Today I spent the day in the HIV antenatal clinic. It was very informative as I have not seen many patients in my training thus far with HIV, let alone pregnant patients. This clinic cares for pregnant patients, postpartum mothers, and infants/toddlers to the age of 18 months. As I discussed previously, every pregnant patient is tested for HIV at their first point of contact unless they have a recent result. Thereafter, it is recommended to test every 3 months until they have finished breastfeeding as HIV can be passed to the child (termed “mother-to-child- transmission”, or MCT) during pregnancy, at birth, and while breastfeeding. Prevention of mother to child transmission (PMCT) is the goal. This can be achieved by ensuring the mothers are on medications, they receive an early diagnosis in pregnancy, and low counts of the virus in the mother are maintained, especially at delivery. The babies are also immediately placed on nevirapine to further reduce the risk of transmission. If they are a high risk baby, meaning any of the components above are not true, they will take this medicine for 12 weeks. If they are low risk, they will take it for 6 weeks. After birth, the babies are registered in a national registry so as to have close follow up in the first couple years of life. In an ideal situation, babies are evaluated at 4 weeks and if their HIV test is negative then they will be evaluated at 9 months, 6 weeks after cessation of breastfeeding, and 18 months. If they remain negative, then they are “discharged” from the HIV clinic. If at any time they are positive, then anti-HIV medications are stated. With all this coordination of care, it was very surprising to me that in a community that is so geographically separated, where close to no one has reliable transportation and few have consistently working phones, most patients attend their visits as scheduled. This speaks to the excellent public health services in the country. Just like the community antenatal clinic, this clinic utilizes community members, called peer mothers, to keep track of and follow up with patients if needed, even if that means going to their homes. These women also act as a source of education for these mothers and as a support group as they have also been through the clinic themselves. Furthermore, the HIV clinic is the first place I have seen a computer in this hospital and the nurse was using a national electronic medical record to enter each patient’s information so that if they present to any hospital in Uganda, they can be tracked and cared for. The last component that helps maintain patient compliance is that all antenatal, HIV, and family planning services are free of charge in Uganda.
Lugandan word of the day: omuwala (“oh-moo-wall-uh”, noun, girl)
Medical learning point of the day: Exclusive breastfeeding is encouraged here for all mothers, including those with HIV (in contrast to the US), due to the affordability and great nutrition that breastmilk provides the infant. Mothers with HIV are encouraged to exclusively breastfeed until 6 months as early introduction of food could cause micro trauma to the esophagus and be a potential access point for HIV transmission through breastmilk. They are then strongly encouraged to stop breastfeeding when the infant is 12 months of age as the risk of HIV transmission at that point outweighs the potential benefit of further breastfeeding.
