1.0 Introduction
The human immunodeficiency virus, abbreviated as HIV, was discovered in 1981 and subsequently emerged as a global pandemic. The modes of transmission of the virus are mainly two- horizontal and vertical. The former refers to the transmission of the virus between two separate individuals, whereas the latter refers to the transmission that occurs from an HIV-infected mother to the child. In order to protect children from the HIV pandemic, the UN initiated an international intervention program, PMTCT (Prevention of mother-to-child transmission).
In Nigeria, the number of PMTCT healthcare centres increased by 875% in 2009 (journals.plos.org, 2019). The major role played by the private healthcare sector in the delivery of healthcare services led the government of Nigeria to develop a framework that would enable the private sector to be engaged with the delivery of PMTCT services. Despite the massive increase in the number of PMTCT centres, however, the number of centres offering PMTCT services represented only 20% of the almost 34,500 healthcare centres in 2016 (journals.plos.org, 2019). There is also a wide disparity in the number of PMTCT healthcare centres between the urban and the rural areas of Nigeria. The increase in the number of PMTCT centres has not translated to a scale-up in the coverage of Antiretroviral drug administration. Despite an increase of 486% in the number of PMTCT facilities from 2012 to 2013, the number of people who were administered ARV only increased by 48%. This apart, armed conflicts in the north-eastern region have affected the delivery of service in that region (journals.plos.org, 2019).
2.0 Impact
Targeted health programmes in recent decades have made antiretroviral therapies (ART) more easily available, helping reduce HIV transmission from the mother to the child, reaching out to almost 85% of women who are pregnant and are infected with HIV in 2019 (Liu et al. 2019). These efforts to prevent mother-to-child transmission have led to improvements in the outcomes of pregnancy for infected women, including reduced rates of preterm birth, stillbirth, and low weight at birth. Moreover, the number of children who are exposed to HIV during breastfeeding or within the womb but are not infected themselves (HEU) is also increasing. In 2018 the number stood at 14.8 million (Odiachi et al. 2018). There is evidence to show that HEU children have poorer development and growth when held in comparison with children who have never experienced maternal HIV infection. The mechanisms which drive poorer developmental and health outcomes in HUE children are not completely understood yet (Yakasai et al. 2021). In spite of enhanced access to Antiretroviral Therapy for women who are breastfeeding or are pregnant, challenges and difficulties with adherence to treatment or related adversities, such as food insecurity, malnutrition, and poor socioeconomic status, have the potential to further worsen poor outcomes related to health (Umeobieri et al. 2018). Thus an integrated and multidisciplinary approach is called for in order to enhance the well-being and health of infants as well as mothers infected by HIV. Several studies have been ongoing in universities across the world which aim to understand how maternally transmitted HIV infection and Antiretroviral Therapy, combined with factors related to the environment at the time of pregnancy and after pregnancy, including food and nutrition security, breastfeeding and maternal nutrition practices affect the health and development of children who are HEU (Erekaha et al. 2018). There is a growing need to reduce the burden and effect of the exposure of infants to HIV in the uterus and at the time of breastfeeding for the proper development and health of the generations to come. This is closely related to the developmental beginnings of health and ailments, resilience and risk across the course of life, as well as the urgent necessity of promoting and supporting a healthy beginning to life (Ezenkiri et al. 2020).
As far as Nigeria is concerned, mother-to-child transmission is a part of the bigger problem of the HIV pandemic. However, the transmission from mother to a child represents the faltering response of the country to the crisis, exposing big gaps in the testing of HIV, allowing infections to remain untreated and the virus to be transmitted (Sam-Agudu et al.2018). The biggest burden of infants born with HIV in the world is borne by Nigeria. Almost one in every four infants infected with HIV at birth comes from Nigeria. According to Sani Aliyu, the head of the National Agency for the Control of AIDS in Abuja, this is an unacceptable situation. However, it is a problem which can be solved even in the case of Nigeria. It is important to administer Antiretrovirals to the relatively small number of HIV-infected pregnant women since those women who receive Antiretrovirals have a lesser chance of transmitting the infection to their children (Nwaiwu et al. 2019). Nigeria, like most other nations, have treated the issue of mother-to-child transmission of HIV with top priority, and the number of cases has reduced appreciably over the years.
