Pretoria dithers while babies are infected
The Department of Health is stalling the introduction of treatment that can prevent over 90% of pregnant HIV positive women from infecting their babies.
Currently, up to 30 000 babies are being infected with HIV by their mothers in KwaZulu-Natal alone each year.
A leading paediatrician has described the delay as ‘shameful’, while the Treatment Action Campaign (TAC) says it is considering court action to force government to expand its programme.
At present, national treatment for the prevention of mother-to-child transmission (PMTCT) consists of one dose of nevirapine to women when they are in labour and one dose to their babies within 72 hours of birth.
However, a year ago the World Health Organisation recommended that pregnant HIV positive women in developing countries should get ‘dual therapy’ comprising of nevirapine and a short course of AZT to protect their babies from HIV infection.
The Western Cape has been using both nevirapine and AZT since May 2004, and has managed to reduce its mother-to-child HIV infection rate to around 8%.
In KwaZulu-Natal with its nevirapine-only regimen, 22% of HIV positive mothers are infecting their babies with HIV.
‘In KwaZulu-Natal alone, 20 000 to 30 000 children are being infected with HIV each year and half of them will need antiretroviral drugs by the age of 12 months,’ said a frustrated Professor Nigel Rollins, head of the Centre for Maternal and Child Health at the University of KwaZulu-Natal.
‘The delay in introducing dual therapy is shameful. How women and children be denied the right to treatment when the people on the ground are saying it is possible to implement this?’
South Africa is one of only nine countries in the world where the child mortality rate is increasing instead of decreasing, mainly as a result of children dying of AIDS-related illnesses.
The Medical Research Council, the National Essential Drugs Committee and the Medicines Control Council have all recommended to government that the country adopt dual therapy.
Last December, many doctors working in government hospitals say they were told to prepare themselves for the imminent introduction of dual therapy.
But the National Health Council ‘ made up of the health minister, provincial health MECs and heads of department — has consistently failed to make dual therapy national policy or even set up a task team to investigate its introduction, even though it has discussed the issue.
Health spokesperson Sibani Mngadi confirmed that the NHC had discussed dual therapy. However, he refused to be drawn on whether the department intended to change its protocol to dual therapy or when this might happen.
‘The National Strategic Plan, adopted by Cabinet, has made room for the introduction of dual therapy,’ said Mngadi.
But when asked if hospitals that were ready could introduce dual therapy, Mngadi said ‘ideally this should not be the case since overarching policies and guidelines stem from the national Department of Health’.
Many hospitals in KwaZulu-Natal and Gauteng are ready to implement the dual therapy. The Northern Cape’s provincial health department has already approved dual therapy, but is waiting for national government’s go-ahead before implementing it.
KwaZulu-Natal health spokesperson Leon Mbangwa said that while his province was preparing to introduce dual therapy, this would not be done ‘until we have received a national directive to do so’ as ‘it is not yet national policy to use dual therapy in South Africa’.
Dr Victor Fredlund confirmed that he had been ‘been corresponding with the national and provincial departments for the past eight months about the desire of five hospitals in Umkhanyakude [in the far north of KwaZulu-Natal] to implement dual therapy’.
At present, Fredlund’s Mseleni Hospital is offering dual therapy to those patients who can afford to buy AZT.
Gauteng health spokersperson Zanele Mngadi simply said that dual therapy was ‘under review’ and ‘it is envisaged that a decision will be made in this regard soon’.
One Tshwane doctor who asked not to be named said his hospital had already started dual therapy as ‘we think it is better to have to say sorry afterwards than to ask permission’.
TAC spokesperson Nathan Geffen said that his organisation could not understand the delay, as ‘dual therapy will save the lives of babies and reduce the burden on the health system of caring for sick children’.
Geffen added that although it would prefer not to, the TAC was considering court action to compel government to introduce dual therapy. In 2003, the TAC succeeded in getting the courts to compel government to make nevirapine available to pregnant HIV positive women.
This week the Joint Civil Society Monitoring Forum, which represents over 20 health and civil society organisations, wrote to the health department and asked it to immediately allow provinces that were ready to offer dual therapy and to set up a task team to consider how best to implement the WHO recommendations on dual therapy.
‘There is no good public health reason to stall the implementation of dual therapy. It is not difficult to implement. If we are serious about preventing HIV, we must start by preventing babies from getting HIV,’ said Forum spokesperson Fatima Hassan.
In May, Dr Francois Venter, president of the SA Clinicians Society, wrote to the SA National AIDS Council (SANAC) asking it to investigate the delay.
‘Several doctors and ARV managers working in both rural and urban environments have raised the issue that they have been promised updated guidelines repeatedly, but these have not been forthcoming,’ said Venter in his letter.
The new National HIV/AIDS Strategic Plan aims to reduce the rate of mother to child transmission to 5% by 2011.
Pregnant women with high viral loads and low CD4 counts (measure of immunity in the blood) are most likely to transmit HIV to their babies, but this risk can be substantially reduced by treating them with at least two antiretroviral drugs to make them less infectious.
‘We will never cut the transmission rate to 5% with one dose of nevirapine. In the US and Europe, mother-to-child transmission has been reduced to around 2% with the use of two to three antiretroviral drugs,’ said Venter.
‘If we fix mother-to-child HIV transmission, we don’t have to expand child HIV treatment.’ ‘ Health-e News Service.
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