Personal reaction to the launch of PMTCT in India

[Guest guest]

Dear All,

According to the health minister, short term Zidovudine & Nevarapine

would be provided free of cost to HIV positive pregnant mothers for

prevention of mother to child transmission from the 1st of January 2002.

Great news except that it is one & half years too late, since

confirmation of the effectiveness of Short-term Zidovudine & Nevarapine

in prevention of mother to child transmission after HIVNET & Petra

trials were published.

Some personal thoughts on the Minister's comments -

(a) Availability of infrastructure: Out of 27 million pregnancies

every year, only 30-40% of deliveries occur in health settings, so rest

of the pregnant women who have delivery home will not be covered by any

antenatal clinic and in turn PMTCT program.

* Do we have enough HIV testing & counselling facilities to handle

even the 30% that attend antenatal clinics in hospitals?

* How can we improve ANC services so that scaling-up of PMTCT

activities can becomes efficient?

( Counselling facilities: Counsellors are required to provide

health education as well as pre & post-test counselling to pregnant

women attending the antenatal clinics around the country.

* Do we have enough trained counsellors to handle all the

pregnancies occurring all over the country?

* Will the group counselling/health education provided to groups of

women in antenatal clinics be pushed into undertaking HIV test

without adequate risk assessment?

* Will there be linkages established between health education

sessions and Voluntary Counselling centres to provide quality

pre-test & post-test counselling?

* How can we ensure uniform standards of messages & quality of

counselling provided by counsellors? The operation research study

on the content of counselling conducted during the course of the

pilot multi-centric study on MTCT showed that the counsellors were

not adequately trained with feeding option issues and

inadvertently, they might have communicated choice towards

substitute feeding. So the women were not provided options for

making an informed choice with regard to breast-feeding or

substitute feeding.

© Prevention of parent to child transmission rather than mother to

child transmission: All over the world it has been seen that you need to

enlist the support of husbands and the mothers-in-law in improving

access to antenatal clinics & Voluntary Counselling & testing centres.

* How can we include husbands in the existing antenatal and maternal

& child health services?

* Will couple counselling be provided before HIV tests?

(d) Cost effectiveness of PMTCT program: PMTCT is an expensive

program when one includes the cost for HIV tests, honorarium for at

least 2 counsellors in every antenatal clinic, cost of medicines

(Zidovudine or Nevarapine), transportation costs and administrative

costs. The only study conducted so far has been by Dr Prasanna in Kerala.

* Should not a study be commissioned to look at cost effectiveness &

cost benefit ratio of various models of PMTCT?

I hope Ministry of Health & NACO keeps all these points in mind while

launching PMTCT services all over the country.

Regards,

Dr Bitra

Sharan & Salaam Baalak Trust

mailto:bitra_george@...

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[Guest guest]

Dear All,

This is in response to the Dr. Bitra 's Personal reaction to the launch of

PMTCT in India.

Considering the fact that a substantial number of deliveries are taking place

in pvt nursing homes/ clinics especially in high prevalence states, it will

be crucial that pvt sector is also to be on board for any such intervention to

achieve its objectives.

Also considering gender dimension, what about treatment to mothers?

Dr.Dinesh Agarwal

E-mail: <dinesh.agarwal@...>

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[Guest guest]

Dear Forum Members,

I think the decision of the health minister to now go ahead with MTCT

should be appreciated, even it is late. India spent a lot of time in doing

the feasibility study.

The biggest challenge I consider to implement would be the recognition of

HIV during pregnancy and it is going to be a difficult task cosnidering the

sensitiveness of the issue. But, then we have to take up the challenge.

There is no escape route. We should take the advantage of the avialibility

of the somewhat affordable means of preventing mother to child transmision.

Even 60% prevention of transmission by the drug is going to be a significant

step towards curbing the growth of the epidemic through perinatal

transmision.

There are places in the country, where HIV is discussed and cared openly

without any visible stigmatization from the community. Perhaps my Manipur,

Maharastra and Andhra Pradesh colleagues would agree with me to some extent.

Thinking country as a whole also I would say people have now beocme more

aware and sensitive towards HIV than they were say 5 years back.

We cannot widely practice the ARVs as done in the West because of the

economic comulsions but we can surely try to adopt MTCT. First is accepting

the challenge, next we would be able to find out and practice how to do it.

Dr.A.K.Agarwal

South Asia, Regional Technical Advisor, HIV/AIDS. CRS

E-mail: crsei@...>

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[Guest guest]

Dear friends,

All those interested in PMTCT are invited to read the following:

1. Merchant RH et al. Strategy for preventing vertical transmission of HIV.

Bombay experience. Indian Pediatrics 2001; 38: 132 - 138.

2. TJ. Mother-to child transmission of HIV must be prevented. Indian

Pediatrics 2001; 38:680 - 682.

3. TJ. Frequency of mother-to-infant transmission of HIV. Indian

Pediatrics 2000; 37: 1027 - 1029

Any local pediatrician will be getting Indian Pediatrics regularly and you

can access the journal locally.

T .

E-mail:<vlr_tjjohn@...>

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[Guest guest]

Reply to Dinesh Agarwal's concerns.

[Dr.Dinesh Agarwal (dinesh.agarwal@...) wrote; (snip)Considering the

fact that a substantial number of deliveries are taking place in pvt nursing

homes/ clinics especially in high prevalence states, it will be crucial that pvt

sector is also to be on board for any such intervention to achieve its

objectives. Also considering gender dimension, what about treatment to mothers?]

Each point is valid.

But, any journey must begin from where you are.

The short course treatment does no good for mother, true, but no harm

either. But we can reduce MTCT from about 305 now to less than 5 % in those

who actually get treated.

The principle and policy are the beginning points. From there, increasing

proportions of mothers will get the benefit in coming years. More deliveries

must take place under supervision, for the sake of the safety of mother and

newborn and the new policy will be one more reason to encourage this.

Let the Govt first accept its responsibility to formulate policies and then

other steps will follow.

Private sector has already begun some action. But it is in a policy vacuum.

T .

E-mail: <vlr_tjjohn@...>

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