It's time to move towards elimination

Over the past decade, South Africa has made significant progress in the prevention of HIV transmission from mother to child through widespread interventions and broadened accessibility to prevention of mother-to-child transmission  (PMTCT) programmes.

According to Dr Kay Mahomed, HIV clinician at Netcare Garden City Hospital in Johannesburg, "South Africa has reached a point where almost complete eradication of paediatric HIV is a reality, compared to 2001 when the country had no PMTCT programme in place and babies were being infected with and dying from the disease on a daily basis."

Dr Mahomed, who has been instrumental in establishing and running the wellness clinic, which aims to empower and educate people living with HIV/Aids, has worked tirelessly to prevent the transmission of HIV from mother to child. Since the clinic was established in 2005, she has managed to eliminate new paediatric HIV infections in all the patients she has treated.

Dr Mahomed says that it is only through the implementation of a comprehensive range of interventions that this can be achieved. "Because an HIV-positive mother can pass HIV onto her baby at any time during pregnancy, labour, delivery or breastfeeding, the transmission of the virus must be blocked at each and every stage," she says. An effective PMTCT programme includes HIV testing throughout the pregnancy, appropriate use of antiretroviral treatment (ART), counselling, safe breastfeeding methods, infant HIV testing and other post-natal healthcare services.

Dr Mahomed advises all pregnant women to get tested for HIV as early as possible in the pregnancy. "If an expectant mother tests positive for the virus she should be offered information on available PMTCT interventions at every single consultation with her doctor or gynaecologist and not only when there is an antenatal visit.  She also needs to be prescribed ART regardless of her CD4 count," she explains. Dr Mahomed outlines some other important information regarding HIV and pregnancy that all women should be aware of:

• Women should be tested for HIV every three months during pregnancy and breastfeeding, at labour and every six months post delivery even if they initially tested negative for the virus. This is because HIV has a window period and women are also at risk of becoming re-infected. "In fact, 4% of women in South Africa who are initially negative become HIV positive later in pregnancy," she says.
• All HIV-positive pregnant women should receive ART with appropriate counselling from their first antenatal visit regardless of their baby's gestational age. They should also have their viral load checked to assess the effectiveness of their treatment and to detect treatment failure.
• In 2001, when the PMTCT programme first began, a pregnant mother just had to take a single tablet of a drug called nevirapine during labour, with very little intervention before and after the birth of her baby. Treatment has now evolved to the point where the first choice of anti-retroviral therapy for HIV-positive pregnant women is a combination of medicines used to treat HIV, which are given as a single, fixed-drug dose.
• All babies exposed to HIV must receive prophylactic NVP/AZT for six weeks. Infant post-exposure prophylaxis should be used for 6 to 12 weeks after delivery depending on when maternal ART was initiated.
• Because conventional antibody tests are not reliable for babies up to 18 months of age, all infants exposed to the virus and who are not on ART should have a rapid test done to confirm their HIV status.
• All HIV-positive pregnant women should receive comprehensive management and care during all phases of pregnancy and birth. They should be taking iron, folate and calcium supplements, have their hemoglobin levels tested and be provided with ARVs. They must also be monitored and treated for opportunistic infections including tuberculosis (TB).

"Transmission from mother to child can only be fully eliminated by providing pregnant women with access to quality care, counselling and education. A programme that goes beyond just the ante-natal and delivery period to include post-natal care and support to women living with HIV, is vital in ensuring that both mother and child live long, healthy and happy lives," concludes Dr Mohamed.

Insurance Gateway, 17 February 2015