3.0 Causes
Although poverty is one of the main drivers, it is not the root cause of the problem of mother-to-child transmission of HIV (Liu et al. 2019). The rates of transmission of the virus from the mother to the child have fallen in countries which are much poorer than Nigeria, whereas Nigeria accounted for about 37,000 of the 160,000 new cases of infection in 2016. Nigeria, being the most populated country in Africa, has almost 3.2 million people who are infected with the HIV virus. The high rate of infection, in combination with the lack of access to Antiretroviral drugs (only 30% coverage) goes a long way in explaining why more than 24000 infants died in Nigeria in 2016 because of AIDS (Odiachi et al. 2018).
A pregnant lady infected with HIV has a chance ranging from 15% to 30% of transmitting the same to her child in the uterus or during childbirth, with breastfeeding increasing the chance by 15% more. A study in 1994 demonstrated that a particular Antiretroviral, azidothymidine, brought down the rate of transmission significantly when administered to the mother as well as the child for six weeks, both before and after birth (Umeobieri et al. 2018). However, because of the high cost of the drug and the complex administration process, most nations could not use the drug. Years later, another study carried out in Uganda demonstrated that the Antiretroviral drug Nevirapine could bring down the transmission rate by 50%. Most countries adopted this drug as a part of their prevention campaigns (Erekaha et al. 2018). Today, Antiretroviral regular combinations are used as the standard model of care for treating all HIV-infected patients, which include infected pregnant women. The treatment subdues the virus in pregnant ladies, and even infants are given Antiretrovirals for six weeks as a precautionary measure. This helps bring down the rates of transmission to lower than 1%. In developed nations as well as in developing ones, the transmission of the HIV virus to the child from the mother is quite rare these days. However, the regimen cannot be administered if the women who are pregnant do not get to know whether or not they are infected in the first place (Ezenkiri et al. 2020).
As per the report of the Joint United Nations Program on AIDS, 21.58% of pregnant women in Nigeria infected with HIV had transmitted the HIV to their babies in 2016. The central problem in Nigeria seems to be the fact that almost 40% of ladies give birth in makeshift health centres, which are administered by untrained birth attendants (Sam-Agudu et al.2018). Women are not likely to get tested in these clinics. Or women may even give birth at home. The main reasons why women do not get tested or seek medical attention at health care facilities which are more formal are multifarious and often overlap with one another. These reasons include poverty, fear of getting stigmatised, facing discrimination for just getting tested for HIV infection, want of education and widespread illiteracy, traditional factors and husbands who are suspicious of health care systems (Nwaiwu et al. 2019).
4.0 Evaluation of policy and programming
Presently Nigeria is burdened with the rapid vertical transmission of HIV due to insufficient knowledge of the Prevention of the PMTCT (Prevention of the Mother to Child Transmission) of the Human Immunodeficiency Virus. The United Nations Organisation has initiated the PMTCT to protect children from dreadful HIV. In the sub-Saharan region, about 90 per cent of the children have been affected by HIV (Olakunde et al. 2019). Hence this virus threatens the life of children. Nigeria has contributed to 15. 3 per cent of global HIV infections. It has been reported that only 11 per cent of Nigerian HIV-infected pregnant women have come across the PMTCT programs. At the same time, the remaining HIV-positive pregnant women are not addressed. The child deliveries that occur under the monitoring of skilled health attendants are only 14 per cent. The United Nations General Assembly Special Sessions has recognised the PMTCT as a mandatory need (Olopha et al. 2021). Besides this, it s also set up the goal to minimise the proportion of the child infected with the human immunodeficiency virus. The programs aimed to reduce 20 per cent of HIV infections in a child by 2005 and 50 per cent by 2010.
Moreover, the Nigerian Federal government has accepted the UNGASS program to increase voluntary testing for HIV. This PMTCT program provides counselling regarding the vertical spread of HIV to pregnant women and their husbands. Rapid HIV testing is also offered to pregnant women during their labour. Moreover, anti-retroviral or prophylaxis treatment is provided to pregnant women (Dirisu et al. 2020). The nevirapine dosage also supplements the ARV treatment during labour. The skilled health workers supervise the ARV and the ANC treatment. The Nigerian government has initiated specific guidelines regarding infant breastfeeding. The mothers have also been advised to take the RV drugs while breastfeeding their children. The management of the PMTCT information system was developed in the program’s early years. Numerous registers have been developed regarding the PMTCT information system. This comprises the clinic register of the general anti-natal and the ARV register (Joseph and Yalma, 2021). Moreover, there are registers for delivery, labour, and child follow-up. The other records comprise that of the partners and the HIV testing and counselling.
