Children's Health HIV and AIDS HIV Prevention HIV Treatment Policy and Legislation Women's Health

Revised PMTCT guidelines Living with AIDS # 336

Written by Health-e News

After years of debate, the national Department of Health has changed its protocol for the prevention of mother-to-child HIV transmission. Last week, the National Health Council’€™s policy committee adopted new guidelines for PMTCT.

KHOPOTSO: The new policy adds a second antiretroviral drug, AZT, to the treatment of pregnant HIV-positive mothers and their babies. Until now, only Nevirapine has been used. The Treatment Action Campaign and medical experts have been campaigning for over a year for more effective treatment than a single drug. The TAC says over 600 000 babies are infected with HIV in South Africa, annually. The group’€™s Nomfundo Eland.


NOMFUNDO ELAND: Many of those infections could have been avoided’€¦ with the improvement of the PMTCT programme, such as dual-therapy prophylaxis.    


KHOPOTSO: According to the new guidelines, pregnant women will be offered Voluntary Counselling and Testing (VCT) at their first visit to an antenatal clinic. Those who test negative will do a repeat test at 34 weeks of pregnancy. If a woman tests positive, she will undergo further tests to assess her CD 4 count. If it’€™s 200 or less, she will be started on Highly Active Antiretroviral Therapy. All HIV-positive women in the programme will receive AZT from 28 weeks of pregnancy until labour. A single dose of Nevirapine will be added during delivery. Babies will receive one dose of Nevirapine and AZT for seven days. Where a mother has received AZT for less than four weeks of pregnancy, the baby receives AZT for 28 days.


But the change has come about a little late. Dr Tammy Meyers is a paediatrician and runs the Children’€™s HIV clinic at Chris Hani Baragwanath Hospital, in Soweto.      


Dr TAMMY MEYERS: At the hospitals where we’€™re working in Gauteng, we’€™re still seeing unacceptably large numbers of children being admitted into the wards and coming into our HIV clinics. At Bara, for instance, we’€™re still seeing about 90 children odd a month – new children coming in for antiretroviral services’€¦ Possibly, it’€™s not as high in every single other place, but it’€™s an indication of what’€™s happening around the country – that we’€™re not getting on top of the paediatric HIV epidemic. And these are the children that are fortunate enough to be found because most of the children actually don’€™t make it into the services and die before they have the chance to access our services. It’€™s really unacceptable that it’€™s taken this long to release guidelines.                  


KHOPOTSO: Meyers says South Africa should have started revising its PMTCT programme to include dual-therapy in August 2006, following a recommendation by the World Health Organisation (WHO).          


The guidelines acknowledge that infant feeding is a huge challenge, as there is still a lack of conclusive scientific evidence to guide policy formulation.

Therefore, mothers are encouraged to make a choice between six months of exclusive breast-feeding and six months of infant formula feeding. After this period, babies are referred for nutritional support. It is also recommended that babies be tested for HIV at six weeks and at 18 months.


And while provision for mothers to receive AIDS treatment at CD 4 counts of 200 or less is made, the TAC wants them to get ARVs sooner. Nomfundo Eland, again.


NOMFUNDO ELAND: Maternal health could also be improved by offering treatment to women with CD 4 counts below 350’€¦ Currently, adults can only receive treatment at CD 4 counts below 200. So, we’€™re saying if women have CD 4 counts below 350, immediate treatment should be initiated.        


KHOPOTSO: In addition, the TAC has called for mothers to get AZT and Nevirapine for a week after birth to reduce the risk of antiretroviral drug resistance. This is known as the ‘€˜cover-the-tail’€™ regimen.   But the Health Department has not included this. The Department said the full guidelines would be available on its website this week. They were still not available at the time of recording.    

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