinics, only for them to transmit the virus to babies. Mentor mothers have therefore been key in walking HIV mothers to having negative babies,” says Njeri.

Women are encouraged to visit the clinics with their spouses for disclosure and support. “Men need to know the dos and don'ts in raising an HIV negative baby, reasons we encourage them to accompany their wives to ANC,”

But even as the government works towards ending child transmission, she says a lot of mothers fear disclosing their HIV status at hospitals and community because of stigma.

A number of women are discovered to be positive during labour when less can be done to save their babies from acquiring the virus. 

Born HIV positive, Njeri decided to be a mentor mother following the challenges she faced while growing up.

Her both parents died of AIDS.

“Being born with HIV is a struggle. You face rejection, stigma, and isolation as a child because your peers fear you will infect them. This is why I decided to be a mentor mother because I do not want to see any child acquire the virus, it is a painful journey,” she narrates.

She adds, “It is not a sin to be HIV positive, this fight of eliminating HIV can be met if we support mothers. Let us encourage them to live positively so that they can give birth to negative babies”.

Dr Caren Mburu, a paediatrician and children and adolescent advisor at EGPAF said to end mother-child transmission, there is a need to work with the community and hospital levels.

Mentor mothers according to her help women to know the dos and don'ts in eliminating transmission.

“Our work is to support our mothers at facility and community, to take their ART to suppress their viral load and test for the disease,” added the specialist.

But with elimination efforts, she regrets that HIV disease progression is currently being experienced, more so among the under fives, leading to deaths.

Data by Nascop reveals that once a child has acquired HIV, without appropriate care and treatment about a third die by their first birthday, 50 per cent by the age of two years and 80 per cent by five years.

"Timely testing and treatment of children who are HIV infected is critical to prevent them from deteriorating to AIDS and dying.

On her part, Christine Awour, Programs Officer at Nascop emphasises the importance of exclusive breastfeeding of babies born to HIV-positive mothers.

Kenya’s target of mother-child transmission is below 5 per cent, as opposed to 2 per cent for non-breastfeeding societies.

“We are saying this mother who is HIV positive should breastfeed their children.

A child born to whether an HIV-negative mother or HIV-positive mother should be exclusively breastfeeding for six months,” emphasises Awuor.

Among interventions the Kenyan Ministry of Health has developed to end AIDS as per Global Alliance by 2030 include early testing and optimal treatment and care of infants, children and adolescents.

The ministry is also keen on closing the treatment gap for pregnant and breastfeeding women living with HIV.

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