How AI is driving war on mother-to-child transmission of HIV

A health official displays ARVs used in the treatment of HIV/Aids. [Courtesy] In 2005, Nelima*, was admitted to the maternity ward at Siaya Central Hospital. However, she did not know that she was HIV-positive. It was not until she was about to give birth that doctors informed her of her status. "When the nurses found out I was HIV-positive, some refused to touch me," Nelima recalls. "They even stopped helping me." Despite the stigma, her son was born HIV-negative. She attributes this to prayers and strict adherence to guidance from doctors. "I was green when it came to understanding how to protect my child from contracting HIV through breastfeeding," she says. "Back then, the stigma was so bad. People thought just sharing a cup or touching someone with HIV could infect them. It's by the grace of God that my son is 19 years now, HIV-free." While Nelima's story ended with hope, recent data paints a troubling picture of mother-to-child HIV transmission (MTCT) trends in Kenya. Despite the country progress on prevention of mother-to-child HIV transmission , challenges such as funding cuts, service disruptions, and shifting demographics threaten to reverse the gains. Dr Calvine Lwaka, Country Manager for the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), says, "Many expectant mothers delay or skip antenatal care visits, missing opportunities for early detection." "Without timely HIV testing and treatment, the risk of transmission during pregnancy or breastfeeding increases," he adds. According to the 2024 National Syndemic Disease Control Council (NSDCC) report, Kenya's MTCT rate stands at 7.3 per cent. However, in counties like Kakamega where MTCT rate stands at 14 per cent, Busia 11 per cent, and Pokot 17 per cent far exceed the national average. Traditionally high-prevalence regions such as Siaya and Homa Bay have seen rates drop below 7 per cent, thanks to targeted interventions and community awareness programs. The Covid-19 pandemic exacerbated existing vulnerabilities. Dr Lwaka says supply chain disruptions affected access to diagnostic tools and antiretroviral drugs. "Delayed interventions critical for preventing transmission became more common," he says. Additionally, demographic shifts have introduced HIV to previously low-risk areas, straining underprepared healthcare systems. Funding reductions have further limited the reach of prevention programs, especially in underserved regions. Globally, UNAIDS reports that nearly 150,000 children were newly infected with HIV in 2023-a 14 per cent increase from pre-pandemic levels. Sub-Saharan Africa remains disproportionately affected. Dr Lwaka emphasizes that preventing MTCT requires a comprehensive strategy: Enhanced Antenatal Care (ANC), partner involvement and frequent viral load checks ensure adherence to antiretroviral therapy (ART). He emphasizes that providing antiretroviral medications to infants until breastfeeding cessation, followed by confirmatory HIV tests is very important. When discussing ARVs for children, it's crucial to consider treatment and preventive therapy. ARVs for children are formulated to suit their needs, often in liquid form or as dispersible tablets, as children generally face difficulties swallowing pills. Additionally, these medications may be flavored to improve acceptance. In cases where a mother is HIV-positive, "she must consistently take HIV treatment to maintain a low viral load, significantly reducing the risk of transmission during breastfeeding." The child receives preventive ARVs during breastfeeding, typically using a combination of nevirapine, zidovudine, and lamivudine. This therapy continues for the breastfeeding period and an additional six weeks after cessation to ensure complete protection. Dr Lwaka explains that, regular testing is essential during this process, at 2-, 9- and 18-months antibody testing post-breastfeeding. These steps help determine whether the child has contracted HIV. If the child tests positive, they are promptly started on lifelong treatment. The key difference between ARVs for children and adults lies in formulation. Children's medications are designed to be palatable and easy to administer. Adults, on the other hand, typically take standard pills or tablets. Like any medication, ARVs may cause side effects. These can vary by individual and are often most noticeable when treatment begins, as the body adjusts to the new drugs. Over time, many side effects diminish. However, if serious adverse effects occur, healthcare providers review and adjust the medication. Mothers and caregivers play a vital role in observing any changes in the child's health, reporting them during clinic visits, and ensuring timely intervention. To ensure effective treatment for side effects healthcare workers regularly assess the child during clinic visits. Adjustments to medication are made, when necessary while severe side effects are reported to national programs for further review. "If a child struggles with ARVs or breastfeeding risks increase, mothers may be advised to transition to alternative feeding options," says Dr Lwaka. Efforts to make ARVs child-friendly, liquid formulations or dispersible tablets, flavoring to ease administration and continuous monitoring and caregiver education on proper use and observation for side effects. Kenya's "PAMA care" model exemplifies this integrated approach, offering families a seamless package of medical, psychological, and social support. Cultural taboos surrounding sexual health education remain a significant barrier. "Providing young people with knowledge about safe sexual practices is crucial," says Dr Lwaka. He advocates for incorporating HIV education into school curricula and community workshops to combat misinformation and stigma. "Prevention is possible, but it requires early action, consistent funding, and community involvement," he stresses. As Kenya battles these challenges, technological innovation offers new hope. Dr Charlie Maere, a global leader in digital health at EGPAF, explains how artificial intelligence (AI) is revolutionizing HIV care. "We don't just focus on pediatric Aids; we consider the child, the mother, and the surrounding community holistically," he says. In Kenya, over 400 healthcare facilities now use AI-driven electronic medical record (EMR) systems to enhance HIV prevention and treatment. These systems predict the likelihood of mother-to-child transmission or treatment default, enabling timely interventions. "AI acts as a co-pilot for clinicians, providing actionable insights," says Dr Maere. For instance, the system can flag high-risk cases during routine visits, allowing healthcare providers to intervene proactively. EGPAF is also leveraging AI in diagnosing other conditions, such as tuberculosis (TB) and cervical cancer. In regions with limited access to specialists, AI-driven tools analyze chest X-rays or medical images, bridging critical diagnostic gaps. Looking ahead, Dr Maere envisions AI systems integrated with national health records. These would allow patients to access personalised advice through chatbots and mobile apps. While still in the prototype phase, this innovation could transform how patients engage with healthcare. "AI has the potential to transform healthcare," says Dr Maere. "But its impact depends on aligning technology with real-world needs." "HIV transmission is preventable. It requires unwavering commitment from all stakeholders-government, healthcare providers, and communities alike," says Dr Lwaka.

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