All state hospitals in South Africa's Gauteng province will provide the antiretroviral drug nevirapine to HIV-positive pregnant women this year, the provincial government announced this week. Gauteng, the thriving commercial hub of the country, is now the fourth province to defy government policy by making the drug available. But doctors and staff at some of the existing 18 pilot sites raised concerns that logistical problems could hamper the smooth roll-out of the programme.
Kalafong Hospital - situated on the outskirts of Pretoria, near the township of Atteridgeville - is one of the two pilot sites in the capital. Within the next 100 days, the programme will be launched at a third hospital in the city. The hospital has been providing nevirapine to HIV positive pregnant women since June 2001. One of the problems has been the low numbers of women choosing to undergo HIV testing. Only 45 percent of women attending the antenatal clinic were tested, while other pilot sites tested up to 80 percent of their patients. As a referral hospital, many of the women who came to the hospital were already high-risk patients and had not received adequate care at local primary health centres.
According to Sabina, one of the two lay counsellors at the site, more voluntary testing and counselling (VCT) services should be provided at local clinics to encourage more women to be tested. Educating women about nevirapine is critical, as many patients incorrectly assume that the drug will cure them as well as their babies. When they found out that the drug was not an AIDS cure, many lost the will to live and take care of their babies, said Sabina. Counsellors at the Chris Hani Baragwanath hospital's Perinatal HIV research unit in Soweto have also dealt with this misconception.
The issue of feeding options for infants was a potential problem, according to Dr Jeffreys. Infant formula was provided for six months at Kalafong hospital and 80 percent of the women chose this option. Some women however feared disapproval from their spouses and families and chose to breastfeed, despite the risks.
The heavy workload of the programme was a major problem for some pilot sites. HIV testing took a long time and could not be assigned to junior staff, noted Jeffreys. Integrating the nevirapine roll-out in existing antenatal clinics could prove to be a challenge for the provincial government, as the staff would be overworked, possibly becoming hostile towards the service.
The Western Cape government solved the problem by contracting NGOs to employ counsellors and by employing extra nurses at clinics. The donor-funded Perinatal HIV research pilot site at Chris Hani Baragwanath has trained dedicated staff, which concentrates solely on MTCT.
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