Tuesday, February 18, 2014

Eliminating Mother to Child Transmission of HIV in Cambodia

Bopha (name changed) talks with Hang Kimhorn, a counselor in the
antenatal clinic at Samdech Ov Hospital, Phnom Penh
© UNICEF Cambodia/2013/Bloomfield

Thirty-three year old Chea Bopha (name changed) is glad that she took an HIV test early in her pregnancy. Two months pregnant and feeling unwell she decided to go the antenatal clinic at Samdech Ov Hospital. “I was very sick,” said Bopha, “[with] weakness, tiredness, fever and diarrhoea.” Accompanied by her husband, Bopha received counselling before receiving the test – a finger prick for a drop of blood. The result came back in a short time: positive. Bopha was immediately referred for treatment.  

Although the test result was distressing, Bopha welcomed knowing her status. The counselling helped her to understand why she had been ill and provided her with information about the treatment she will receive to protect her baby. “I want my baby to be healthy,” said Bopha as she looked affectionately at her raised abdomen.

Expanded voluntary counselling and testing in antenatal care
Antenatal care in Cambodia includes voluntary HIV counselling and testing. Use of the rapid HIV finger-prick test in health centres and hospitals has significantly reduced the number of children infected through their mothers.

Dr Prak Sovann, Chief of Maternal and Child Health for Operational District Choeung in Phnom Penh, says that more expectant mothers are being tested. “Because they get the results the same day, we do not lose those who may not [otherwise] return,” said De Sovamma. This means that for those who test positive, antiretroviral treatment can start straight away.

The hospital also works with non-governmental organisations (NGOs) in communities to promote same-day testing among expectant mothers, provide home-based care, and HIV prevention and nutritional counselling. Although Bopha has not disclosed her HIV status in her community, she says she feels supported by knowing that known HIV positive mothers are being treated well.  

Five months after her HIV test and the start of her antiretroviral treatment, Bopha feels much better. She says, “I have a lot of energy and I rest very well.” Her husband, who tested negative, encourages her to take her medication on time and to keep all her clinic appointments. As a result of early treatment Bopha is aware that there is a very good chance her baby will be HIV negative.

Linking HIV, maternal and newborn health services
At every antenatal visit, Bopha receives attention from a team of health carers who monitor her well-being and the progress of her pregnancy. She benefits from nutrition advice, immunisation, antiretroviral medication and reproductive health information that are all part of a ‘continuum of care’ which systematically links HIV, maternal and newborn health services in Cambodia.
UNICEF is working in close partnership with the National Centre for HIV/AIDS, Dermatology and STD and the National Maternal and Child Health Centre to support this Ministry of Health approach, which provides effective communication, referrals and treatment to prevent mother-to-child transmission of HIV.

“I follow all the advice that the doctor, nurse and counsellor give to me,” said Bopha who is determined to give her child the best start in life. Early detection of HIV in pregnant mothers, made easier by rapid testing, has enabled Bopha to get the treatment she needs in order to do so.

Early in her pregnancy, a woman receives the finger-prick HIV test from Ourn Kesa,
a laboratory technician at Samdech Ov Hospital
© UNICEF Cambodia/2013/Bloomfield
 By Boris Bloomfield