By Jackson Okata
In 2012, pregnant Elizabeth Atieno, 29, made her first antenatal clinic visit to the Rachounyo East sub-county hospital, a visit that would change her way of life.
Atieno tested positive for HIV against her expectations.
“The thought of being HIV positive had never crossed my mind. It threw me off balance and drove me into depression,’’ Atieno says.
During her first pregnancy, Atieno says she never attended antenatal clinics. She gave birth at home with the assistance of a traditional birth attendant.
Unknown to Atieno, her first child was born with the HIV virus.
“We went for a second test with my husband, and the results were still positive. Our first child also tested positive,” she narrates.
She says the realization that she had infected her first child with the virus hit her hard, and at some point, she thought of committing suicide.
“I regret because had I known the importance of antenatal clinic visits and the need of giving birth in hospital, my firstborn would be negative’’ she notes.
She was put under the Homa Bay county prevention of mother-to-child transmission (PMTCT) program, which saw her give birth to an HIV-negative baby.
The Homa Bay success story
In the recent past, Homa Bay County has been touted as a beacon of success in the fight against HIV/AIDS, with a steady decline in new infections and HIV-related deaths.
The 2023 estimates by the National Syndemic Diseases Control Council (NSDCC) show a decline in Homa Bay County’s HIV prevalence rates from 26.5% in 2022 to 15.2% as of 2023.
At the same time, the county’s prevention of mother-to-child transmission (PMTCT) of HIV was at 5.3% in 2023 compared to 18% in 2012.
Mother-to-child or perinatal transmission of HIV happens when the virus is passed from mother to child during pregnancy, childbirth or breastfeeding.
The success of a vibrant PMTCT program has been cited as a key contributor to the drop in HIV prevalence rates in Homa Bay.
Justus Ochola, who is in charge of research and innovation in the Department of Health, says a lot of work has been done to ensure the success of the county’s PMTCT program.
“This program is critical in our endeavor to completely achieve zero HIV infections among children and infants and ultimately towards our goal of having an HIV-free society’’ he explained.
“We are working to go below 2.5%’’, says Ochola.
Ochola attributes the success of the county PMTCT program to the test-and-treat approach where every pregnant mother visiting a clinic undergoes HIV testing, with those who test positive immediately put on ART to prevent mother-to-baby transmission.
“Currently, we are at 99 percent of testing of all pregnant mothers across the county with the remaining one percent constituting the ones who go to private hospitals where HIV testing is not done or those who don’t go to hospital’’ he observes.
Apart from being put on ARVs, Ochola notes that those testing positive are encouraged to use other combination methods like the use of condoms and abstinence to avoid possible reinfection.
ART helps in suppressing HIV viral load in pregnant women. A high viral load increases the risk of perinatal transmission.
For Judith Atieno, 40, a HIV-positive mother, the PMTCT program helped her deliver an HIV-negative baby in 2019, two years after testing positive.
“When I got pregnant, I battled the fear of giving birth to an HIV-positive child, but the PMTCT program turned out to be a savior”, Atieno says.
She was put on ART and followed it through.
Judith notes, “The good thing about the program is that it walks with you throughout the pregnancy and postnatal period.”
The approach
Homa Bay County has 218 health facilities that offer HIV testing and ART services, something Ochola observes has been key in achieving a higher testing rate.
Under the PMTCT program, pregnant HIV-positive mothers are encouraged to make 8 antenatal clinic visits as opposed to the usual four.
“With 8 ANC visits, we can do close and consistent monitoring to guarantee the baby’s safety during pregnancy and at birth’’ Ochola explains.
To further widen the scope of the PMTCT program, the county is also implementing testing in the community through the integrated community approach.
“We have vulnerable pregnant women who don’t visit hospitals, and the only way to reach them is through door-to-door visits and moonlight testing, which targets minority groups like sex workers’’, says Ochola.
The UNAIDS has set targets for HIV epidemic control at 95-95-95, which aims at having 95% of all people living with HIV diagnosed, 95% of all HIV-positive persons put on treatment and realizing 95% of HIV viral suppression.
In Homabay, Ochola confirms that the PMTCT program has helped realize 96% identification, 97% treatment and 94% suppressions.
“Only 5 per cent of women in Homabay County are yet to know their HIV status”, Ochola confirmed.
Peer educators and support groups
Pregnant women delivering in hospitals has also greatly contributed to the reduced HIV prevalence rates in Homa Bay.
According to Ochola, the PMTCT program has seen a surge in the number of women giving birth in hospitals, from 48% in 2012 to 78% in 2023.
“The Community has realized and embraced the need to deliver in health facilities, and currently, all HIV-positive mothers are delivering in hospitals”, Ochola notes.
Ochola explained that home delivery increases the chances of mother-to-child transmission because the blood of the fetus mixes with that of the mother during birth.
