Role of TBAs in Preventing Perinatal Transmission of HIV: BMJ

[Guest guest]

" Role of Traditional Birth Attendants in Preventing Perinatal

Transmission of HIV "

British Medical Journal (01.26.02) Vol. 324; P. 222-225::Marc

Bulterys; Glenn Fowler; Shaffer; Pius M. Tih; Alan E.

Greenberg; Etienne Karita; Hoosen Coovadia; M. De Cock

Worldwide, more than an estimated one million women infected

with HIV deliver babies without professional help each year. In

rich countries, rates of perinatal transmission of HIV less than

2 percent are now reported because of the use of antiretroviral

drugs, elective caesarian section and the avoidance of breast-

feeding. Transmission rates of 5 percent or lower are now

possible in middle income nations and some urban areas of the

developing world due to the use of short course antiretroviral

drugs, infant feeding choices and possible elective caesarian

delivery. However, offering these benefits to most women infected

with HIV is a tremendous challenge, especially in rural

communities, in which more than two-thirds of the population of

sub-Saharan Africa lives.

Current pilot projects to prevent perinatal transmission of

HIV in poor countries have focused primarily on women living in

urban areas or in areas with relatively developed health care

infrastructures. The simplicity and low cost of the use of short

course nevirapine (single dose) suggest that this regimen might

be very useful in rural settings. Obstacles to its use in the

face of precarious health care infrastructures and few counseling

and education services are great. This article considers the role

of traditional birth attendants who, over the past decade, have

been trained in midwifery and basic hygiene as part of a safe

motherhood initiative as intermediaries between the new medical

services and the women in need of them.

The ability to prescribe short courses of antiretroviral

therapy presupposes that the infrastructure for antenatal care is

able to provide quality care, including HIV counseling and

testing. In rural areas of developing countries, transportation

difficulties and fear of violence or discrimination hamper

women's decision to get services, as do the lack of facilities.

Innovative models of prevention of perinatal HIV transmission

involving birth attendants are needed to overcome these obstacles

to care by providing decentralized and home-based intervention

strategies. These strategies could be adapted to rural settings

where formal antenatal and maternity care services are severely

limited, and where local concerns could be directly addressed.

In villages in India, workers have been trained to assess

signs of neonatal sepsis, deliver prophylactic co-trimoxazole,

and provide supportive neonatal care. In Tanzania and the Gambia,

when traditional birth attendants are selected for training, an

understanding exists that the community will support them by

helping with farming and by buying small items such as soap and

razor blades. Although traditional birth attendants often

complain about the lack of rewards for their work, these issues

could be addressed, as well as their needs for continuing

education.

According to the authors, the present challenge is to

translate the findings of research looking at perinatal

transmission of HIV into implementable public health programs and

to link these efforts to primary prevention of HIV infection in

adults and the care of infected individuals. Resistance and

barriers to effective collaboration between birth attendants and

healthcare workers will also have to be reduced.

The use of birth attendants to help prevent perinatal

transmission of HIV would include their learning the tasks of:

*Disseminating information about HIV

*Identifying pregnant women in their communities and facilitating

their use of antenatal and maternity services

*Facilitating appropriate counseling and testing by pregnant

women and their partners

*Reinforcing health messages, including the importance of

improved nutrition during pregnancy

*Supervising directly observed treatment of mother and infant

with nevirapine

*Offering advice on reducing the risk of HIV transmission to

women and their partners.

In conclusion, the authors believe that " generalizable

models applicable to other poor settings could be developed from

demonstration projects that involve traditional birth attendants

as part of an innovative and successful model of rural healthcare

delivery that emphasizes prevention of perinatal transmission of

HIV. "

__________________

Dr Dirk Buyse

International Program Officer

Glaser Pediatric AIDS Foundation

1730 Rhode Island Avenue,NW

Suite 400

Washington, DC 20036

Phone: 202-296-9165

Fax: 202-296-9185

Email: dirk@...

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