Mentor mums stem the tide of newborn HIV infections in Kwale

Listed as one of the 10 counties that perform dismally in preventing HIV transmission from pregnant women to their unborn children, Kwale County had a headache in its hands.

At Diani Health Centre, one of the newer facilities in the county that serves about four pregnant women every day, denial and stigma would see some of these expectant mothers disappear as soon as they found out they were HIV-positive, making it difficult to initiate measures to prevent transmission of the virus from the mothers to their babies. Of those who needed the intervention, two in every five would stay off crucial medication.

It was against this background that the “mentor mothers” project was born last year, to stem the tide of pregnant HIV-positive women who fled after finding out their HIV status, by getting them on treatment to prevent mother-to-child transmission of the virus (PMTCT). Josephine*, a mother of a two-year-old boy who is HIV-negative is one such mentor mother.

When she learnt she was HIV-positive at the ante-natal clinic in 2013, her first impulse was to keep that information from her then fiancé because she was convinced he would reject her. To her utter surprise, he stood by her in the face of discrimination, and went on to marry her.

When the “mentor mothers” project was launched, she was one of the first to sign up as a volunteer. She is one of 24 women tasked with tracing and persuading HIV-positive women in 12 health facilities to get on the treatment that will protect their babies from infection. To prepare them for this work, the women are trained by the County Health Department. They also get a monthly stipend of Sh7, 500.

When she started, Josephine was surprised by the sheer number of HIV-positive pregnant women who had defaulted on treatment.

NEW MODEL

“I was given 400 files of mothers who disappeared after learning they were HIV-positive,” she explains. To convince the women to get on treatment, she shares her own story, which often does the trick.

However, the work is not without challenges as some women give false contact information, making it hard to trace them. To get around this, Josephine reaches out to community health volunteers, who are more knowledgeable about the people who live in various villages.

Apart from tracing defaulters, Josephine also counsels and walks with the women attending the ante- and post-natal clinics at health facilities in Msambweni Sub-County. She has even devised a curriculum.

“We talk to them about how to feed their babies and how to live happily as a discordant couple where one partner is HIV-negative and the other is HIV-positive,” she says.

Though Kwale County’s HIV prevalence rate of 5.9 per cent is lower than that of counties in Nyanza which record the highest prevalence in Kenya, it was worrisome that women who tested HIV-positive would not be enrolled for treatment, and those who were did not adhere to treatment. The fear was that this would roll back the gains in prevention of mother-to-child transmissions. Nationally 79,000 women needed PMTCT in 2015, and 59,000 (74 per cent) were put on treatment.

This led to a decline of babies infected with the virus from 12,000 in 2010 to 6,600 in 2015. And though experts commended Kenya for the progress it had made in reducing HIV transmission from mothers to their children, during the annual HIV conference held last year in Nairobi, they raised alarm that it remained a challenge in some counties. Flora Shali, a PMTCT nurse at the Diani Health Centre told HealthyNation that ever since they introduced the mentor mothers, they are able to retain 93 per cent of pregnant women who test HIV-positive and get them on treatment, a 53 per cent increase.

While the model is new in Kwale, using patients to stem the tide of HIV infection has been used in other places such as in Homa Bay, Migori and Kisumu counties, where Faces – Family Aids Care and Education Services— pays a monthly stipend to patients who are stronger to reach out to those who have a hard time accepting their status. Such programmes work as public-private partnerships, where private companies give financial incentives to the peer mentors.

The impact of this approach has been the lowering of HIV transmission to newborns, but it also comes with an economic benefit.

“The first batch of mothers received a seven-month contract and they work on a full-time basis, enabling them to take care of their families and to start small businesses,” says Juma Mwamvita, the Kenya Mentor Mothers Programme champion for Kwale County.