On the contrary, developing countries like the UK have reduced the vertical transmission f HIV by the end of 2002. The National antenatal HIV targets recommend HIV tests for all pregnant women as a significant part of the antenatal care program. 90 per cent of HIV screening has been done for pregnant women. As about 80 per cent of pregnant women get infected by HIV during their antenatal phase, hence the UK government has become severe in combating the issue of HIV transmission from the mother to the child (Brown et al. 2018). Thus the number of infants infected with HIV has reduced in the UK compared to Nigeria. The anti-retroviral therapy is widely used in the UK compared to Nigeria, which has resulted in the rapid decline of the vertical transition of HIV in the UK. As the UK has succeeded in reducing the number of HIV transmissions, it aims to achieve a zero transition of HIV infection (Peters et al. 2018). Hence the combination of HIV screening along with the improved quality multidisciplinary care for pregnant women has lessened the rapid of vertical HIV infection.
5.0 Preventive strategies
Globally 37, 600 vertical transmissions of HIV infections are found every year. The federal government researches preventive measures to curb the spread of HIV. The various areas of HIV prevention treatment comprise microbicides, prophylaxis, and vaccines (Bautista-Arredondo et al. 2018). The Centre for Disease Control and Prevention suggests that all women get tested for HIV before getting pregnant. The early the virus gets detected, the sooner the medication can start. HIV testing, HIV medications, Post Exposure Prophylaxis and Pre Exposure Prophylaxis can help to prevent the spread of the human immunodeficiency virus. The Prevention and elimination of the mother-to-child transmission of HIV are supported by the promotion of the MTCT and global commitments. Besides this, the developed access to sexual health and reproductive health services has prevented the spread of the virus. The Prevention of unintended pregnancies and the screening of sexually transmitted infections in women who have HIV has been highly promoted. The Triple Elimination Initiative promoted the morbidity and mortality of children with HIV. This initiative encourages countries to screen pregnant women for HIV. The various services of the Triple Elimination Initiative consist of testing for syphilis, HBV and HIV in the care clinics in the antenatal stage. Moreover, counselling the women and their husbands is also essential to reduce the risk of HIV transmission. The pregnant woman shall be attended to with care and should undergo after delivery (Visser et al. 2019). Furthermore, the children should be given HBV vaccine as a birth dose in order to prevent the risk of HIV transmission. The initiative also highlights the lifelong care and treatment for mothers who are infected with HIV. The Nigerian government has adopted the PMTCT program based on the national guidelines to prevent the vertical transmission of HIV. The other measures taken by the PMTCT are single-dose nevirapine, anti-retroviral, prophylaxis, and zidovudine monotherapy to impede vertical transmission. Moreover, the polymerase chain reaction has been introduced by the PMTCT program for the diagnosis of the infant at six weeks. Moreover, the mother and the baby are subjected to anti-retroviral therapy and other reproductive services and support (Olopha et al. 2021). The program of the Nigerian PMTCT was initiated as a pilot program in the tertiary institutions, and this is further decentralised to the PHCS and the other secondary hospital.
6.0 Recommendations
HIV and AIDS threaten the survival of many children across the globe. In developing countries, the anti-retroviral treatment during pregnancy is successful in reducing the vertical transmission of HIV. Nigeria should develop the PMTCT program and increase the use of anti-retroviral drugs for pregnant mothers. The prophylaxis treatment shall be increased at a rapid scale to control the spread of the virus. The Nigerian government shall follow the guidelines of the UNAIDS program (Visser et al. 2019). Moreover, the health care providers shall help the mother to modify the feeding practices of the woman after they have taken the anti-retroviral prophylaxis drug. The chlorhexidine cleansing of the birth canal of the mothers shall be implemented in the government hospitals of Nigeria. This will help to prevent the rate of vertical transmission of HIV from the mothers to their children. In addition to this, there should be effective administration of nevirapine drugs in pregnant mothers. A combination of lamivudine, placebo and zidovudine can help the Prevention of HIV the children from the mothers. The HIVNET 012 nevirapine will be of advantage to the underdeveloping country like Nigeria for its feasibility, cost and adherence. However, the resistance to the drug after the administration cannot be much advantageous (Dirisu et al. 2020). The intrapartum dosage of the nevirapine shall be increased for pregnant women. In addition to this, pregnant women should be given more advice on breastfeeding techniques. Breastfeeding contributes to the major transmission of HIV from the mother to the children. Hence, in conclusion, it can be said the causes of the transmission of HIV shall be ruled out by the health department of the Nigerian government. Following this, various other HIV prevention programs shall be implemented by the government apart from the PMTCT. Then only the percentage of the children and the mother suffering from HIV can be brought to an end.
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