Findings from South Africa’s most recent  Antenatal HIV Sentinel Survey show that more than a quarter (27.5%) of pregnant women in the country are living with HIV. This rate is still high, but it shows a decrease from the 30% prevalence recorded in the previous survey.  

The survey is conducted every two years in South Africa to monitor the HIV epidemic among pregnant women attending public health facilities. 

At a national level, out of the 32 828 pregnant women surveyed, 9027 (27.5%) had HIV. Kwa-Zulu Natal (KZN) had the highest HIV prevalence of 37.2%; followed by the Eastern Cape with 32.9%; Mpumalanga with 30.8%; Free State at 30.3%; Gauteng with 26.4% and North West with 25.7%.

The Northern Cape had the lowest HIV prevalence of 15.2%; followed by the Western Cape with 16.3%, and Limpopo province with 19.4%.

Women from all nine provinces and 52 districts were surveyed. The Umkhanyakude, Umgungundlovu, ILembe, Ugu, EThekwini and Zululand districts (all in KZN) had an HIV prevalence among pregnant women of over 35%. 

Whereas the Capricorn (Limpopo), Sekhukhune (Limpopo), Vhembe (Limpopo), John Taolo Gaetsewe (Northern Cape), Pixley ka Seme (NC), Frances Baard (NC), Namakwa (NC), Zwelentlanga Fatman Mgcawu (NC), Cape Winelands (Western Cape), Eden (WC), West Coast (WC) and Central Karoo (WC) districts had a 20% and below prevalence. 

Because of immunosuppression (a weakened immune system), HIV can adversely affect the frequency and course of many infections in pregnancy, including genital herpes, human papillomavirus (HPV), syphilis, hepatitis B and C,urinary tract infections and bacterial pneumonia. This is why a high HIV prevalence among pregnant women is a concern.

SYPHILIS

The survey also measures the prevalence of syphilis among pregnant women. KZN had the highest syphilis sero-prevelance at an estimated 4.5% followed by the Western Cape at an estimated 4%; Free State at an estimated 3.8%; Eastern Cape at 3.7% and Northern Cape at 3.2%. 

Syphilis is a preventable and curable bacterial sexually transmitted infection (STI). If untreated, it can cause serious health issues for both the woman and her unborn baby. 

Congenital syphilis is a severe, disabling, and often life-threatening infection seen in infants. A pregnant mother who has syphilis can spread the disease through the placenta to her foetus. According to the National Institute For Communicable Diseases (NICD), mother-to-child transmission of syphilis occurs in up to 80% of cases in untreated women. 

Untreated maternal syphilis infection could cause miscarriage, stillbirth, perinatal death, and symptomatic congenital syphilis in the newborn. Prevention of congenital syphilis is dependent on the effective screening of pregnant mothers for syphilis.

Compared to the 2017 and 2019 survey, the Eastern Cape, Free State, KZN, Northern Cape, Gatueng and the Western Cape showed the highest increase in maternal syphilis screening. 

ANC ATTENDANCE

According to UNICEF, antenatal care (ANC) is important for several reasons. Women attending antenatal care can access micronutrient supplements and get treatment for hypertension to prevent eclampsia (seizures during pregnancy or post birth). Women can also get tested for HIV, and receive antiretroviral drugs (ARVs) to prevent mother-to-child transmission of HIV.

The Western Cape showed the highest early ANC attendance before 20 weeks, followed by KZN, North West, Limpopo, Free State, Mpumalanga and Northern Cape. The Eastern Cape and Gauteng showed the lowest.

The World Health Organization recommends that screening for syphilis should be conducted at the first antenatal care visit, ideally before 20 weeks’ gestation and repeated at least once later in pregnancy (32-34 weeks).

OTHER FINDINGS

Pre-exposure prophylaxis (PrEP) is a safe HIV prevention method. Oral PrEP are pills that need to be taken daily to prevent HIV infection. It has been shown to reduce the risk of HIV infection by more than 90% among people who are at high risk for HIV infection.

Limpopo province, Western Cape and the Northern Cape had the lowest PrEP coverage before and during pregnancy. KZN had the highest PrEP coverage before and during pregnancy, followed by Mpumalanga, Free State and Gauteng.

RECOMMENDATIONS 

Dr Tendesayi Kufa-Chakezha, a senior epidemiologist at the NICD says there is a need to continue to strengthen and promote early ANC attendance. 

“This can be done through primary health care clinics, pharmacies and private practitioners that look after women at risk of or are planning to get pregnant,” says Kufa-Chakezha.

She also says there is a need to strengthen HIV testing and ART initiation among women of reproductive age, and to maintain viral load monitoring.

“Sending viral load results directly to mothers via sms or MomConnect should be continued or introduced. Expediting the roll-out of the dual HIV/syphilis and single syphilis tests for pregnant women, their partners, individuals presenting to STI services and other priority populations is key to identify and treat individuals with active syphilis for treatment,” she explains.

Kufa-Chakezha says the continuation of male circumcision and condom use as strategies for primary prevention of maternal and congenital syphilis warrants further focus for inclusion in existing prevention strategies. – Health-e News