By: Nyantee S. Togba, LHRJN Fellow
In 2004, the HIV Prevention from Mother-to-Child Transmission (PMTCT) program was set up by Global Strategies for HIV Prevention, an NGO based in San Francisco, California, USA, with the help of the African Education Foundation.
The program was officially introduced in Liberia in 2005, at the time the country was recovering from years of civil war, where the transmission of the HIV virus from an infected mother to her unborn baby was practically a possible case due to lack of medication.
Since its introduction, the program has significantly reduced HIV infections among infants in Liberia.
Mother-to-child transmission of HIV (MTCT) is defined as the transmission of HIV from a mother to her child during pregnancy, labor, delivery, or during breastfeeding. In the absence of any interventions, transmission rates range from 15% to 45%
Currently, Liberia is among other progressing countries in West and Central Africa that have recorded high success in preventing HIV-positive mothers from transmitting the virus to their unborn babies. There have been consistent testing and treatment initiation of PLHIV mothers.
Amidst this progress, the Liberia Women Empowerment Network (LIWEN) holds the view that more still needs to be done in order to achieve the 95 -95-95 target of ending AIDS by 2030 through new approaches.
LIWEN is an organization established to address societal issues women infected and affected by HIV are experiencing in the country.
Madam Cecelia K. R Cole, President of LIWEN said “For prevention of mother-to-child transmission in Liberia, we are getting good results because nowadays the report for infant diagnoses is far better than years back. The health workers and mothers PLHIV who were trained to work at the prenatal care departments at the various health facilities are helping to reduce the risk and this program has worked well.”
Madam Cecelia K. R Cole, President of LIWEN
In an interview with the Liberia Health and Rights Journalists Network, Madam Cole named more testing, virus load suppression and home-based visits at county and community levels are new approaches that need to be given consideration to improve the program.
She however stated that the payment of mother peers, the shortage of supplying antiretroviral therapy (ART) at health facilities as well as the lack of an empowerment program for PLHIV should be worked on in order to scale up improvement.
Also speaking, the Monitoring and Evaluation Officer of the Liberia Network of People living with HIV (LibNeP+), Batie Nah asserted that Liberia has made significant progress in the prevention of Mother-to-Child Transmission.
Mr. Nah said is a mandate given by the Liberian Government that all mothers living with HIV who are pregnant should do their test and know their status.
According to him, the government and other private facilities are doing well in helping mothers to remain safe and alive.
The National AIDS Commission has said Liberia has made good progress in accelerating the testing coverage to reach 68% of persons living with HIV knowing their status, indicating that most of the people tested and on treatment are pregnant women, through the PMTCT program.
The new plan has to be innovative to reach more men and initiate more key populations that test positive for HIV to be treated.
Liberia, according to the UNAIDS report has one of the highest Antenatal coverage for PMTCT services offered to pregnant women. The country’s Mother-to-Child Transmission (MTCT) rate including the breastfeeding period is 15.12%, while the MTCT rate at 6 weeks is more than 6.73%.
Madam Theodosia S. Kolee, Chairperson of the National AIDS Commission said with this progress in the PMTCT program, the country is now focusing on the Elimination of Mother to Child Transmission of HIV (EMTCT) through different programs.
Madam Kolee quotes the National HIV Strategic Plan II (NSP II) as saying, primary prevention of HIV and prevention of unintended pregnancies among girls and women who test HIV positive are the first and second strategies for prevention of mother-to-child transmission among girls and women is absent.
Madam Kolee said, “the focus remains on diagnosing pregnant women for HIV and initiating treatment. Loss to follow-up of HIV-exposed infants reflects the challenges in the health system to identify these children at the first immunization clinic attendance which is scheduled at 6 weeks after birth. Immunization coverage for the first visit is very high and this is a missed opportunity for the national program.”
According to the AIDS Commission boss, high levels of stigma and discrimination and related GBV which is quite prevalent in Liberia also contribute to mothers not disclosing their HIV status and not demanding to know the HIV status of their infants.
“Less than 15% of exposed infants are diagnosed with HIV in Liberia and there are large numbers of children under 15 years diagnosed with HIV and on treatment at the various hospitals, especially in Monrovia. No child should be born with HIV with the medication and services that are available in most health facilities. More effort will be required to close this gap,” Madam quotes the country’s HIV NSP II-2021-2025.
Madam Kolee said the country’s new HIV strategy documented in the NSP-II is fully aligned with UNAIDS’ Fast Track targets, focused on evidence-based interventions, and aims to accelerate programs on HIV combination prevention, test and treat and reduce loss to follow-up of persons living with HIV.
She said, “The next five years are critical for Liberia as it takes stock of progress made, the gaps and challenges, and what it will take to get back on the Fast Track with the national response. We, as national stakeholders, must take ownership of the results and targets that are to be the focus for Liberia”.
The plan according to her aims to create an enabling policy and legal environment free of stigma and discrimination.
She however said to achieve this, multiple stakeholder engagement and strong leadership and coordination will be required.
The PMTCT cascade analysis of Liberia indicates that 671 new infections among children were documented in 2018, 27% and 41% of the infection come from HIV-infected pregnant women that were not on ART and from HIV-positive women that drop out from ART during pregnancy (20%) and breastfeeding (21%)
The Joint United Nations Program on AIDS (UNAIDS) documented Liberia as having the fastest rate of acceleration between 2017 and 2018. However, the loss to follow-up of PLHIV initiated on treatment has increased significantly with only 2,000 of the 13,000 tested positive initiated on treatments.
This fellowship story was supervised by the Liberia Health & Rights Journalists Network (LHRJN), with funding from the American Jewish World Service (AJWS).