Tuesday, December 18, 2012

Preventing mother to child transmission of HIV in Cambodia

16 months HIV negative thanks to the counselling, testing and treatment.
© UNICEF Cambodia/2012/Shepherd-Johnson
Ngin Eng (aged 24) knew in the first month that she was expecting a baby but did not visit the health centre for antenatal care until a member of the community’s Voluntary Health Support Group met her when she was four months pregnant and urged her to do so.

At Mean Chey health centre, Eng and her husband Math Nasy (aged 23) learned that her pregnancy was progressing smoothly. They also found out that they were both HIV positive.

“At the health centre, the nurse asked if I wanted to volunteer to be tested for HIV. I knew about HIV and wanted to know my status. For myself, I wasn’t afraid because the nurse told me not to worry and explained that if I knew my status I could get treatment. I was only worried about my baby,” says Eng.

Voluntary counselling and testing part of antenatal care

Voluntary HIV counselling and testing is an integral part of antenatal care in Cambodia. Primary midwife, Yin Soura says the health centre tests about forty pregnant women each month and so far no one has refused the test. She says good counselling makes all the difference in whether women and their partners take the test. “I reassure them and tell them if you know your status, you will know how to take care of yourself. If positive, we will refer you to the hospital. By preparing people we have avoided extreme reactions.”
Eng and Nasy both agreed to be counselled and tested. Following their positive test results, the nurse immediately referred the couple to Kampong Thom Provincial Hospital where they were both put on a course of antiretroviral treatment (ART).  Prompt referrals and the timely initiation of HIV-infected pregnant women on triple antiretroviral treatment helps to ensure that less than 3 per cent of HIV exposed infants become infected each year, as well as improve the overall health of their mothers.

“I received four types of tablets which they told me to take regularly [while pregnant] and I visited the hospital every two months for antenatal check-ups and information on taking care of myself,” says Eng.

Five months after her initial hospital referral, Eng went into labour at 3 a.m. She endured for three hours before heading to the hospital by taxi accompanied by her husband. Their son, Moth Lyha, was delivered at 3 p.m. and as advised by her midwife, Eng exclusively breastfed him from birth. She knew that this would provide her baby with the perfect balance of nutrition for his physical and intellectual growth but she had one nagging worry. “After delivery I asked about the [HIV] status of my baby and they said I should return to the hospital at six weeks [for him] to be tested,” says Eng. “After I got the result I was very happy and I was told to bring the baby back for another test at 6 months.” That test was also negative. Now 16 months old, one final test for Moth Lyha at 18 months will confirm his HIV negative status.

Linked HIV, maternal and newborn health services

With each hospital visit, the health care team continue to monitor Eng, her husband and her baby and provide them with a package of maternal, paediatric and HIV care services including nutrition advice, immunisation, antiretroviral medication, and reproductive health information.

Eng and her family have benefited from the ‘continuum of care’ that systematically links HIV, maternal and newborn health services in Cambodia. With funding from the MAC AIDS Foundation, UNICEF is working in close partnership with the National Centre for HIV/AIDS, Dermatology and STDs and the National Maternal and Child Health Centre to support this Ministry of Health approach to provide effective communication, referrals and treatment to prevent mother-to-child transmission of HIV.

It is a strategy that has safeguarded the health of Eng and her family. “We don’t have any difficulty taking our tablets. My husband and I remind each other. My baby is not ill. He’s happy and strong and I’m happy too,” says Eng.

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