On a Mission to Save Babies

An interview with the determined Catherine Motswere-Chirwa, whose work features in last month’s MMWR

In Botswana, 30 percent of pregnant women are infected with HIV. Although Botswana has reduced mother-to-child transmission of HIV from 40 percent to less than 4 percent, hundreds of infants are born infected with HIV each year.

The Early Infant Diagnosis Program (EID) was started to quickly diagnose infants and start them on antiretroviral treatment. To evaluate the program, Ms. Catherine Motswere-Chirwa of CDC Botswana went through hospital records to track down all 202 HIV-infected infants who were diagnosed from 2005 through 2012 around Francistown. Only 75 percent of mothers ever received their infant’s HIV test results and 60 percent ever received antiretroviral treatment. By late 2013, only 41 percent of these infants were alive.

In a recent interview, Ms. Motswere-Chirwa said her interest in the EID study went beyond simply collecting data: “I was determined to see that even those who were infected were able to receive care, treatment and support they needed to live longer just like adults.”

The study, “Follow-Up of Infants Diagnosed with HIV — Early Infant Diagnosis Program, Francistown, Botswana, 2005–2012”was featured in the Feb. 21 edition of CDC’s MMWR. An interview with Ms. Motswere-Chirwa follows:

I originate from Tonota village in the Central District and grew up in Francistown. I am married to Dr. Lovemore Chirwa (a senior physician researcher with CDC Botswana) from Kitwe, Zambia. I joined CDC Botswana on the 31st May 2005. During my first week with CDC, Dr. Tracy Creek arrived from Atlanta to start the EID pilot study. In June-December 2005, we piloted it in Francistown. I was involved in training health care workers, data collection, counselling and, of course, follow-up of infected infants.

During the pilot of the study, one of my mandates was to track all HIV positive infants and determine how many of them were referred and started on HAART (Highly Active Antiretroviral Therapy). After the results were released for the pilot, I decided to continue with follow up for PMTCT (Prevention of Mother-to-Child Transmission) programmatic purposes. Feedback was given on yearly basis to the national PMTCT program during updates workshops and trainings.

My main interest in this was to try and save as many babies as possible. EID was able to inform us that at least 96 percent of our infants exposed to HIV were born free from infection, and I was determined to see that even those who were infected were able to receive care, treatment and support they needed to live longer just like adults.

The main message of this report is that even in the most successful PMTCT program like in Botswana, we are still left with major challenges of testing all infants born to HIV infected mothers. Some parents do not receive test results of their infants, including HIV positive infants, and linking infected infants to care and treatment is still a challenge. Above all, we are losing a large number of infants who are not initiated on treatment.

These 202 infants were tracked on a quarterly basis each and every year from 2005 to 2012. I worked very closely with PMTCT lay counsellors from the clinics. I would start at our HIV Reference Laboratory in Francistown and collect information on infant’s names, sex and facilities they visited. I then went around to all of the 13 clinics to collect information on date of blood collection, date of post-test counselling and those that were reported dead either before starting treatment or after being initiated on treatment.

The main challenges I encountered were missing information from the infants’ testing registers because of poor documentation. There were challenges with lack of transport for lay counsellors to conduct home visits, as well as having wrong house numbers and phone numbers.

The results were kind of shocking to me. On a yearly basis, we were reporting results and I would become very emotional when I noticed the high number of infants who were dying and those who were lost to follow up. We used to say that for those who were lost to follow up, it is likely they were either started on treatment somewhere else or have died without being reported. At the same time, I was consoled by the fact that those infants who were started on treatment from as way back as 2005 were alive and doing very well.

The lesson is that with rigorous follow-up of infants, all of our babies can live a healthy, longer life just like adults. Integration of services is very important to allow patients to seek help in a one-stop shop. We need to put mechanisms in place to ensure that all infants are referred and seen and started on treatment on time. For those on treatment, we have to ensure that they stay on treatment.

Maybe we have lost a lot of children, but we should not lose sight of the number of children who never acquired HIV and those who are HIV-infected and doing well on ARVs.  It’s the successes that should keep us all going.

I want to appreciate each and every one who was involved in this study: the CDC team, Francistown DHMT and Nyangabgwe Referral Hospital. A special appreciation to all those individuals who believed in me and in what I was doing, including Dr. Tracey Creek, Ms. Lydia Lu,  Dr. Thierry Roels, Dr. Molly Smit, Dr. Kathleen Toomey, Dr. Andy Pelletier, Dr. Drew Voetch and, of course, my husband, Dr. Lovemore Chirwa.

Ms. Catherine Motswere-Chirwa was the PMTCT Team Lead in Francistown during the time of this study. She has since been redeployed to the position of Program Manager for the Project AIM Study at CDC Botswana in Gaborone. The EID study can be found on the MMWR website: http://www.cdc.gov/mmwr/