GULU UNIVERSITY MEDICAL JOURNAL

Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5.
within the scope of comprehensive multisectoral HIV/
AIDS control programmes (Gundel et al 2003). The
provision of antiretroviral (ARV) drugs to pregnant
women living with HIV can reduce transmission to
below 2%, yet 20,000 children in Uganda become
infected annually, accounting for an estimated 42% of
all new infections in the country according to Family
Health International [FHI] (2007).
According to Gundel et al (2003), “the major
components of the PMTCT Programmes are
sensitisation of the general and the target population,
continuous support and training of the health personnel,
improvement of infrastructure in the intervention sites
and implementation of voluntary counselling and
testing services (VCT).” Others include procurement
of reagents, supplies, test kits, drugs, offering of
nevirapine, infant feeding counselling and replacement
feeding, if wanted, HAART for mothers, their children
and partners, implementation of a monitoring and
evaluation system, and accompanying research.
The high prevalence of both obstetric related maternal
mortality and HIV among pregnant women in most
African nations shows the need for programmes that
simultaneously address both problems (CHANGE,
2005). The FHI (2007) reported that integrating
PMTCT within the health care delivery system has
proven that it is possible to provide services to pregnant
women living with HIV and their families with better
outcome. In Tororo Uganda, 90% of pregnancies
among HIV positive women were observed to have
been unintended and this highlighted the need to
integrate the country’s family planning and HIV
services. Providing such services could help HIV
positive women avoid unintended pregnancies and
where pregnancies occur, contribute to PMTCT. For
example, it was established that integrating family
planning services within Voluntary Counseling and
Testing (VCT) centers improved family planning
service provision without compromising VCT quality
of care in Kenya (FHI, 2007). Similarly, an assessment
of the cost of two models of integrating HIV VCT into
family planning clinics in South Africa’s Northwest
province found that the integration made either service
less expensive.
PMTCT programmes in Uganda were first piloted in
the year 2000 in Kampala and in the northern districts
of Arua and Gulu but the services are now available in
most health facilities all over the country (UN IRIN,
2008). Studies have also shown that knowledge of
the availability of services and correct infant feeding
options after birth are still low. Many HIV positive
women do not know what food or drink to give their
breast feeding babies. Instead, cultural beliefs, social
stigma, ignorance and economic status influence
their attitude and preference for the different feeding
alternatives being used (UN IRIN, 2008).
The benefits of the PMTCT programme
According to Nuwagaba, Mayon, and Okong (2007)
the benefits of the PMTCT programme in their
study included improved health seeking behaviour
among women, acquisition or refurbishment of new
buildings put in place to accommodate the PMTCT
staff plus new equipment, training of hospital staff
and the first PMTCT sites to be established becoming
resource centres for training other health workers.
Other benefits included sharing experience and giving
technical advice, improved obstetric care and laboratory
services, increase in the number of women delivering
in the hospital, and reduced chances of MTCT of HIV
among others.
In northern Uganda where conflict has severely affected
health services, an estimated 70% of women have access
to PMTCT services. The MoH had intended to scale
up the services to all county level health centers by
2010 and indeed the services are now available at most
county level health centers (UN IRIN, 2008). As such,
despite the insecurity caused by a two-decade-long
war, PMTCT programmes in the region are reported
as largely successful. For instance, the Association of
Volunteers in International service (AVSI), reported an
acceptance rate of above 90% of its HIV testing and
counseling programmes in Kitgum and Pader districts
between May 2002 and September 2003; and that
more women are now attending an antenatal clinics
and delivering in health facilities (UN IRIN, 2008).
At the same time, the HIV prevalence ranged between
5% and 9% so in these two districts
(Ciantia et al., 2004).
Gulu University Medical Students’ Association (GUMSA) Passion for life 36