AIDS

Prevention of Mother-to-Child Transmission of HIV

Published by: 
Department of Health (South Africa)

The HIV epidemic in South Africa has progressed rapidly over the past eighteen years. It is estimated that by 2007, 5.5 million people in South Africa were living with HIV/AIDS (ASSA model 2003). The annual Antenatal National HIV and Syphilis Prevalence Survey, conducted since 1990, shows an exponential growth in prevalence, with the national HIV sero-prevalence rate peaking at 30.2% in 2005, but declining to 29.1% in 2006 and 28% in 2007. Despite all its inherent limitations, this is currently the most reliable form of HIV surveillance in South Africa.

The various provinces have different prevalence rates in 2007 the Western Cape had the lowest prevalence at 12.6%. However, in some areas in the Western Cape the prevalence exceeds the national average. There is also variation in prevalence by age group, with the highest prevalence in 2007 in the 20-39 year age groups. In the 30-34 year age group the prevalence was as high as 40.2%. The national prevalence in the 15-29 year age group has declined from 2005 to 2007.

In the Western Cape, from 2004 to 2006, the prevalence in pregnant women less than 25 years of age has reduced each year possibly suggesting a reduction in incidence in this age group. In 2006, 21.1% of pregnant women in the 25-29 year age group were HIV-infected. This still constitutes a considerable disease burden for women in their reproductive years. By 2003, non-pregnancy related infections (NPRI) were found to be the most common primary cause of maternal death. Of these NPRIs, AIDS was the most common sub-category, and TB and pneumonia the most common causes of death in this group of women.

An estimated 60,000 to 70,000 children are newly infected with HIV each year. In 2006 there were approximately 257,900 HIV-infected children under 14 years of age in this country. Mother-to-child transmission (MTCT) is the overwhelming source of HIV infection in young children.

HIV infection is currently one of the leading direct and indirect causes of morbidity and mortality amongst South African mothers and children, and is a threat to the country's ability to meet the Millennium Development Goals.

Prevention of Mother-to-Child Transmission of HIV
In the absence of any interventions to prevent MTCT, an estimated 25-45% of HIVinfected mothers will pass the virus to their infants. HIV may be transmitted during pregnancy, labour and delivery or during breastfeeding.

Since the mid-1990s, clinical trials have shown the effectiveness of antiretroviral drugs in lowering the rate of transmission of HIV from infected mothers to their newborn infants. In 1994, the findings of the PACTG 076 study showed a two thirds reduction of MTCT with antenatal oral Zidovudine and intrapartum continuous Zidovudine infusion. In 1999 a study from Thailand showed a 50% reduction in MTCT with antenatal oral AZT and 3 hourly oral AZT during labour. Shortly thereafter the HIVNET 012 study showed a 47% reduction in MTCT with single dose NVP to mother and infant.

Subsequently the problem of rapid emergence of viral NNRTI resistance after such limited exposure to NVP and its negative impact on maternal and neonatal ART became a major concern, particularly as the national ART program rolled out.

In 2004, the Thailand group published a study showing that intrapartum and early neonatal NVP added to their AZT regimen (including 1 week of neonatal AZT) reduced early MTCT to a startlingly low 1 - 2%. With dual therapy and a restriction of maternal NVP to only a single dose, NNRTI resistance was less evident, but still of concern.

Prevention of mother to child transmission of HIV (PMTCT) with maternal HAART and replacement feeding in the developed world has been shown to be almost 100% effective. There is also evidence that elective caesarean section, safe obstetric practices and safe infant feeding practices reduce MTCT of HIV. However, in developing countries with resource constraints, HAART may not always be deliverable to pregnant women. In these settings where infectious diseases are common replacement feeding (or lack of breastfeeding) may also be associated with an increase in morbidity and mortality due to malnutrition and infections.

QUALITATIVE EVALUATIONS MANAGER

Closing date: 31 August 2009

We are seeking to recruit a suitably qualified and experienced candidate to develop and implement qualitative research components for existing ECHO projects and to develop a qualitative research programme within ECHO.

