With over 3,500 infants delivered annually in Barbados and 90 percent of these at the Queen Elizabeth Hospital (QEH), there have been no new cases of Paediatric HIV, or deaths recorded in the last three years, on the island.??
This information, coming during Child Month, has been described as ???very heartening??? by Consultant Paediatrician at the QEH, Dr. Anne St John, who is a leading researcher on Paediatric HIV/AIDS in the region. Dr. St John has published and presented numerous research papers related to the results of the Paediatric HIV/AIDS epidemic in Barbados, at national and international meetings.
She attributed much of the island???s success to an aggressive programme for the Prevention of Mother to Child Transmission (PMTCT) of HIV and for?? the treatment of diagnosed cases of paediatric HIV. ???Over the last 25 years, we have been very successful using a multi-pronged approach. Firstly, emphasis is placed on the prevention of HIV infection in women, where we look at voluntary testing and counselling. This has been quite effective. At every opportunity, health care workers encourage the women and their partners to be tested,??? said Dr. St. John.
She added: ???For those who are sexually active, we stress HIV education, discussing how it is spread, discouraging multiple partners and also encouraging abstinence for those who prefer that practice.???
Elaborating on the PMTCT programme, the consultant pediatrician stated that another aspect of the public health approach, used here, focused on measures to ensure that transmission of HIV did not occur from the pregnant woman to her newborn infant.??
She stressed: ???Doctors recommend abstinence from breast feeding in HIV infected mothers, since this is a significant mode of transmission. Counselling is provided, anti-retroviral therapy is prescribed from early in pregnancy and the mother is also supplied with alternative sources of nutrition in the form of baby formula.?? This reduces the chance of transmission, significantly.???
Anti-retrovirals are also given to the baby for one week after birth to reduce the virus which the infant might have developed, up at the time of birth. This has proven to be extremely successful in reducing the transmission of HIV in new babies.
It was also revealed that, in Barbados, with over a 99 percent follow-up of infants born to HIV infected women, attaining an overall transmission rate of less than two percent during the past five years of the PMTCT programme, no new case of mother to child transmission had been recorded since 2006.
With there being no deaths recorded of a child diagnosed with Paediatric HIV, or from its associated complications in the past three years, this can be further attributed to the extremely aggressive approach to care and treatment of children with Paediatric HIV/AIDS and, a tremendously successive PMTCT programme on a national level.
The pioneer in research since the 1980s recounted that early initiatives at screening children for HIV were marked by a high degree of suspicion she said: ???In the early stages of the epidemic, cases were investigated mostly after presenting clinical illness and after more of these were diagnosed, policies were developed and education of the medical and allied professionals, on the island, was upgraded.???
The first adult case of HIV was recorded in Barbados in 1984 and the first case of Paediatric HIV was in 1985. The latter was a child with recurrent infections, weight loss and suspected congenital immune deficiency who was sent to a paediatric specialist centre overseas for further investigation.?? Some weeks after the child???s return to the island, information was received of a positive test for HIV antibodies.?? The child died within a year.
From 2000 to 2002, no deaths from paediatric HIV were recorded; however, in 2003, the figure rose to three.?? While there were no deaths recorded in 2004, one child succumbed to the illness in 2005.?? According to Dr. St. John, the four deaths in this period were all diagnosed before the PMTCT intervention was introduced.
Commending the initiatives taken to stem HIV/AIDS on the whole, Dr. St. John noted that there were multiple goals of management and therapy in paediatric HIV/AIDS, all geared towards reducing complications from the disease and mortality. ???The main goal is to reduce the viral load.?? In Barbados, we are very privileged to have a state of the art regional laboratory, the Ladymeade Reference Unit, equipped for monitoring patients who have been diagnosed with HIV/AIDS.
???At the QEH, we follow infants who are exposed in utero, for at least 18 months or, until testing negative, according to a protocol in keeping with regional and international guidelines. HIV infected patients are also followed up periodically, according to their clinical picture and we measure what???s called CD4 count, which are white cells in the blood that deal with infection.?? The aim is to reduce viral load with therapy and increase patients??? CD4 count,??? said the consultant paediatrician.
It was further explained that treatment and monitoring also seeks to reduce the occurrence of opportunistic infections ??? yeast and skin infections, meningitis and particular types of pneumonia – responsible for death.?? ???We prescribe a regimen of antiretroviral medication which is supplied free by Government to combat the virus and associated conditions,??? said Dr. St. John.??
The Caribbean is the second region, after Sub-Saharan Africa, with a high prevalence of HIV/AIDS in children. The pattern on HIV/AIDS has varied, with numbers being highest in Haiti, Jamaica, Trinidad and the Bahamas. In places such as Haiti, where cases of HIV/AIDS continue to be diagnosed, the age range varies and, survival rates can be quite low, with not a lot of children surviving beyond the age of two.?? Figures provided by the Caribbean Epidemiology Centre (CAREC), in Trinidad state that approximately 3,000 children born per year to mothers in this region are infected by HIV and, approximately 1,000 would be HIV-infected without PMTCT intervention.??
However, what is more telling, according to CAREC, is that 500 lives per year could be saved through a PMTCT programme, as demonstrated in the Bahamas, Bermuda and Barbados – territories which have been leading the way in the fight against HIV.??
jgill@barbados.gov.bb