B. Ryan Phelps is Medical Officer for PMTCT and Pediatric HIV, and Melanie Tam is a PMTCT Intern. Both work in the Office of HIV/AIDS. Photo credits: Victoria Guerra and Melanie Tam.
“Oh, most definitely. Most definitely,” Nurse Maria responded [in Portuguese]. I had asked if expectant, HIV-infected mothers in her clinic were excited about lifelong HIV treatment.
As in many clinics in Angola’s Luanda province, the sound of women, babies, and traffic surrounded us with a unique din. Leaning in closer, Nurse Maria continued, “They want to breastfeed and they want to stay healthy to care for their babies. Lifelong treatment lets them do that.”
That was on June 28. I was part of a visiting delegation reviewing Angola’s prevention of mother-to-child transmission of HIV (PMTCT) portfolio for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Two days later, the World Health Organization (WHO) released its new 2013 consolidated guidelines for antiretroviral treatment (ART). These guidelines pave the way toward lifelong treatment for all pregnant and breastfeeding women with HIV, regardless of CD4 count or clinical stage.
Physicians, nurses, and community health workers of Clinical Km 12 with PEPFAR technical consultants during site visit. Photo credit: Dr. Samson Ngonyani
Angola’s National Institute in the Fight against AIDS (INLS) has already drafted guidelines to reflect many of these changes. Angola’s new guidelines provide an opportunity to significantly expand access to PMTCT for the country’s pregnant women living with HIV. One in five of these women currently receive the drugs and services required to protect their babies from infection. Unfortunately, because access to HIV treatment among infants and children in Angola is minimal, infection often means that these children face either a fast (<1 year) or slow (1-5 years) death.
Knowing this all too well, Nurse Maria, with support from PEPFAR, USAID Angola and USAID’s partner, ForcaSaude, has begun preparing for the transition to universal treatment. Maria works in a clinic called, “Clinico Kilometero 12”, after the nearest distance marker along a very busy road outside of Luanda, Angola’s capitol. It is a lively place, and thousands of mothers depend on the clinic near kilometer 12 for their pre- and post-natal care.
I met one of these mothers while there. Her name was Gloria, and she let me hold her healthy, newborn baby girl. These few seconds of face-time with one of PEPFAR’s newest beneficiaries was easily the highlight of my week.
As for the new WHO guidelines, I am not going to go into too much detail about them here. Global health policy documents, even those that exist to protect babies like Gloria’s, are not exactly page-turners. I will say, however, that these new guidelines are the product of over a year of work with dozens of global partners, including USAID. They represent the first ever consolidated global HIV guidelines, incorporating all age groups, several life-preserving interventions, as well as specific, practical programmatic guidance. And for the first time, these guidelines provide an option for universal, lifelong treatment of pregnant mothers who test HIV-positive.
Approximately 5,800 new pediatric HIV infections occur in Angola each year–one in fifty of all children born with HIV worldwide. Nurse Maria and others like her, with support from PEPFAR through USAID, are striving to change that. It is a hopeful time in Angola. If you doubt this, drive approximately 12 kilometers outside downtown Luanda and see for yourself.