At Mtwapa Subcounty Hospital in Kilifi County, mentor mothers play a pivotal role in reducing mother-to-child HIV transmission. These women, living with HIV, guide expectant mothers and new parents through prevention, treatment, and care, ensuring that infants are born HIV-free.
Mentor mothers, like Francisca Adhiambo, affectionately known as ‘Nyako’, are at the forefront of this mission. Adhiambo starts her day early, meeting pregnant women and breastfeeding mothers, providing them with crucial health information. Her role extends beyond just providing advice during pregnancy. She ensures that mothers continue to receive support after childbirth, guiding them on how to care for their infants and prevent HIV transmission. “It is my responsibility to ensure the child is HIV-free and that the mother is well cared for,” she explains. Her work includes educating mothers about HIV, promoting family planning, and referring them for antiretroviral treatment (ART) as necessary.
The hospital has seen significant progress in reducing the transmission of HIV from mother to child. In 2020, during the height of the COVID-19 pandemic, seven infants were born with HIV. However, by 2021, this number had dropped to just one, and in 2022, there were no cases at all. The success continued in 2023, with only one case recorded, which was classified as a seroconversion a case where a baby born to an HIV-negative mother later tested positive due to unknown factors. The introduction of Pre-Exposure Prophylaxis (PrEP) for discordant couples and improved treatment protocols have helped in reducing such occurrences.
The hospital manages up to 230 mothers who receive care, including those who discover they are HIV-positive during pregnancy or breastfeeding. The facility provides continuous monitoring of viral loads, health education, and nutritional guidance. Support from organizations such as USAID through the Stawisha Programme has been instrumental, providing vital supplies like HIV testing kits and medication, which are critical in managing HIV cases.
Despite the success, the hospital faces challenges in maintaining these achievements. Stockouts of HIV test kits and vital medications like nevirapine syrup, especially for infants, have sometimes hindered their ability to provide timely services. Additionally, a shortage of equipment for viral load monitoring and Polymerase Chain Reaction (PCR) testing means some children cannot be tested immediately for HIV. These gaps in resources can be distressing for healthcare workers, as they fear the potential consequences of not being able to fully monitor and treat HIV-positive mothers and infants.
The mentor mothers, who are often in close contact with the community, face emotional highs and lows in their work. While it is incredibly rewarding to help a mother deliver an HIV-negative baby, the opposite outcome can be heartbreaking. “It is so devastating to see a child test positive. So many questions run through your mind on where you went wrong or where the mother made a mistake,” says Adhiambo.
Disclosure of HIV status by mothers to their partners is another challenge. Without full disclosure, a mother’s viral load can increase, putting both her and her partner at risk. While mentor mothers cannot force disclosure, they offer guidance to help women understand the importance of openness in preventing transmission to their partners and children.
Technological innovations have supported the hospital’s efforts in reducing transmission rates. The introduction of electronic medical records (EMR) has streamlined patient tracking, reducing missed appointments and enabling better follow-up care. The hospital has also embraced contact tracing, allowing mentor mothers to track down patients who miss appointments or move to other areas, ensuring continuity of care.
Although the hospital has made significant strides, there is a call for more support from both the government and partners. Increased staffing and the provision of more testing kits and viral load monitoring equipment are essential to sustaining the progress. The hospital’s success is a result of teamwork and collaboration with various partners, including private hospitals, to ensure that every mother and child has the chance for a healthy future.
As one mentor mother puts it, “Being a mentor mother is not just a job, it is a calling. Every healthy baby reminds me why I do this. We are building a future free from HIV, one baby at a time.” The collective efforts of mentor mothers, healthcare workers, and community support have played an invaluable role in protecting the future generation from HIV, offering hope for a world where no child is born with the virus.
