Saving Babies - A Victory in Botswana (continued)
FRANCISTOWN - A year after giving birth to her twins, Balekanye Mosweu says her babies are still healthy and growing up fast. Thata and Thatayaone are as normal as any children their age, and that's what makes their story so special. Mosweu, who is HIV positive, says she looks forward to the day when she can tell her twins the truth about her successful path in the Prevention of Mother to Child Transmission (PMTCT) program, which ensured that the children did not get infected. Meanwhile, the rest of the world is already catching on. Botswana's PMTCT program is being heralded as one of Africa's best examples of how a developing country can save babies from acquiring the deadly virus. Recent surveys show that Botswana has been successful in reducing the rate of HIV transmission from mother to child to less than 4 percent, representing the first time that a developing country with a high prevalence of HIV can lower transmission rates to those in Western nations
Ambassador Mark R. Dybul, the U.S. Global AIDS Coordinator, told the Boston Globe newspaper that Botswana's results were "extremely impressive."
"That's getting down to what we've been able to do in the United States and Europe," where fewer than 2 percent of babies born to HIV-positive pregnant women have the virus. "It's a great model of how you can do it in Africa," Dybul said.
The challenge for Botswana is especially pressing: 32 percent of its pregnant women are HIV-positive.
So how did Botswana do it? The success here may be due to political support and several policy decisions, including the routine "opt out " testing of all pregnant women for HIV and providing HIV test results in 20 minutes to the expectant mothers. Because of this, uptake of PMTCT services was around 97 percent in 2006.
Also, women who are HIV-positive are given dual drug treatment - four weeks of AZT, and then a single dose of nevirapine at birth to mother and child. With no interventions, the risk for an HIV-positive woman to pass on the virus to her baby is 30 to 35 percent. With a single dose of nevirapine, that risk is cut roughly in half. In the cases where a mother passes HIV to her child, roughly twothirds occur during birth and one-third during breast-feeding.
The U.S. government is encouraging other countries to adopt parts of the Botswana model; already, Cameroon, Kenya, and Zambia, among others, have started testing all pregnant women for HIV, unless the women specifically decline the test. HIV prevalence in other African countries is still high. In Lesotho, for example, transmission rates from mother to child are still as high as 37 percent.
Early Infant Diagnosis
Last year, with support from the U.S. President 's Emergency Plan for AIDS Relief (PEPFAR) and technical help from BOTUSA, the Botswana government rolled out a new method of testing babies for HIV using dried blood spots. The goal of the program is to get more HIV positive babies on treatment before they become ill, but the Early Infant Diagnosis (EID) method is also proving that the PMTCT program really works.
Using DNA technologies, the babies' dried blood is tested for HIV just six weeks after birth. The samples are stable, do not require refrigeration and can be easily transported. Previously, babies were tested for HIV at 18 months using an ELISA (Enzyme-Linked Immunosorbant Assay) or rapid HIV tests. While these tests produce accurate results, the approach was inadequate for program monitoring and clinical purposes since the health care workers had to wait until the infant was 18 months old to be tested. By this time, as many as half of the HIV-positive babies will have died of AIDS.
In a pilot project using the dried blood spots to test for HIV, the government and BOTUSA found that 7 percent of 1,917 infants born to HIV-infected mothers had the virus in 2005. Satisfied that the tests were accurate, the government rolled out the program nationwide. A follow-up study from November 2006 to February found that just 51 of 1,300 babies tested were HIV-positive, or 3.9 percent.
"The new tests have lifted spirits of everyone involved. Health workers and families can now learn the baby's HIV status in the second month after birth, " Dr. Tracy Creek, a medical epidemiologist at the US Centers for Disease Control and Prevention, said.
"The testing is serving as a powerful morale booster for everybody -- for health workers, who are finally seeing their work succeeding, and for the mothers, who almost all are being rewarded with [HIV]-negative babies," Creek said.
The U.S. President 's Emergency Plan for AIDS Relief (PEPFAR) is providing more than $4.5 million in fiscal year 2007 funding to support Botswana's PMTCT program.