By Emma Black

From a zoom meeting  held on 7 April 2025 with local and international healthcare workers, Mariama Conteh, a start registered nurse  with 20 years of working experience at Bo  hospital , said  as Sierra Leone presses forward in its fight against HIV/AIDS, a troubling gap in pregnant women’s understanding of antiretroviral therapy (ART) threatens efforts to halt mother-to-child transmission, a new study from Kaduna State, Nigeria, offers critical lessons that could bolster Sierra Leone’s push to eliminate vertical HIV spread provided the country acts swiftly.

published as beyond HAART unveiling the Reality of Antiretroviral therapy knowledge among pregnant women living with HIV in Kaduna State, Nigeria, the study reveals a stark divide: while 75.4% of surveyed pregnant women had solid HIV awareness, only 44.3% understood ART well, despite 98.6% expressing willingness to use it. Sierra Leone, with an HIV prevalence of 1.5% and systemic hurdles mirroring Nigeria’s rural healthcare shortages, stigma, low literacy, and underfunded facilities faces a parallel challenge.

under Sierra Leone’s Option B+ strategy, HIV-positive pregnant women are tested and immediately started on lifelong ART to prevent transmission to their babies. Yet, success hinges on more than access to drugs; it demands comprehension, many women don’t grasp how ART works or why it’s lifelong, said Mariama Conteh, a nurse at a Bo community health post, we explain, but without consistent counseling, some drop off.

The stakes are high, untreated, the risk of a mother passing HIV to her child ranges from 15 -45%. With ART, that plummets below 5% or even 2% in non-breastfeeding contexts, the Nigerian findings underscore a key truth: a positive attitude isn’t enough if knowledge lags, undermining adherence.

Kaduna’s researchers advocate tailored solutions client-specific education at every healthcare touch point, spousal involvement in counseling, and better-trained staff, for Sierra Leone, where health workers juggle heavy loads and outreach funding is thin, these strategies could be a lifeline, we need counselors and materials in local languages, said Fatmata Bangura, a Kenema community health volunteer, women want to protect their babies they just need clear, steady guidance.

With a 2030 target to end mother-to-child HIV transmission, Sierra Leone must prioritize closing this knowledge gap. Task-shifting to community workers, routine counseling, and monitoring could turn intent into action, the Nigerian study’s call for education-first approaches offers a roadmap if Sierra Leone can muster the resources and resolve.