[pronut-hiv] South Africa: Govt Finally Introduces AZT for HIV+ Mothers

["ProNut-HIV" <pronut-hiv@healthnet.org>]

Health-e ( http://www.health-e.org.za/ ) (Cape Town)

28 January 2008
Anso Thom

After years of stalling and much criticism from the HIV/AIDS sector,
the Policy Committee of the National Health Council on Friday finally
adopted new guidelines for the prevention of mother to child
transmission (PMTCT).
At the heart of the new policy is the addition of second antiretroviral
drug, AZT, for pregnant women with HIV and their babies to the current
treatment with nevirapine only.

The announcement came two days after the Treatment Action Campaign,
supported by the HIV Clinicians Society, condemned government inaction
and said that over 60 000 infants were being infected each year by HIV,
mainly as a result of an outdated drug regimen and an inadequate
programme.
"Much of it, particularly dual-antiretroviral prophylaxis, should have
been adopted at least in November 2003 but by no later than August 2006,
when the World Health Organisation (WHO) amended its PMTCT guidelines,"
the TAC said.
The new guidelines require that pregnant women be offered voluntary
counseling and testing (VCT) at the first visit to the antenatal clinic.
For those who test HIV negative, VCT is repeated at 34 weeks of
pregnancy.
If a woman tests positive, her CD4 count is tested and if it is 200 and
below, she is provided highly active antiretroviral treatment (HAART).
Pregnant women enrolled in the programme will receive AZT from 28 weeks
until labour and a single dose nevirapine during labour. Their babies
will receive a single dose nevirapine and AZT for seven days. Where a
mother has received AZT for less than four 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 will have to be prescribed by a doctor.
Health department spokesperson Sibani Mngadi said infant feeding
remained a major challenge. "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,"
he said.
The guidelines also dictate that babies should be tested for HIV using
the highly sensitive PCR test at six weeks and antibody test at 18
months.
Mngadi said that this testing and general follow up of patients should
be strengthened if the PMTCT programme was to be more effective.
TAC said that maternal health could also be improved by offering by
providing mothers with a week of AZT and lamivudine after birth (known
as the "cover-the-tail" regimen) to reduce the risk of antiretroviral
drug resistance. The health department opted not to include a tail
regimen.

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.
Mngadi said that implementation of the guidelines required 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.
He said the guidelines were undergoing final editing and will be posted
on the Department of Health website this week. - Health-e News Service.