To discourage home deliveries, the county hired 2000 traditional birth agents (TBAs) and peer educators whose duty is to refer pregnant mothers to health facilities. Each TBA is paid Sh200 for every referral.
Benta Atieno, 44, is among the many peer educators the county has employed. She has been living with HIV for 17 years. Like other peer educators, her work is to fight stigma and encourage HIV-positive mothers to attend clinics and stick to treatment, as well as offer psychological support.
“Through our community work, we have seen an increase in the number of mothers coming to hospitals and giving birth to HIV-negative and healthy babies”, she says.
Peer educators also help in forming support groups for HIV-positive pregnant mothers.
Benta observes that HIV/AIDS-related stigma has greatly reduced, and more women are openly living positively.
Maureen Adhiambo chairs the Upendo Women group, a support group for women living with HIV in Ringa Village, Homabay County. In 2014, during a hospital visit with her third pregnancy, Adhiambo and her husband took a HIV test. She tested negative, while her husband tested positive.
“Since I was negative, I was immediately put on Pre-exposure prophylaxis (PrEP) to protect me and my child from possible infection, and this helped me deliver a HIV-negative child’’ Adhiambo says.
She adds, “Support groups are critical because, through them, we have been able to spread the gospel on the importance of HIV testing, clinic visits, hospital birth, and adherence to ART.
Early testing and retention
Leonard Okumu, a clinical officer and AIDS and STIs Coordinator (CASCO) in the Kabondo sub-county, opines that early testing on pregnant mothers has been key to the success of the PMTCT program.
Okumu says that under the test-and-treat approach, those found to be HIV positive are immediately put on treatment to prevent the risk of mother-to-child transmission.
“Those at risk, including sex workers and those with multiple partners or those suspicious of their partner’s sexual lives, are put on Pre-exposure prophylaxis (PrEP) to protect the mother from new infections. ARVs help in suppressing viruses and enhancing the immunity of the mother while protecting the baby from infection by reducing chances of mother-to-child transmission.” One important Key thing in ensuring the success of the program, according to Okumu, is monitoring drug adherence and retention of positive mothers.
“Support groups and peer educators have played a big role in helping us achieve high retention levels, and with free ART services, the uptake of ARVs has also gone high’’ Okumu observes.
Kabondo sub-county reproductive health Carolyne Atieno noted that early antenatal clinic visits help identify positive mothers, with testing done from the first trimester to the day of delivery.
“For mothers who test negative on the first test, we normally re-test continuously for up to 6 months while promoting the use of prep to avoid possible infections”
Atieno says they also encourage couples’ testing
He explains that early treatment improves the health of pregnant mothers and prevents babies from getting infected.
Country Status
According to the World Health Organization (WHO), in the absence of intervention, the rate of transmission of HIV from a mother living with HIV to her child during pregnancy, labour, delivery or breastfeeding ranges from 15% to 45%.
WHO cites pregnancy and breastfeeding as the periods of high risk of transmission.
In Kenya, according to the National AIDS and STI Control Programme, 5% of mothers are newly infected with HIV during pregnancy and 17% during breastfeeding, which poses increased risks of transmission to the infants.
NASCOP notes that 21% of mothers who are pregnant or breastfeeding and living with HIV do not receive antiretroviral therapy (ART), and 47% drop off of ART
Kenya seeks to end AIDS in children by 2027.
In September 2023, the Ministry of Health launched an action plan dubbed the Kenya Plan to End AIDS in Children by 2027. The plan seeks to prevent new HIV infections among children.
In the past decade, Kenya’s HIV infections have reduced by 57%, while AIDS-related deaths have decreased by 68%.
Kenya’s mother-to-child transmission rate remains high at 8.6%, with treatment coverage of children living with HIV being at 85%, with about 74% of those virally suppressed.
Ochola is optimistic that with the existing interventions, Homa Bay County will lead the country in eradicating HIV among children by 2027
“Homa Bay is getting it right, and we will keep working to close the gap’’ he concludes.
Kenya’s biggest achievement in her journey to end AIDS by 2030 has been on the prevention of mother-to-child transmission (PMTCT) coverage which currently stands at 94.60 %, with the mother-to-child transmission rates dropping to a single-digit figure of 7.28%.
As of June 2024, data from Kenya’s National Syndemic Diseases Control Council (NSDCC) shows that Kenya had 1,378,457 people living with HIV, among them 890,747 females and 487,710 males.
Kenya’s new HIV infections as of 2024 stand at 16,752. New infections are high among females at 10, 784 with males’ new infections at 5,968.
In 2024, Kenya recorded 20,480 AIDS-related deaths, among them 17,873 adults and 2,607 children.
National HIV prevalence rates among females are high at 4.46%, while the male prevalence rate is at 2.16% compared to the national prevalence rate of 3.3%.
