N'Djamena – Judith Haltebaye, a midwife with 15 years of experience, has spent the past seven years serving at the Abena-Atetip Health Centre in central N'Djamena. Over the years, she has supported hundreds of women throughout their pregnancies and beyond. For some, her care involves highly specific follow-ups, as in the case of 34-year-old Menodjie, who is living with HIV. "Menodjie came for a consultation in January, and through routine tests, we discovered she was living with HIV. At the time, she was expecting her second child," Judith recounts.

In Chad, an estimated 65 000 women over the age of 15 were living with HIV in 2023, according to the latest UNAIDS report. The report also highlighted an HIV prevalence rate of 1.3% among women aged 15 to 49 years. To combat the virus, the Government of Chad launched the Prevention of Mother-to-Child Transmission of HIV (PMTCT) Programme in 2005. The initiative aims to protect children born to HIV-positive mothers from infection during three critical stages: pregnancy, childbirth, and breastfeeding.

Overall, indicators of HIV care for mothers and children in Chad have shown significant improvement. The rate of mother-to-child transmission of HIV in Chad has significantly declined, dropping from 29% in 2012 to 19% in 2023. By 2023, according to the same UNAIDS report, 91 000 HIV-exposed children had tested negative for the virus, and 1300 new infant infections had been prevented through the efforts of the PMTCT Programme. In comparison, these figures were 82 000 and 1100 respectively, in 2015.

"We're proud of this progress," says Dr Hassan Ndengar, HIV focal point for the southern district of N'Djamena. "PMTCT really saves lives. Children are the strength of a country, and they represent the future generation. That is why we must invest in them and look after their health." In Dr Ndengar’s opinion, prevention is key. "We know that if we screen pregnant women, we'll be able to reduce transmission rate. From there, we can break the chain of infection and lower the prevalence within the population."

Providing care for pregnant women is central to Chad's efforts to prevent and control HIV/AIDS. Midwives, alongside doctors and paramedics, play a pivotal role as front-line workers in this fight. To strengthen their capacity, they have received technical and financial support from World Health Organization (WHO). WHO's support has also included the development of national guides and guidelines, as well as the implementation of monitoring and evaluation systems to ensure the effectiveness of these efforts.

In collaboration with the Sector-wide HIV/AIDS, Hepatitis, and Sexually Transmitted Infections Programme, 750 healthcare workers have been trained in recent years on the comprehensive management of HIV and hepatitis. "We learned that HIV/AIDS testing is a must for all women who come for antenatal consultations. From the very first contact, we must ensure they understand the importance of being screened," says Judith Haltebaye, a midwife and one of the trained workers. If the initial test is positive, a confirmatory test is conducted. Women who test positive are then provided with free, comprehensive care, including counselling and antiretroviral medicines (ARVs).

Antiretroviral medicines (ARVs) save lives and give people living with HIV the hope of a brighter future. In 2023, 7700 pregnant women in Chad required ARV treatment, and 70% of them received it, an increase from 64% in 2022. The care provided by healthcare teams has profoundly changed lives, as in the case of Menodjie. "These medicines have given me back my strength. Before, I couldn't lift anything, not even a cup near me. Afterwards, the delivery went well, and my daughter was born without the virus," she shares.

The success of the PMTCT Programme and its achievements particularly the majority of children being born HIV-free are transforming attitudes and building trust. "We've seen many HIV-positive women confidently commit to another pregnancy because they know their baby will be healthy if they follow the protocol. They come back to us because they received proper care," says Judith Haltebaye. "Thanks to PMTCT, we're saving a lot of lives, and I'm very proud of that."

In collaboration with the Government, WHO is engaged in resource mobilization, particularly through the Global Fund, and supports the revision of standards and guidelines, the enhancement of diagnostic tools, and the strengthening of data management systems. Beyond addressing HIV, WHO is working to integrate the control of hepatitis B and syphilis into the PMTCT Programme, as well as into maternal, neonatal, and child health services.

"This programme, which addresses three critical diseases affecting mothers and children, will enable us to improve maternal and child health, reduce mortality rates, strengthen the health system, and uphold human rights," said Dr  Blanche Anya, WHO Representative in Chad. "This approach is vital because it places the patient at the centre of interventions. We are working to promote health for all."

Chad has made significant progress toward achieving the 95-95-95 targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) for HIV testing, treatment, and viral load suppression. In 2023, 71% of people living with HIV in Chad knew their status, and 86% of those were on ARV treatment compared to just 47% and 70%, respectively, in 2015. Data on the third target, viral load suppression, were not available.

In N'Djaména, a few months after the birth of her daughter, Menodjie continues her treatment. For her, life has returned to a normal pace, almost making her forget the virus she's living with. "I feel good today, and my children are healthy too. I still remember how happy I was when I heard my daughter's results. Knowing that she is healthy is a great relief, which I wish for all people living with HIV because every mother in the world wants the best for her child."