Eliminating Mother-to-Child HIV Transmission: Zambia’s Challenges and Commitment
By Tendai Mumba on January 18, 2025
Since the emergence of the human immunodeficiency virus (HIV), the number of children infected with the virus has risen significantly, particularly in developing countries. This increase is largely attributed to the growing number of HIV-infected women of childbearing age. HIV, a retrovirus, can be transmitted through vertical (mother-to-child), sexual, and contaminated blood products or intravenous drug use. Globally, mother-to-child transmission (MTCT) accounts for 9% of all paediatric HIV infections, with Africa bearing the brunt of the burden. In sub-Saharan Africa, over 95% of paediatric HIV cases result from mother-to-child transmission.
Recognizing the critical need to address this issue, the government of Zambia, through the Ministry of Health, has committed to the global initiative for the elimination of mother-to-child transmission (EMTCT) of HIV. This initiative offers a comprehensive, family-centered approach that integrates clinical services and public health efforts to prevent HIV transmission from parent to child. In alignment with the World Health Organization (WHO), Zambia is working towards the goal of zero new HIV infections in infants and young children by 2030. Central to this effort are the WHO's four pillars of the Prevention of Mother-to-Child Transmission (PMTCT) program, which aim to provide effective, sustainable solutions to prevent vertical transmission.
The first pillar focuses on the prevention of HIV in women of childbearing age. This involves providing condoms to prevent unwanted pregnancies, promoting behavior change through media platforms such as posters, TV, radio, and social media, and encouraging abstinence as the safest method of avoiding HIV. Additionally, empowering women to reduce their HIV risk, preventing and treating sexually transmitted infections (STIs), and ensuring regular HIV screening and contact tracing are essential components of this pillar.
The second pillar addresses the prevention of unwanted pregnancies among women living with HIV by offering family planning services specifically targeted at this group. The third pillar emphasizes preventing HIV transmission from mother to child. This includes providing antiretroviral (ARV) drugs to prevent transmission during pregnancy and breastfeeding, conducting regular HIV testing for pregnant and breastfeeding women, and administering Septrin to improve health outcomes. It also involves monitoring viral load at key stages three months and four weeks before delivery—and providing adherence support to ensure viral suppression.
The third pillar focuses on providing appropriate treatment, care, and support for women, children, and families living with HIV. This comprehensive approach aims to offer holistic care that addresses the needs of those affected by HIV, ensuring better health outcomes for both mothers and children. While the fourth pillar focuses on the provision of appropriate treatment, care, and support to women children living with HIV and their families.
During the 16th Annual National HIV/TB/STI Viral Hepatitis Conference held in Lusaka, Professor Lloyd Mulenga highlighted a critical issue in the fight against mother-to-child HIV transmission, noting that most paediatric HIV infections occur during breastfeeding. This alarming revelation underscores the urgent need for targeted interventions to prevent transmission during this period.
In my role as a Professional Nurse, I have encountered pregnant women who refuse to take pre-exposure prophylaxis (PrEP), despite being informed of its importance. Many believe they are not at risk because they are HIV-negative, but by the ninth month, they often test HIV-positive. This refusal leaves both mother and child vulnerable to transmission.
Some women who accept PrEP fail to adhere to the regimen, increasing the risk of transmission. Despite claiming adherence, closer investigation often reveals non-compliance, posing risks to both maternal and child health.
A recent survey across hospitals highlighted several factors contributing to mother-to-child transmission, including failure to properly administer PrEP to infants. Economic hardship also plays a role, with many mothers unable to exclusively breastfeed, increasing the risk of HIV transmission through breast milk.
Additionally, a higher maternal viral load increases the risk of transmission. Poor adherence to antiretroviral therapy (ART) exacerbates this issue.
Considering the factors contributing to mother-to-child HIV transmission, it is imperative to implement comprehensive strategies aimed at its elimination. To achieve this goal, several key actions must be taken:
Firstly, it is crucial to ensure consistent follow-up of all pregnant women living with HIV throughout their antenatal care. This includes regular HIV testing and counselling to provide necessary support and guidance.
Secondly, it is essential to administer prenatal treatment, which requires HIV-infected women to consistently take antiretroviral drugs during pregnancy and while breastfeeding to prevent transmission to their infants.
Thirdly, establishing community-based health systems is vital. These systems will facilitate regular and consistent access to care for women, as well as provide ongoing education on the administration of pre-exposure prophylaxis (PrEP) to reduce the risk of transmission.
Lastly, conducting radio programs aimed at informing and educating mothers about safe breastfeeding practices is another effective intervention. These programs can play a crucial role in disseminating life-saving information to a broad audience.
Addressing mother-to-child HIV transmission remains a significant challenge, particularly in sub-Saharan Africa, where most paediatric infections occur. Zambia’s commitment to the global Elimination of Mother-to-Child Transmission (EMTCT) program provides a promising framework to reduce new infections by focusing on prevention, treatment, and education.
However, challenges such as poor adherence to prevention measures and limited access to resources highlight the need for sustained efforts, better support systems, and enhanced community engagement. Achieving the goal of zero new HIV infections in children by 2030 requires a concerted, long-term commitment to these objectives.
These findings emphasize the need for targeted interventions to improve PrEP and ART adherence, educate mothers on infant feeding practices, and address economic challenges, ultimately working towards the goal of eliminating paediatric HIV infections by 2030.
The author is a BSC Registered and HIV Nurse.
