analysisBy Mitch Besser
"With access to testing and treatment, mother to child transmission of HIV is almost entirely preventable. And yet, in 2011, 330,000 children were newly infected with HIV. Of these, 90 percent were born in Africa, where most health systems lack resources and capacity to achieve the best outcomes."
Thirty-four million people are living with HIV. Each year, approximately 1.4 million mothers with HIV become pregnant and deliver babies. With access to testing and treatment, mother to child transmission of HIV is almost entirely preventable. And yet, in 2011, 330,000 children were newly infected with HIV. Of these, 90 percent were born in Africa, where most health systems lack resources and capacity to achieve the best outcomes. While some countries, like South Africa, Kenya, Zambia and Namibia have seen greater than 40 percent reductions in new pediatric HIV infections in the last two years, in Nigeria, Mozambique and Angola there has been little improvement.
The expense of building and delivering better health services is enormous. HIV investments in 2011 were $16.8bn. UNAIDS estimates low- and middle-income countries will need $24bn by 2015. It is unclear where the money will come from to close this gap. And yet, great strides are being made. In 2011, for the first time, domestic funding by those countries most adversely affected by the HIV epidemic exceeded donor funding. Still, most countries lack the resources to meet people's needs for medicine and services.
The Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive (Global Plan) was launched at the United Nations in 2011. It focuses attention on the 22 countries hardest hit by the HIV/AIDS epidemic and promotes their efforts to reduce pediatric HIV infections by 90 percent and halve the number of HIV-associated maternal deaths by 2015.
Achieving this vision is no easy task. Africa bears 25 percent of the world's disease burden, yet has only 3 percent of the world's doctors and nurses. Women who come for care experience long waits, little time with health care providers and often leave more confused than reassured. Frustrated, they go home and don't come back. The demands on health systems are immense and will grow as we are increasingly able to provide tests and effective medicines. We will require patients to understand and adhere to more complex medical interventions, and for the best results, to remain in care.
mothers2mothers (m2m) recognizes and addresses these challenges. Through task shifting, we support over-extended doctors and nurses. Employing mothers living with HIV as "mentor mothers", m2m staff are trained to work in health care facilities. Mentor mothers provide education and psychosocial support to pregnant women and new mothers, encouraging uptake of and adherence to interventions that contribute to the best possible outcomes. They often result in a HIV-negative baby and a mother who remains healthy to care for her family. And when women don't come back for important health visits, using cell phones and home visits, mentor mothers and community health workers can encourage them to stay in care.
In 2011 in Zambia, 80 percent of m2m clients delivered in a health care facility, compared to the national rate of 47 percent. In Lesotho, the respective rates were 78 percent and 59 percent. In Malawi in 2011, among clients who attended m2m four or more times, 87 percent received ARVs, compared to a national average of 58 percent. At present, mothers2mothers provides service in seven countries in Africa (Kenya, Uganda, Tanzania, Malawi, South Africa, Lesotho and Swaziland), with almost 400 program sites employing nearly 1000 mentor mothers. (November 2012).
mothers2mothers works. The mentor mother program we have pioneered is written into the Global Plan as an essential service. In taking the program to scale, mothers2mothers is in transition from an organization that has historically focused on direct service delivery in health facilities to one that will build capacity in government health systems and among local partners.
This will ensure they can first support, then independently provide, mentor mother services. Aspirational public health programs require inspirational leadership. African health systems will need to scale up health services to achieve at levels required to meet Global Plan goals. With less than 1000 days to go until the Global Plan deadline, indications are that many African countries are rising to meet the challenge.
There have been dramatic declines in the number of new infections among children, and increases in mothers receiving life-sustaining treatment. m2m's future efforts will be directed towards assisting governments in creating sustainable systems for successful service delivery. We, and organizations like ours, must encourage visionary approaches to existing challenges. Only in this way can we eliminate pediatric HIV and keep mothers alive to care for their families.
Mitch Besser is medical director and founder, mothers2mothers.