Mother-to-Child Transmission of HIV and Prenatal Care Quality Assessment

Maternal, newborn and child health deficiencies continue to be a major problem in developing countries. Globally, 358,000 women die each year in pregnancy or childbirth, and an estimated 7.6 million children die before their fifth birthday.

Many of these deaths could be prevented by implementing essential interventions that are part of the continuum of care. Since many of these essential interventions were not being implemented at every level of the health services, and often less effective interventions are implemented. In different Latin American countries, progress in sexual and reproductive health has been uneven but, above all, insufficient. Although Colombia has made important achievements in this area, much remains to be done, especially in relation to prenatal care, childbirth and puerperium, which are fundamental elements in guaranteeing the right to life and health of mother and child.

Colombia currently has comprehensive and sufficient norms and regulations to ensure timely, continuous and comprehensive prenatal care. However, progress in terms of national indicators of maternal and infant morbidity and mortality continues to show a highly inequitable distribution, mainly due to the changes observed in large urban concentrations, as they maintain high figures in territorial entities in situations of poverty and with a double humanitarian impact: armed conflict and natural disasters.

In 2009, national figures on universal access to information, prevention, care and treatment for HIV/AIDS showed that only 45% of pregnant women were tested for HIV and were given the result during pregnancy, childbirth or postpartum. This showed that 55% of pregnant women were unaware of their HIV status, which prevented them from taking the necessary measures to reduce mother-to-child transmission of HIV. At the end of that year, 76% of the 2,344 HIV-exposed children registered in the database of the strategy for the elimination of mother-to-child transmission of HIV between 2003 and 2009 lacked follow-up information, and the country did not know their virological status with respect to this infection. Likewise, of the 555 cases with follow-up information, 50 had HIV. This situation resulted in a cumulative percentage of 9% of mother-to-child transmission of the virus. This study was developed by Sinergias within the framework of the technical cooperation agreements of the Ministry of Health and Social Protection as a financing entity and technical referent with UNICEF, UNFPA and IOM.

This process has been a successful case of inter-institutional cooperation, the first phase of this process was carried out between June and November 2010 in the seven departments and three districts that contributed more than half (52%) of the cases of children exposed to HIV without follow-up in the country, namely: Antioquia, Atlántico, Bolívar, Córdoba, La Guajira, Magdalena and Valle del Cauca, with the districts of Barranquilla, Santa Marta and Cartagena. The results of this phase were positive, since it should be noted that in these territories 75% of the cases were closed and the proportion of cases of exposed children with complete follow-up information increased from 30% to 70%. In the second phase, the active search for unmonitored HIV-exposed children and their mothers continued, in addition to the evaluation of the quality of prenatal care in the country. During this phase, which was implemented between March 2011 and May 2012, twenty departments and three districts were prioritized (Amazonas, Antioquia, Arauca, Atlántico, Bolívar, Caldas, Caquetá, Cauca, Córdoba, Chocó, La Guajira, Magdalena, Putumayo, Nariño, Norte de Santander, Quindío, Resalada, Santander, Valle del Cauca and Vaupés, with the districts of Barranquilla, Santa Marta and Cartagena) which were selected based on two main criteria: 1) that had the highest number of pregnant women registered in the strategy's information system without data on the outcome of delivery and exposed children without follow-up, and 2) that were silent in terms of notification of HIV cases in pregnant women or had higher vulnerability indexes (unsatisfied basic needs, differentiated ethnic groups, population dispersion). In this second phase, satisfactory results were also obtained, since 88% of the cases were closed and an increase from 56% to 95% of the complete follow-up data was achieved.

The third phase continued with the active search process in the territorial entities of Bogotá, Cesar, Córdoba, Magdalena, Santa Marta, Tolima, Risaralda and Valle del Cauca, in which 95% of the cases were closed. In this phase, the documentation on barriers and facilitators of access to care and insurance continued.

Simultaneously, a methodological proposal is being developed to improve the quality of care in the first thousand days of life of children born in fourteen municipalities in six of the country's departments, as follows:

• Cordoba: Montelibano and Puerto Libertador

• La Guajira: Dibulla and Manaure

• Cauca: Buenos Aires, Santander de Quilichao and Suárez

• Bolívar: Arjona, Mahates and Magangué

• Chocó: Quibdó and Istmina

• Putumayo: Orito and Puerto Guzmán

This methodology, framed within the national strategy “From Zero to Forever” and with a systemic approach, focuses its efforts on strengthening local technical capacities to improve the care of women during the periods of pregnancy, childbirth and puerperium, and the care of children in their first two years of life, key aspects in the integral development of our children and therefore in the progress and future of the country.