95% of Bangladeshi mothers in treatment for HIV give birth to HIV-negative babies
Since 2013, Bangladesh had been providing free treatment to HIV-positive mothers under its Preventing Mother-to-Child Transmission programme. It’s working.
30 March 2023 by Mohammad Al Amin
Md. Akhtaruzzaman, Senior Manager of the AIDS STD Programme at the Directorate General of Health Services.
Credit: Mohammad Al Amin
"My baby boy is now around two years and eight months. He tested HIV-negative after his birth and he is now healthy," said Aklima* of Bogura district, who was diagnosed HIV-positive around five years ago. "My boy has already completed all routine immunisation," she added.
For years, Aklima has been taking regular treatment at the ART (antiretroviral therapy) Centre of Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka city. The drugs have successfully suppressed her viral load, keeping her well. And, along with other life-saving protocols, that has prevented the transmission of HIV from her to her son during pregnancy and birth.
“Bangladesh has achieved more than 95% success in giving birth to safe babies by HIV-positive mothers."
Md. Akhtaruzzaman, Senior Manager of AIDS/STD Programme of the Directorate General of Health Services (DGHS)
That's given him his best chance at a healthy life. The virus tends to progress more quickly in children with perinatally-acquired HIV than in others, and HIV+ children have higher rates of morbidity and mortality. Dr Mohammod Shahidullah, professor in the Department of Neonatology at BSMMU, explained HIV-positive babies are particularly vulnerable to various diseases like pneumonia and measles and other childhood infectious diseases as their immune system remains weaker than that of a healthy baby.
More, children are often overlooked: globally, only half of children with HIV are on treatment, against 76% of HIV-positive adults.
Bangladesh is trying to head that problem off at the first opportunity. Since 2013, Bangladesh's national AIDS/STD Programme has been providing life-saving treatment totally free to HIV-positive pregnant women under a Prevention of Mother-to-Child Transmission (PMTCT) programme.
The programme's traction has grown over the years, with World Bank data showing that 36% of pregnant, HIV-positive women were reached with ART in 2021.
The effects are plain. In 2022, a total of 74,491 pregnant women came under HIV testing under the PMTCT programme across the country. Twenty-two new HIV-positive pregnant women were detected at ART centres. 25 babies were born to HIV-positive women that year, and of those 25 babies, 24 were born HIV-negative. Only one was detected as HIV-positive.
Data from the Directorate General of Health Services (DGHS) further revealed that so far 238 HIV-positive mothers who took treatment at the ART centres from 2013 to 2022 gave birth to 224 HIV-negative babies. Only 14 newborns tested HIV-positive during this time.
"Bangladesh has achieved more than 95% success in giving birth to safe babies by HIV-positive mothers. The remaining 5% of babies were positive as their mothers delayed taking treatment or avoided the treatment," Md. Akhtaruzzaman, Senior Manager of AIDS/STD Programme of the Directorate General of Health Services (DGHS) said.
Rahima* was one of the first HIV-positive women in Bangladesh to give birth to a healthy child after being treated at the ART centre in BSMMU. That baby is now 11 years old, she said, and studying in a local school.
Md. Akhtaruzzaman, Senior Manager of the AIDS STD Programme at the Directorate General of Health Services.
Credit: Mohammad Al Amin
According to Akhtaruzzaman, ART centres have been set up in 11 hospitals including in the BSMMU, across the country, though three centres suspended activities temporarily for last few months.
Dr. Md. Mahafuzer Rahman Sarker, Line Director (TB-L & ASP) of the DGHS, said the government has planned to expand the activities of the PMTCT programme to more areas to ensure the birth of healthy children from the HIV-positive mothers.
"More ART centres will be set up in areas where the HIV/AIDS prevalence is comparatively high," the DGHS official added.
The ART centre at BSMMU offers a glimpse into how the programme works. Here, men and women who are concerned they've been exposed to the virus can get a free test on any day except holidays, said Sabrina Akhter, counselor-cum-administrator.
"During the antenatal checking (ANC), many women are also tested HIV-positive at the ART centre. After testing HIV-positive, both the pregnant and non-pregnant women get treatment for AIDS disease free of cost in both the Outpatient Department and Inpatient Department of the hospital," she explained.
Akhter further said suspected AIDS patients are brought under counselling before and after HIV testing at the ART centre. "The pregnant women are also given necessary counselling about pregnancy and how to give birth to a healthy baby," she added.
ART centre at BSMMU. Suspected HIV patients including women get tested HIV here and take drug.
Credit: Mohammad Al Amin
Prof Dr Begum Nasrin, chairman of Department of Obstetrics & Gynecology at the BSMMU, said the HIV-positive pregnant women are put on a triple antiretroviral (ARV) drug protocol. "The HIV-positive women take the ARV drug regularly and are given same medical care as the negative pregnant women," she said.
"Viral load of the positive pregnant women also will have to be tested after six months of taking the drug to ensure proper medicare," she explained.
Dr Nasrin said after birth, a baby whose mother is HIV-positive will be tested to detect whether the baby is HIV-positive or negative. "After giving birth of the baby by the HIV-positive mother, the baby will have to be given Nevirapine syrup for six weeks," she said, referring to an antiretroviral often used in newborns as a preventive. "Later, the baby will have a PCR test at the age of six weeks to detect whether the infant is free from HIV or not.
"After the six weeks, if the baby tests positive then it will be given ARV drugs. And then the baby will have to be tested at the age of 18 months to determine treatment," she added.
"HIV-negative babies born to positive mothers remain protected from different types of childhood diseases through immunisation like inoculation with the EPI vaccines," advised Dr Shahidullah, the neonatologist. It's worth noting that for HIV-positive babies too, vaccination can be a lifeline. Bangladesh recommends a modified immunisation schedule for HIV-infected children, noting, "It is important to immunise HIV-infected children as quickly as possible so that they can mount protective responses prior to the failing of their immune system."
According to Directorate General of Health Services (DGHS), in Bangladesh the first HIV case was detected in 1989. HIV prevalence remains less than 0.01% among general population. The estimated number of people living with HIV in Bangladesh is 14,513. Some 947 new cases were detected in 2022, and 232 people have died with the disease.
*Not their real names
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Source: https://www.gavi.org/vaccineswork/95-bangladeshi-mothers-treatment-hiv-give-birth-hiv-negative-babies
"Reproduced with permission - Gavi, The Vaccine Alliance"
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