Issued by Department of Health
25 January 2008
The Policy Committee of the National Health Council (NHC) held a special meeting today to consider the draft Policy Guidelines for the Implementation of the Prevention of Mother-To-Child Transmission of HIV (PMTCT) Programme.
This was the final of series of consultations in the development of these guidelines. The guidelines have been discussed with researchers, clinicians, programme managers and public health experts and they have been considered by health managers at national and provincial level.
The Department of Health emphasizes prevention as the cornerstone of South Africa's response to the spread of HIV and the impact of AIDS and PMTCT programme is part of the interventions in this regard.
The recommendation of mono-therapy (using single dose nevirapine) as a model for PMTCT has always been a challenge for the Department regarding particularly the limited effect of this approach and the possibility of resistance that is associated with it.
Despite these challenges, the Department of Health expanded PMTCT programme to over 90% of our public health facilities. All antenatal clients are offered counseling to assist them to take individual decisions with regard to accessing PMTCT services.
The new guidelines as adopted by the NHC today require that pregnant women be offered voluntary counseling and testing (VCT) at the first visit to the antenatal clinic. For those who test negative, VCT is repeated at 34 weeks of pregnancy. CD4 count testing and clinical staging is done at first HIV positive diagnosis. Women with a CD4 count of 200 and below are provided highly active antiretroviral treatment (HAART).
According to the new guidelines, pregnant women enrolled in the programme receive AZT from 28 weeks until labour and a single dose nevirapine during labour. An infant receives single dose nevirapine and AZT for 7 days. Where a mother has received AZT for less than 4 weeks of pregnancy, the infant receives AZT for 28 days.
The two drugs used in the programme - AZT and nevirapine - are schedule 04 medicines and they therefore have to be prescribed by a medical officer after an appropriate assessment of the patient.
Infant feeding remains a major challenging area. The guidelines acknowledge that there is still lack of conclusive scientific information to guide policy formulation in this area. The guidelines encourage a choice between six months exclusive breast-feeding and provision of infant formula for six months. After six months, babies are referred for nutritional support.
Babies should be tested for HIV using PCR test at six weeks and antibody test at 18 months. This testing and general follow up of patients should be strengthened in other to establish the effectiveness of the PMTCT interventions.
The implementation plan for the new PMTCT guidelines have been developed to guide expansion of the programme with the aim of ensuring universal access to PMTCT services across the country. The implementation of the guidelines require an increase in the 2008/09 budget for PMTCT from R85 million to R281 million. Request for additional resources is to be made to Treasury in a bid for 2008 adjustment.
Implementation of the guidelines requires further strengthening of patient recording system, adequate access to laboratory services, uninterrupted supplies of drugs, formula and other nutritional support and rapid training of health workers involved in the programme.
It is necessary that all role players work together to ensure successful implementation of these guidelines. There is a need to build partnerships in mobilizing family and community support for those enrolled in the programme, to address challenges of stigma and improve uptake.
The guidelines are undergoing final editing and will be posted on the Department of Health website next week.