PMTCT - a difficult birth

Lowering the chances of an HIV positive mother passing the virus onto her child is a simple case of giving mother and baby one dose of the antiretroviral drug, nevirapine. Implementing a national prevention of mother-to-child HIV transmission programme, however, is far less simple.

"When the fight against AIDS began, children were not an issue, it was only adults," noted Dr Souam Nguélé Silé, a paediatrician at the National General Reference Hospital (HGRN) in N’Djamena, the capital and Chad’s national PMTCT coordinator. “Then the pandemic set in and [HIV-infected] children appeared, which made people stop and think. Today the demand [for PMTCT services] is very high.”

Chad's first PMTCT services were set up at HGRN in 2005, but it was only in 2006, that a PMTCT programme was properly launched, with funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria and with support from other partners, such as the United Nations.

Uncertain funding and staff shortages

Suspensions of HIV/AIDS funding by both the World Bank and the Global Fund, between 2006 and 2007, however, slowed down the expansion of PMTCT services. Funding has since been reinstated, but a lengthy healthcare workers strike in 2007 further interrupted services. For the four-month period of the strike, which was due to non-payment of salaries, women could not always access antenatal consultations, let alone PMTCT services.

Healthcare workers are, in any case, in short supply. Only around 20 gynaecologists, three quarters of whom work in the capital, serve a country of around 9.5 million inhabitants.

Perhaps the greatest obstacle preventing more pregnant women accessing PMTCT are the low numbers who give birth in hospitals. According to a 2004 national health survey, 43 percent of pregnant women attended an antenatal clinic at some point during their pregnancy, but only 13 percent delivered their babies in a medical facility.

“The women have reasons [for not coming]. Generally they say it is because they have to pay for consultations and they don’t have the means. The wait at the hospital also puts the women off,” explained Silé. “There is also another issue: in certain cultures, the women cannot be touched. It is very difficult.”

In 2006, only about 6 percent of the 170,000 pregnant women who visited antenatal clinics in the country’s six main towns were given information about PMTCT, according to official statistics. Of the 49 percent that agreed to an HIV test, 7.7 percent were HIV positive.

Dr Tharcienne Ndihokubwayo, who runs the HIV/AIDS programme of the UN Children’s Agency (UNICEF)in Chad, refuses to be daunted by these hurdles.

"We will never have enough, but you always have to start somewhere,” she argued. “First we are resolving the issue of service provision: providing training for staff in PMTCT, a testing laboratory and antiretrovirals (ARVs). We cover at least the women who come for antenatal consultations; we're not expanding our work, we are working with the women who come.”

“I am sure that with effective community work and by carrying through the PMTCT work, we will increase the number of antenatal consultations,” Ndihokubwayo told IRIN/PlusNews.

Still a lot of work to be done

A lack of regular medical check-ups for children born to HIV positive mothers is another consequence of inadequate healthcare workers and services. At HGRN, check-ups for such babies only take place on Thursdays.

"It is hard for some mothers as you have to be there at 7 in the morning to get a [consultation] ticket and if you are a bit late, your ticket gets redistributed,” said Claire M’Darangaye, who has an HIV-positive son. "Some mothers come from far away and haven’t got the money to pay for a taxi [to get there on time]...If your child’s life is important to you, the only solution is to arrive the day before and sleep outside the hospital, but without a mosquito net, you and your child are at risk of catching malaria.”

Silé is well aware of such problems, but has no solution. "I’ve got other sick children in the paediatric ward and there are only two of us - my assistant and myself - for all these children and the current 130 [HIV-exposed] children,” she said.

Although the number of health facilities providing PMTCT has increased from one in 2005, to 22 in 2007, covering 15 of the country's 18 districts, Silé commented that there is still a lot of awareness-raising work to be done. Outside of the capital, providing PMTCT services is even harder, she noted.

"The crucial problem is that women cannot do anything without their husband’s permission ... when women agree to take the HIV test, the men come and harass the healthcare workers," she said.

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