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Government's programme to reduce HIV infection in babies

Preventing mother-to-child transmission of HIV forms part of Government's programme of HIV/AIDS prevention. It is also part of a broader strategy to combat HIV/AIDS that depends critically on building partnerships across society.

Our programme to prevent sexual transmission of HIV and in particular our prevention programme amongst young people has been described by the head of UNAIDS, Dr Peter Piot, as the largest and most comprehensive in Africa and one of the largest in the world; a programme, he says, with very high levels of government investment, which is starting to show results.

At the International AIDS Conference in Durban in July 2000, research was presented on the use of Nevirapine to reduce mother-to-child transmission of HIV.

Based on these results, Government developed a more comprehensive programme to reduce HIV transmission to babies and to conduct further research on the subject. In May 2001, the first of 18 national research sites began to operate. By the end of 2001, these sites involved 215 clinics and hospitals.

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What happens at the research sites?

Women attending these sites are offered counselling and voluntary testing for HIV. Mothers who are HIV-positive are also offered Nevirapine for themselves and their babies; vitamins to improve their health during pregnancy; preventive measures and prompt treatment of infections in mother and baby; and formula-feed if they choose not to breast-feed.

All mother-and-baby pairs will be followed up comprehensively at one year and beyond to check if the benefits are as good as expected and if there have been any unforeseen problems.

About 70 000 women have so far received antenatal care at the hospitals and clinics in this research programme. More than 38 000 opted to take the HIV-test and about 9 500 of them were HIV-positive. Over 3 700 of the HIV-positive mothers have received Nevirapine and where they have already given birth -- in more than 2 600 instances -- their babies also received Nevirapine syrup within 72 hours of birth.

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What have we learned from the research?

Research is a key part of building this new service so that we fully understand the implications of using Nevirapine. We need to know what changes must be made to our existing mother-and- child clinics to run a Nevirapine programme that is accepted by our communities and smoothly operated. What is required in terms of space, information, staffing, and community support? We also want to be sure what the longer term impact and efficacy of using the drug is, both for baby and mother.

We have learnt a lot about what it takes to run a good mother-to-child HIV prevention programme.

• Good quality counselling in private conditions is critical to success. This may require us to build new rooms, relocate ante-natal clinics, hire additional staff, form partnerships with NGOs.
• Many factors affect mothers' choices around safe infant feeding. There is a need for community and family support where a mother wishes to use formula-feed. Lack of access to clean water and electricity has a major impact.

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When will this service reach more people?

The information from the research sites has been studied by decision-makers in every province and, on the basis of this, some have recommended an increase in the number of hospitals and clinics where Nevirapine is available. Any new services decided collectively should be an expansion of the research programme and must be done in accordance with national guidelines and protocols.

In some provinces, it may take slightly longer to extend the research sites because services are less developed. But universal access will be decided on when important questions have been answered by the research.

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Why is Government appealing against the court ruling?

In December 2001, the Pretoria High Court said Government should make Nevirapine available to pregnant women in all public health institutions, beyond the pilot sites.

Government is appealing against this judgement. This is not because we are against expanding the mother-to-child programme - that process continues. It is because we need to gain clarity on whether the courts or the elected government decides on the detail of providing health services:. This is a critical question about the division of powers in our democracy. The wisdom of the Constitutional Court should be applied to it.

The appeal process will not stand in the way of health authorities expanding the programme. Any expansion of the pilot sites will continue to be guided by research results and by available resources - including human resources and the standards we have set for comprehensive care.

24 February 2002
Source: GCIS

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Last modified: 23 September 2004 13:00:47.