The Eradication of the Immunodeficiency Virus Human (HIV/AIDS) Transmission from Mother-to-Child (ETMC) in the Maternity Ward at the Ratoma Medical Centre, Conakry, Guinea

Objectives: The objectives of this article are to: 1) Determine the prevalence of parturient that escapes from the ETME, 2) Determine the rate of acceptability or non-acceptability of the HIV tests, 3) Describe the epidemiological profile and 4) Describe the factors explaining the lack of screening during pregnancy. Methodology: This report is based on an eventual descriptive study carried out in the Maternity Ward at the Ratoma Medical Centre for the past six months. The study took place over six (6) months from June 15 to December 15, 2016. The data were collected by individual interviews using a data collection sheet and prenatal consultation booklet that were administered to parturients in their language of comprehension. Each unscreened parturient received in the delivery room or in immediate postpartum received pre- and post-test HIV/AIDS counseling with immediate announcement of the outcome for all those who accepted the principle. For parturients who were in the active phase of work, counseling/testing was done in the immediate women that have recently given birth, ignore their HIV status. About 36.90% (66/177) rejected the screening and the 6.4% (7/111) that accepted were HIV/AIDS positive. The epidemiological study revolved around the following categories of women aged between 24 and 33 (42.85%), 1) Married (100%), 2) Housewives (57.14%), 3) Out-of-school (57.14), 4) Lack prenatal follow-up (42.85%), 5) Ignorance of the existence of HIV (71.42%). Reason Invoked for the Unawareness: No screening was proposed for prenatal follow-up (90.40%). Conclusion: The HIV testing approach in the work room could serve as a catch-up strategy to reduce vertical transmission and thus increase the operational coverage of the PMTCT service. The upgrading providers of basic facilities would be necessary in order to offer the HIV screening in refocused prenatal consultations, which could reduce the catch-up/contamination in the work room.


Introduction
The eradication of the human immunodeficiency virus (HIV/AIDS) Transmission from Mother-to-Child (ETMC), in its comprehensive approach is an intervention package in view of preventing or reducing the transmission of the HIV/AIDS from the mother to the child [1]. The catch-up of the ETMC is a measure consisting the rapid screening counselling of the HIV in the workroom for women who are unaware of their seropositive status and to put the seropositive ones and their newly born babies under intensive care anti-retrovirus RVs [2]. These prophylactic practices have considerably reduced the vertical transmission of HIV/AIDS in developed countries especially in France and in the United States at least to 2% [3].
In Africa, the HIV screening services have been introduced at the prenatal consultations level (ANC). However, the coverage of these services remains insufficient. As a result, many women still give birth without knowing their HIV status and cannot benefit from adequate prevention measures in this context [4].
The survey which was carried out in 56 ETMC sites in Benin in 2008, shows that the HIV prevalence among pregnant women has attained 3.9% [5]. They were all under antiretroviral treatment.
The sero-survey sentinel report in Ivory Coast in 2008 indicated that HIV seroprevalence has attained 4.5% among pregnant women aged 15 -49. Almost all of these women have received antiretroviral treatment [6].
The first investigation in Guinea had given prevalence median rates of 2.8% and 2.5% among pregnant women in 18 health centres in 2004 and 2008 [7].
Thus, we carried out this study with the following objectives: to determine the prevalence of parturient who escapes ETME, determine the rate of acceptability or reaction to HIV tests, describe the epidemiological profile and describe the

Methodology
It was a descriptive prospective study of a duration of 06 months conducted at the maternity ward of the Ratoma CMC which is a 2nd level structure in Guinea.
The study focused on a continuous series of 423 parturient received in the working room. Included in the study were all women who had come to give birth despite age, residence, who did not know their HIV status and had accepted the screening. Any parturient who refused to do part of the study was not included in the study. We conducted a comprehensive recruitment of cases according to defined criteria as mentioned above.

