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Wednesday, 14 August 2013 08:12

South Africa's new highly effective PMTCT guidelines

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Written by Professor Ashraf Coovadia and Liezel Pienaar

In the last 12 years, South Africa has shown great progress in the prevention of HIV transmission from mother to child (PMTCT). This success has been in large part due to improvements in anti-retroviral drug choices available and the widespread accessibility to the PMTCT programme.

In 2001, when the PMTCT programme began, this involved the pregnant mother taking just a single tablet of a drug called Nevirapine during labour, with very little intervention before and after the birth of the baby. The baby also received a few drops of Nevirapine syrup. Breast-feeding was also initially discouraged as it was another route of HIV transmission. The South African government committed to providing formula, but due to high costs and distribution problems this, in itself, led to additional and more serious problems. Babies were at serious risk of developing conditions like diarrhoea and malnutrition and even death from these. A revision of the guidelines was clearly necessary and the policy has since undergone several stages of improvement, largely based on recommendations from the World Health Organisation, with adaptations by local experts in the field.

With the latest guidelines implemented as of April 2013, it is now felt that the country has reached a point where almost complete eradication of paediatric HIV is a reality.  Women are now able to receive highly effective treatment as soon as they enter the programme at any clinic throughout the country. Breast-feeding is also encouraged as anti-retroviral drugs will assist with prevention of HIV transmission and the baby will receive all the well-known benefits of breast milk. The programme goes beyond just the ante-natal and delivery period to include post-natal care by providing appropriate treatment, care, and support to women living with HIV, their children and their families.

Additional services that are available for all women and men include routine counseling and testing, TB screening and provision of TB preventative treatment. The involvement of the partner to provide care during the pregnancy is also encouraged as well as HIV testing for this partner. Counseling on safe infant feeding practices is available to all new mothers and infants will receive Nevirapine daily for six weeks to protect against infection. This six-week programme is called “infant prophylaxis”. These infants are followed up in care and infant HIV testing is carried out at the immunisation clinics at six weeks of age.

With all these changes the hope is that the utilisation rate and the effectiveness of this health programme will be enhanced to provide true holistic ante-natal and post-natal care for all women.

The PMTCT programme also links to the United Nations’ Millennium Declaration adopted in the year 2000, contributing to a number of the Millennium Developmental Goals or “MDGs”, as they are commonly referred to as. By having a good policy in place, we see less babies being born HIV-positive. This is a significant contributor to the reduction in child mortality.

It also contributes to the general improvement of maternal health where we will see a major reduction of maternal deaths due to preventable conditions.

Government’s message to all women who are either planning to have a baby, are currently pregnant or are breast-feeding, is that it is vital to know your HIV status so that the appropriate interventions can start as soon as possible. If you are newly diagnosed or previously diagnosed HIV-positive (but not on treatment) you should receive triple anti-retroviral therapy at your first antenatal visit or at the time of diagnosis. The sooner you start your treatment the better the outcome. Once you start your treatment, take your therapy daily and don’t skip doses. Good adherence is the key to a good result and the same applies to your baby’s medication.

 

It is also very important to always practice safe sex by using condoms, even if you are HIV-negative. Continuous exposure to the virus is not good for your health or the health of your unborn baby. It is also highly recommended that you involve your partner in the pregnancy experience. That way, he will feel part of it all and provide the support you need. And lastly, take all the information about safe infant feeding options for your baby into consideration and make an informed, safe and acceptable feeding choice for your baby, bearing in mind that the Department of Health recommends breast-feeding for all women, including HIV-infected women.


These revised and improved guidelines will enable a further reduction in the number of HIV-infected babies. It is now attainable to reduce the transmission rate to less than 2% compared to 25-30% if a mother and infant have no PMTCT intervention.

South African policy makers and health care workers will make every effort to improve maternal and child health in the strife to ultimately eradicate paediatric HIV.

 

* Professor Ashraf Coovadia is the chairperson of SANAC's Children's Sector and head of HIV services at the Rahima Moosa Mother and Child Hospital, in Johannesburg.

* Liezel Pienaar is a research pharmacist at the Empilweni Services and Research Unit, in Johannesburg.

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