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 (TAC), 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government inaction and said that over 60 000 infants were being infected each year by HIV, mainly as a result of an outdated drug regimen and an inadequate programme.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.