Prevalence
The survey indicated that out of the 41.80% (177/423) women who have recently given birth, ignored their HIV status. Open Journal of Obstetrics and Gynecology

Result of the Testing Test
The survey indicated that 6.4% (7/111) among the parturient who have accepted the screening test were HIV/AIDS positive.

The Epidemiological Profile
1) Age: The most concerned amongst age groups are from 24 to 33 with an average age of (42.85%) 24.75 years and 14 and 40 years beyond.
2) Profession: 57.14% of the most concerned were Housewives.
3) Level of education: 57.5% of the majority of our patients were illiterate 4) Matrimonial status: 100% of the patients represented were Brides.  and 07 were positive (6.4%).  [9] in their respective surveys with 4.34% and 72%.

Prevalence
The non-completion of prenatal care, the repudiation of some women to be diagnosed and the absence and/or insufficiency of screening tests could justify these results.

Result of the Screening Test
Among the parturient who have accepted the screening test, 6.4% (7/111) were HIV/AIDS positive. This result is in accordance DEMBELE B's [8] and Mwembo Tambwe A.N.K. et al.'s findings [11] in their respective surveys with 10% and 4%, 8%. At National level, this result is far superior to that of Guinea's DHS III, which reports a prevalence of 2%, 8% among women.

He Epidemiological Profile
1) Age: The most concerned amongst age groups are from 24 to 33 with an average age of (42.85%) 24.75 years and 14 and 40 years beyond. This result is in accordance with DEMBELE B's [8] and Mbang D.D [12] et al.'s findings [11] in their respective surveys with 51.4% and 33.8%. This high proportion of HIV/AIDS among young women could be explained not only by the fact that they are highly involved in promiscuous sexual behaviour and have no notion of preventive methods, but also their early involvement in marriage with sexually active men, which exposes them to a major risk of contamination. 2) Profession: the most concerned were Housewives with an average of 57.14%.
This result is similar to DEMBELE B. findings [8] 54.1%. The consequence could be explained by not only the low level of education of these women, the lack of means, and the influence of the society but also the partner's refusal to use the condom during sexual intercourse.
3) Level of education: 57.5% of the majority of our patients were illiterate. This result is lower than that found by Mwembo-Tambwe A.N.K et al. [11] in Lubumbashi 92.6%. This result reflects the realities socio-cultural activities in Africa and particularly in Guinea where the rate of enrolment of girls is only 41% according to EDSG III [13]. 4) Matrimonial status: Brides represented 100% of the patients.
ESSIDAGUI/2001 [14] found a similar result 92%. This could be explained by the fact that in our communities it is frowned upon that a single woman conceives on the one hand and on the other hand, the use of means of protection (condom) is almost non-existent even in polygamous homes

Clinic Open Journal of Obstetrics and Gynecology
Reasons that prevented HIV testing include: non-provider testing during prenatal follow-up, lack of information, and lack of interest in the test. These patterns are similar to those advanced by Moth et al. [15] Kalichman et al. [16] and Muchedji and Al [17] in their respective studies.
-THE HIV/AIDS AWARENESS LEVEL: Women in the workroom had a low level of knowledge about HIV (71.42%). Similar results were obtained by Perez et al. [18]. The lack of information on the need for NPCs and the lack of training of health providers on the refocused NPC would contribute to this result. This shows, on the one hand, the need for an awareness of the population centered on the ETME and, on the other hand, a service organization that can increase its geographical, socio-cultural and financial accessibility. Recent studies have shown a correlation between HIV testing in pregnant women and the strategy used. Programs that wait until the demand comes from the pregnant woman have low prevalence of screening compared to those who routinely offer the test to all pregnant women with routine ANC [18]. However, the proposal should be made in such a way as to allow the pregnant woman to freely accept this test. In the same vein, a poor quality service may lead pregnant women to abandon prenatal consultations after the results of screening [16].

Conclusion
The HIV testing approach in the work room could serve as a catch-up strategy to reduce vertical transmission and thus increase the operational coverage of the PMTCT service. Upgrading providers of basic facilities would be necessary to provide HIV testing in refocused prenatal consultations, which could reduce catch-up in the work room.