Counselling and testing for HIV/AIDS among TB patients in the Free State

Published by: 
Centre for Health Systems Research & Development
TB patients uptake of HIV counselling and testing (HCT) is affected by a wide variety of health systems/ services-related and patient/community-related factors. This research set out to explain comparatively low rates of HCT among TB patients in Lejweleputswa and Thabo Mofutsanyana Districts in the Free State Province. By interviewing patients, community health workers, front-line providers and health managers this fact-finding research sought to identify and illuminate barriers to and facilitators of uptake of HCT by TB patients.

CD4 cell counts becoming lower soon after infection with HIV, suggests virus becoming more virulent

The initial CD4 cell counts of patients newly infected with HIV fell significantly between 1985 and 2001, US research published in the May 1st edition of Clinical Infectious Diseases has shown. This suggests that the virus may have evolved to become more virulent during this time period, which could have clinical implications, shortening the interval between infection with HIV and the need to start HIV treatment. In people with HIV, CD4 cell counts provide an important indication of the strength of the immune system, of HIV disease progression and of when to start antiretroviral treatment.

Developing Treatment Guidelines for Women of Reproductive Age

Published by: 
Health Systems Trust
In South Africa, the issues surrounding HIV/AIDS have long been contested and are, in themselves, complex. Treatment has been normalized, embraced and guided by the National HIV/AIDS and STI Strategic Plan (NSP), which is the overall guiding plan for HIV/AIDS in South Africa. The Plan is implemented in partnership with the South African National AIDS Council (SANAC). The NSP has gaps in the key areas of sexual and reproductive health and rights (SRHR), and this has been an important critique of policy guidelines. SRHR are only identified in the indicators of prevention and are absent from other provisions in the Plan. These gaps are also challenges in the Southern African region and globally. While the process of addressing SRHR in South Africa has started, these comments have the potential for wider application globally.

Cervical Cancer and HIV: The intimate connection

Published by: 
Health Systems Trust

Since 1997, over 33 000 women have died of cervical cancer in South Africa. This translates into roughly 3 000 per year. In addition, approximately 7000 women develop the disease every year. In 2000, a national cervical cancer screening policy was developed and put into place. The system uses a screening method to prevent the precancerous lesions from developing into cervical cancer through early detection and treatment. Screening takes place through pap smears with three free pap smears being offered to women in the public service at the ages of 30, 40 and 50.

Disadvantage of late treatment start in Africa may persist for years, studies find

Starting antiretroviral therapy earlier, before the development of symptoms, is the most likely way to reduce the high death rates after treatment initiation seen in people with HIV in resource-limited settings, two large cohort analyses show. The studies also show that the major disadvantage of starting treatment late an increased risk of death may persist for some years, burdening already overstretched health systems with illness that could be avoided by earlier treatment.

Cross-border health crisis hits mineworkers

Two years ago Mopeli Mofoka, 39, left his wife and child in Maseru, Lesotho's capital, and joined the more than 50,000 men pushed by poverty and unemployment in their home country to seek work on mines in neighbouring South Africa. It was his second stint as a miner the first had been 15 years earlier. This time he was hired as a sub-contractor, which meant that despite testing positive for HIV during his preliminary health screening he did not have access to the on-site health services available to mine employees. When his health began deteriorating 18 months later, he went to a local public hospital but was turned away because he lacked a South African identity document. His only option was to return home, where he is receiving treatment for tuberculosis (TB) at a government clinic run in partnership with international medical aid organisation Medecins Sans Frontires (MSF) in Morija, about 50km south of Maseru, the capital.

Vaginal gel blocks HIV but not enough to be scientific success

Candidate microbicide PRO 2000 cuts HIV transmission by 30 percent, falling just short of the one-third required to be deemed a success. But scientists say this trial offers proof that the concept of a vaginal gel to block HIV is possible. For the first time in over a decade of research, a vaginal gel called PRO 2000 has been show to cut HIV transmission by 30 percent. Principal investigator Professor Gita Ramjee described this as extremely hopeful at the simultaneous launch of the results in Durban and Montreal, Canada, yesterday (9 Feb). This is the first microbicide study in over a decade that shows promise. It suggests that we are on the right track and we will be able to develop a women-controlled product to prevent HIV in the future, said Ramjee, who heads HIV research at the Medical Research Council (MRC).