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41% HIV-positive pregnant women get treated late due to stigma, lack of support: study

🔴 Of concern, according to the study findings, was that more than half of the babies born to HIV-positive mothers are reported beyond the stipulated time period of 6-8 weeks for HIV testing under the Early Infant Diagnosis (EID) component of the National AIDS Control Programme (NACP.)

Written by Anuradha Mascarenhas | Pune |
Updated: December 1, 2021 11:26:52 am
HIV can be transmitted from HIV-positive pregnant mothers to their infants during pregnancy (antenatal), at birth and after birth as well as during breastfeeding.

Nearly 41.3% HIV positive pregnant women received antiretroviral treatment for either less than one month of pregnancy or after delivery due to stigma, discrimination and lack of family support, a new study by Indian Council Medical Research, National AIDS Research Institute and Tata Institute of Social Sciences has revealed.

Of concern, according to the study findings, was that more than half of the babies born to HIV-positive mothers are reported beyond the stipulated time period of 6-8 weeks for HIV testing under the Early Infant Diagnosis (EID) component of the National AIDS Control Programme (NACP.)

“So, they miss the opportunity of early HIV diagnosis and subsequent initiation of ART treatment,” Dr Suchit Kamble, principal investigator of the study and scientist at ICMR NARI, Pune, told The Indian Express. “Though 94.3 per cent of women were on ART treatment, 41 per cent of them got treated late in pregnancy,” Dr Kamble said.

Scientists at NARI and TISS conducted a study across the country to assess the gaps in the implementation of Early Infant Diagnosis programme and reviewed EID programme data across 62 Integrated Counselling and Testing Centres and 30 Anti Retroviral Treatment centres across 11 states of India. Data of over 800 HIV positive pregnant women and more than 850 HIV exposed infants was reviewed during the study period 2018-19.

HIV can be transmitted from HIV-positive pregnant mothers to their infants during pregnancy (antenatal), at birth and after birth as well as during breastfeeding. However, studies have proved that initiating treatment for HIV positive women as early as possible during pregnancy and giving prophylaxis with certain antiretroviral drugs to the newborn during the early days of life has significantly reduced the risk of perinatal HIV transmission from 30% to less than 5%,.

Moreover, diagnosis of HIV infection among infants born to mothers with HIV at an early age of infancy is crucial to prevent further mortality and morbidity (illness) among these babies. The ‘Children with HIV Early Antiretroviral Therapy’ (CHER) trial conducted in South Africa provided much-needed evidence that early therapy against perinatal HIV infection can help reduce early infant mortality, researchers have said.

HIV diagnosis during earlier days of infancy requires sophisticated molecular diagnosis techniques like nucleic acid application tests (NAT) at specialised laboratories. The National AIDS Control Programme has initiated an Early Infant Diagnosis EID testing-programme since April 2010. All HIV exposed infants are followed-up at peripheral Integrated Counselling and Testing Centres (ICTCs) until they are 18 months of age (ICTCs), said Dr Sheela Godbole, head of Epidemiology at ICMR-NARI.

Under this EID programme, Dried Blood Spots (DBS) are collected from infants on a special filter paper periodically at six weeks, 6 months, and 12 months of age until confirmed HIV diagnosis is ruled out. These DBS samples are couriered to regional reference laboratories (RRLs) located across seven regions in India for NAT. These RRLs communicate test results to concerned ICTCs and then to the concerned caregiver of HIV- exposed infants. Infants with confirmed HIV diagnosis are linked with ART centers for treatment initiation.

WHO has recently released guidelines that specified that nucleic acid testing (NAT) should be initiated right from birth. The guidelines also specify that in settings with a high burden of HIV infections, infants and children with unknown HIV status who are admitted for inpatient care or attending malnutrition clinics should be routinely tested for HIV.

While the country is committed to elimination of mother to child transmission of HIV (EMTCT) and aims for universal access to HIV testing for all pregnant mothers and their babies, this study has captured the key processes, gaps, and barriers, along with the quality of services and data in the EID programme, Dr Nilesh Gawade, co-principal investigator from TISS, Mumbai, pointed out.

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