Revised PMTCT guidelines by Friday

Home / Health / Revised PMTCT guidelines by Friday

Health department spokesperson Sibane Mngadi said a special council meeting would ‘endorse’ the guidelines which involves adding a course of the antiretroviral drug AZT to the current once-off dose of nevirapine.

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.

Mngadi’s announcement comes shortly after the Treatment Action Campaign announced it would be hold a press briefing today (SUBS: WED) as ‘it does not appear the government will meet its commitment without pressure from TAC’.

The TAC said the Minister of Health had ‘again made false statements that, on 14 December 2007, the National Department of Health will roll out dual therapy for prevention of mother ‘to-child transmission (PMTCT) to all provinces’.

At a South African National AIDS Council (SANAC) meeting held at the end of November, civil society raised concern about the delay in improving treatment regime for PMTCT.

This follows a letter written last May to SANAC by the SA Clinicians’ Society asking it to investigate the delay in rolling out this ‘dual therapy’.

At the time, SANAC said in a statement that the Department of Health had confirmed that a new protocol on PMTCT would be announced within two weeks.

A source at the meeting confirmed that Deputy President Phumzile Mlambo-Ngcuka, who chairs SANAC, had said at the November SANAC meeting that provinces should be allowed to implement the new regimen even though it had not yet been endorsed at national level.

Health Director General Thami Mseleku initially agreed, but later asked for two weeks’ grace.

Mngadi denied that the delay had been due to the documents not being signed by the health minister.

He said the main hold up was due the costing that had to be done by the department’s AIDS Unit and that this was now complete.

The new drug regimen will see pregnant HIV positive mothers receiving AZT from 28 weeks as well as the current single dose of Nevirapine administered during labour.

Their babies will then receive AZT for seven days. However, if the mother received AZT for less than four weeks the infant will be given AZT for 28 days.

Mngadi said the current PMTCT budget of R85-million will be increased to R281-million.

Mothers will also be tested at their first visit to the ante-natal clinic. If they test negative, the test will be repeated by 36 weeks.

CD4 counts will be done on women who test HIV positive.

The TAC has in the past called for the PMTCT programme to be properly monitored with its results published.

The new HIV/AIDS Strategic Plan for South Africa (2007-2011) is committed to measuring annually the percentage of pregnant women tested for HIV, the percentage of HIV-positive women who receive antiretrovirals to reduce the risk of HIV transmission, the percentage of children born to HIV-positive women and the percentage of children born to HIV-positive women who receive polymerase chain reaction (PCR) tests.

The PCR test, also known as a viral load test, is an important method for diagnosing HIV in children.

Mngadi confirmed that no ‘tail’ regimen had been included.

There is strong evidence that the addition of single dose of the ARVs tenofovir and emtricitabine to the short-course AZT and single-dose nevirapine for the mother was a ‘new effective, and feasible’ approach to reducing nevirapine resistance when the mother needs ARV therapy herself later.

Some women show resistance even when nevirapine was used in conjunction with AZT. The resistance issue is expected to continue dogging PMTCT programmes despite the addition of AZT, as countless women will continue to receive the single dose of nevirapine only. Many women only present at clinics or hospitals once they are in labour, when it is too late to administer the AZT component.