“Being told that my baby, Aditi*, was born without the human immunodeficiency virus (HIV) was probably the happiest news I’ve ever heard,” said Belagavi-based Radhika Naik*.
The relief — after protracted periods of guilt and fear — was unmatched, she told South First.
Naik is one of the 311 HIV-positive women in Karnataka who managed to deliver HIV-free children in the last seven months.
And it has been possible apparently thanks to Karnataka’s strict implementation of Lifelong ART (anti-retroviral therapy) programme for all pregnant women living with HIV for the Prevention of Parent-to-Child Transmission (PPTCT) of the virus.
A senior official from the Karnataka State Aids Prevention Society (KSAPS), quoting statistics, told South First that Karnataka had been gearing up for the elimination of mother-to-child transmission of diseases like HIV and syphilis.
“We have succeeded in bringing the number from 65 newborn babies with HIV in 2019 down to 16 so far this year. The state is showing a declining trend in the detection of new cases among pregnant women, and the results of Mother-to-Child Transmission (MTCT) look promising,” said an officer from KSAPS.
ASHA, ICTC centres play a role
Naik learnt that she was HIV positive when she was three months pregnant. “I was tested by an ASHA (Accredited Social Health Activist) from my village for giving me the tayi card and tested at the ICTC centre. As soon as I got my reports, I made my husband tested and we realised he was also HIV-positive,” she said.
Her life appeared shattered. It was the couple’s first baby and they did not want to inform their families about their HIV-positive status due to the fear of stigma and humiliation.
The ASHA, Sunandamma*, and the ICTC counsellor were “my biggest moral strength”, said Naik.
They referred Naik to an ART centre where antiretroviral treatment was initiated immediately.
“Any pregnant woman will be counselled first before HIV testing. The aim is to ensure that the child is HIV-free. So, as soon as a woman is found HIV-positive, she will be placed on ART treatment,” said Rama M*, an ASHA.
“It becomes all our responsibility to ensure the mother delivers a healthy, HIV-free baby,” she explained.
Test-and-treat policy for HIV+ mothers
MTCT of HIV is the primary route of transmission of the virus among children.
According to Lalitha Hande, the transmission is known to occur during pregnancy, delivery, and breastfeeding periods with equal frequency.
“Without any intervention, the risk of transmission of HIV from the infected mother to her child is 20-45 percent. In Karnataka, the PPTCT programme was implemented in 2002 with emphasis on registration of mothers for antenatal services, HIV testing, institutional deliveries, and continuous care,” Dr Lalitha Hande, State Consultant for PPTCT and Maternal Health Programmes, UNICEF, Karnataka, explained.
She said this programme was an earlier single-pronged approach where a single dose of a medicine called Nevirapine was given to the mother during delivery and to the child soon after birth till 2012.
In 2014, the state adopted the WHO guidelines on PPTCT called the ‘Test and Treat Policy’on the directives of the National Aids Control Organisation (NACO).
“Since then, the transmission of cases has been coming down every year. Karnataka’s strict implementation of this policy and follow-ups have been leading the state towards the elimination of MTCT of HIV,” Hande said.
Reduction in number of MTCT cases
According to statistics from KSAPS, the number of women who were identified as HIV-positive in the state in 2018-19 was 772. However, only 65 babies from them were found to be HIV-positive.
The number went down to 51 babies from 627 women in 2019-20, 49 from 575 women in 2020-21, 54 from 528 women in 2021-22, and 16 from 327 women till October in this annual cycle.
“Earlier, with single dose Nevirapine, the MTCT rate was 11 percent in Karnataka, which is now reduced to 3 percent with the WHO’s recommendation of combination medicine (triple-drug regimen) of Tenofavir, Lamivudine, Efaviranezor, Lamivudine, and Dolutegravir as soon as the mother is detected positive,” said Hande.
“This is a lifelong treatment, and the baby is given syrup of NVP (ARV prophylaxis) from birth to six weeks of age and periodic testing for HIV is done,” she added.
What worked in Karnataka?
Apart from strict testing for HIV cases in all pregnant women, tracking them to guide them to referral centres, ensuring that they take the medicines, and regular treatment and counselling did the trick, said the officers at KSAPS.
The role of public-private partnerships, where more than 400 private institutions enrolled to implement ICTC services in their facilities played a role in reducing transmissions.
The officials also said that meetings are held every six months to ensure meticulous follow-up of all pregnant women, institutional deliveries, and tracking children till 18 months of age.
Through this initiative, Karnataka trained private practitioners and medical college faculties as well.
Several periodic review meetings and data-quality assessments are being conducted in the state for completeness and correctness of data, says a senior official from the state health department.
Recommendations by KSAPS
Karnataka is gearing up to meet the goal of UNAIDS and promising to eliminate MTCT by 2025 with these recommendations:
- Mandatory registration of all pregnant women at health facilities in the first trimester.
- Counselling and testing for HIV and Syphilis
- If a woman is found HIV positive, then refer her to an ART centre and initiate Antiretroviral treatment at ART centres.
- Adhere to ART treatment and regular follow-up.
- Advocate for institutional delivery only
- Advice exclusive breastfeeding soon after delivery.
- ARV prophylaxis to the child soon after delivery.
- Periodic early infant diagnosis testing at 6 weeks of birth, six months, 12 months and again at 18 months of age.
- Placement onto ART if the child is detected HIV positive
- Involvement of family and enrolment in social protection schemes.
*Names have been changed to protect the identity of persons quoted in this story as per their requests.