MPH Grad Uses Data To Protect Babies In Ivory Coast From HIV

by Kathleen Joyner

As an epidemiologist in the West African country of Ivory Coast, Marie-Huguette Kingbo keeps her mind focused on health research and data. But her heart is with its children.

“My dream is ensuring that no baby in Cote d’Ivoire is born with HIV,” said Kingbo. She acknowledges that’s a formidable task.

The Ivory Coast, also known as Cote d’Ivoire, is one of the 15 countries most affected by HIV/AIDS in the world, she said. With a population of slightly more than 22 million, roughly 460,000 are living with HIV, according to data from the Joint United Nations Programme on HIV and AIDS—42,000 are children ages 14 and younger. This is especially challenging for a country recovering from a civil war that ended less than a decade ago.

“The country was severely damaged by the war,” Kingbo said. The violence forced thousands to flee to neighboring countries or remote regions of the Ivory Coast, where they had little access to food and health services.

Kingbo spent the first 10 years of her health career as a doctor—five of those years in the pediatric emergency unit of a public hospital in Abidjan, a major urban center in Ivory Coast. There, she took care of children suffering from anemia, malaria, diarrheal diseases and respiratory infections. She also cared for children with HIV, most of them 5 or younger.

“One experience that I will never forget happened one day when an HIV-infected new mother walked into my office,” Kingbo recalled. “I learned she did not accept to be HIV tested and she did not come to any prenatal consultations during her pregnancy.

“Her one-month-old twin babies were seriously ill. They had AIDS,” Kingbo said. “And I was unable to prevent their deaths two days later because they did not receive any anti-retroviral drugs during the pregnancy, during labor or thereafter. I was heartbroken, and I felt helpless.”

Soon after, Kingbo said, she made the decision to pursue a degree in public health and a career focused on ending the mother-to-child transmission of HIV. To prepare herself to fight the virus’ spread on a large scale, Kingbo sought to study in the United States and gain research experience with the Centers for Disease Control and Prevention in Atlanta. But first, she had to break the language barrier.

Marie Kingbo

Marie Kingbo

Kingbo, whose native language is French, said she struggled with the English language tests required to gain admittance to American schools. Just as Kingbo contemplated giving up, her brother invited her to visit him in the United States for a summer vacation. During her visit, Kingbo toured the Smithsonian museums and participated in an HIV/AIDS seminar organized by the World Bank.

“At the end of this trip, I was more motivated than ever,” she said.

In 2011, Kingbo earned a Fulbright scholarship and enrolled at the School of Public Health at Georgia State University. After graduating with her Master of Public Health degree in epidemiology in 2013, Kingbo returned to her home country, where she works for Fondation Ariel Glaser.

The foundation is operated in the Ivory Coast by local public health officials and residents and gives technical and financial support to local health authorities, who in turn provide counseling, testing and treatment to children and pregnant women. (The foundation is an offshoot of the Elizabeth Glaser Pediatric AIDS Foundation, a non-profit founded in 1988 by Elizabeth Glaser shortly after the death of her 7-year-old daughter Ariel, to whom she unknowingly had passed HIV.)

Kingbo is a technical advisor of operations, which means she is a professional problem-solver. She tracks HIV data to identify areas that need more research and suggests ways to improve patient monitoring. One issue that Kingbo is focused on is postpartum care.

“Many children born to women with HIV are not being systematically monitored and followed up on during the postpartum period and are thus missing out on life-saving services,” she said. According to data from health centers supported by Fondation Ariel Glaser, they identified 1,095 infants born to HIV-positive pregnant women between October 2014 and September 2015. But 18.5 percent, or 202, of those babies did not receive antiretroviral drugs within two months of birth, putting them at serious risk of developing deadly infections.

Continued tracking and services are not only critical for infants who contracted HIV from their mothers before or during birth, but also for infants who did not to lessen the risk of transmission later on, Kingbo said. Roughly 150,000 infants worldwide are infected with HIV after birth through breastfeeding, according to the World Health Organization.

Until recently, WHO recommended that women with HIV not breastfeed, or stop breastfeeding as soon as they could, Kingbo said. That meant more babies being fed formula. However, infant formula is not always affordable for mothers in developing countries, and studies have shown that children fed formula in places without access to clean water and secure food supplies face higher mortality rates due to diarrhea, malnutrition and other diseases.

“Many Ivorian women reported that financial barriers and associated stigma or fear of disclosure prohibited adherence to these guidelines,” Kingbo said. “As one interviewed woman summarized it, ‘Imagine a woman who doesn’t want to tell her mother-in-law or relatives and friends that she is HIV-positive. She will be asked by the mother-in-law and the community why she gives formula milk to the baby.’”

Public health officials in the Ivory Coast now recommend that HIV-positive mothers who are continuing treatment should exclusively breastfeed their children for the first six months. Mixed feedings—when a mother gives both breast milk and formula or other liquids to her infant—before the age of six months is discouraged for these mothers because studies have shown that practice may damage an infant’s intestinal wall, making it easier for the virus to be transmitted through breast milk, Kingbo said.

Despite their struggles, Kingbo said she believes she and her country have come out stronger.

In the time that Kingbo has worked for Fondation Ariel Glaser, more mothers and children have stayed connected to health services and received life-saving antiretroviral medications. The foundation’s patient retention rate has improved from 78 percent to 81 percent from September 2015 to June 2015.

“What I have learned about my country is that Cote d’Ivoire is a very resilient country,” she said. “And what I have learned about myself is that we should never give up trying to do what we really want to do in life.”

Marie Kingbo (right) and her mother in front of downtown Abidjan.

Marie Kingbo (right) and her mother in front of downtown Abidjan.