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Following the High Court judgement on the use of Nevirapine in the public sector in an effort to reduce mother-to-child transmission of HIV, the Health Minister, Dr Manto Tshabalala-Msimang, and the MECs for Health from eight provinces met to consider the implications of the ruling to the public health sector.

After much debate, we were left with no option but to appeal against the court judgement. While the Minister will spearhead the appeal, we agreed that provinces will continue with the implementation on an effective MTCT prevention pilot programme.

In Gauteng we have a total of 17 institutions which provide pilot studies on the prevention of MTCT. These pilot sites are all provided according to the national protocol for PMTCT. In addition, protocols include introduction of revised protocols for safe obstetric procedures to limit transmission of HIV for all deliveries of babies whose mothers are HIV positive.

A new service for Garankuwa Hospital and a Soshanguve clinic will open ahead of schedule in early February 2002. This will be the eighth service site in the province.

Special efforts have been made to ensure that all the pilot sites are supported to make a programme successful. This support includes orientation and training of managers and service providers and support staff, recruitment of lay counsellors, organising supplies of test kits, medicines and baby milk, and ensuring services are implemented efficiently.

With regard to the Nevirapine programme in the province for the first four months of the programme, 6 075 women attended the ante-natal service in the four sites. 2 244 agreed to testing following counselling (37%) with 715 testing positive. 270 of the women have now delivered their babies, accessing Nevirapine and breast milk substitutes. These women are supported with counselling, education, and follow up visits. More education for pregnant mothers in these sites is needed.

A provincial steering committee comprising of service providers, managers, and technical experts such as paediatricians who are experts in the field meets monthly to review progress and guide further development.

Gauteng together with other provinces is clearly committed to implementing a prevention of MTCT programme.

We support the Minister's commitment to broad consultation on the MTCT prevention programme that aims to share the lessons of the pilot site and to chart plans for the future of this programme on the basis of broad consensus.

The appeal is not intended to block implementation of the PMTCT programme. It is necessary to clarify the role of the judiciary in deciding policy on implementation of health services.

Dr Gwen Ramokgopa
Gauteng MEC for Health

For more information, please contact Popo Maja (082-373-1169)

Issued by the Office of the MEC for Health, 19 December 2001