In 2011, only 54 percent of HIV-positive pregnant women in Cameroon received antiretroviral drugs (ARV) to prevent HIV transmission to their infants, and only seven percent had a CD4+ count done to determine their eligibility for antiretroviral therapy (ART) for their own health. Due in part to low ART coverage among pregnant women who are eligible for HIV treatment, Cameroon has an estimated rate of mother-to-child transmission (MTCT) of 24 percent. In response, the Government of Cameroon is taking action to rapidly improve the coverage and quality of prevention of mother-to-child transmission (PMTCT) services in the country. For example, in 2012, the Ministry of Public Health (MOH) endorsed Option B+ as a potential strategy to achieve the elimination of MTCT. Option B+ involves providing ART for all HIV-positive pregnant women for life—irrespective of CD4+ cell count and regardless of their eligibility for treatment.
ICAP initiated its activities in Cameroon in October 2012 to assist the MOH and the National AIDS Control Committee (NACC) to enact the national PMTCT elimination strategy. ICAP’s work focuses on strengthening the national monitoring and evaluation (M&E) system for PMTCT and providing policy makers and health leaders with data to guide the scale-up of PMTCT services, including Option B+.
On April 26th, ICAP’s team in Cameroon, led by Dr. Ebogo Mesmey, joined representatives from NACC, the MOH, and U.S. Government partners in Yaoundé for a launch of a report on the estimated cost of a phased introduction to Option B+ in Cameroon. At the meeting, results were shared from a model developed by CDC/OGAC that demonstrated that Option B+ would be cost effective on the long term.
“In Cameroon, the intent is to use data to inform every stage of the strategy to eliminate mother-to-child transmission of HIV,” said Dr. Mesmey, who worked with researchers to gather inputs for the B+ costing study and organized the recent dissemination meeting. “Evidence is telling us that Option B+ can prevent 75,000 new infant infections in five years, safeguard the health of mothers, and may even reduce horizontal transmission to partners.” The report acknowledges that several programmatic challenges could intervene to constrain such potential benefits, including low antenatal care attendance, poor retention and adherence during pregnancy and beyond, and ARV stock outs, among others.
ICAP is currently working with partners to enhance the way health facilities collect and manage information about mothers and infants enrolled in PMTCT programs. Since 2012, ICAP’s team of technical experts has worked with the MOH and other PMTCT stakeholders to revise patient registers, summary reports, and other tools needed for a robust national M&E reporting system. After pilot testing the revised tools, plans are in place to reproduce and distribute the registers and to train health workers in 84 health districts in the Central, Littoral, Northwest, and Southwest regions of Cameroon on their use. The goal of these activities is to generate more accurate information about PMTCT patients, to use the data to detect challenges in service delivery, and, ultimately, to improve the way patients receive care. In addition, ICAP is working with CDC and other partners to design a large-scale evaluation to determine the extent to which women utilize PMTCT services during pregnancy. All of these activities will provide key information that will inform the country’s approach to preventing, and eventually eliminating, MTCT.
