Aids-free generation within grasp

2009-12-10 00:00

KWAZULU-NATAL has managed to slash HIV transmission from mothers to their newborn babies by almost two thirds — to seven percent — since it introduced dual therapy. This is according to research which was released on Tuesday following a huge, year-long study that involved interviewing 38 000 mothers at 347 clinics in six districts in the province.

“The study has shown that an HIV-free generation is both achieveable and within our reach,” said Dr Sibongile Zungu, head of the KwaZulu-Natal Department of Health, who welcomed the findings.

Dual therapy was introduced in April 2008 and it involves giving pregnant HIV-positive women and their newborns two antiretroviral drugs, nevirapine and AZT.

From 2002, HIV-positive mothers and their newborns were only given nevirapine, but 20% of HIV-positive mothers were still passing the virus on to their babies.

The mothers were interviewed when bringing their babies to the clinic for immunisations, and those with babies under the age of 16 weeks (19 500) were selected for further research.

Researchers found that almost all these women had been tested for HIV and almost 36% of the women reported being HIV-positive.

Of those who were HIV-positive, two-thirds had received dual therapy, 13,4% were sick enough to be on three ARVs (triple therapy), 14% received nevirapine only and 3,9% got nothing. Some 84% of the babies received dual therapy.

Researchers then took blood samples from all babies attending the immunisation clinic aged between four and eight weeks to test them for HIV, testing 8 013 babies.

Some 15% of babies whose mothers got no treatment became HIV infected, while 13,5% of pregnant omen who only got nevirapine passed HIV on to their babies.

But the transmission rate for those on dual therapy was dramatically reduced to only 5,6%, while only five percent of mothers on triple therapy passed HIV to their babies.

“The infant mortality rate has tripled in the province over the past 10 years because of HIV/Aids, so it is very exciting to see the impact of dual therapy, which will make massive strides to prevent the deaths of babies and children,” said Dr Christiane Horwood, the principal investigator of the KwaZulu-Natal Impact Study and deputy head of the Centre for Rural Health at the University of KwaZulu-Natal.

The study involved the province’s biggest urban districts, eThekwini and uMgungundlovu, as well as the more rural Umkhanyakude, Zululand, Amajuba and Ugu districts.

The study also exposed some of the weaknesses of the programme. Over two-thirds of the women were only tested late in their pregnancies, by which time dual therapy should have already started.

In addition, a third of the women who tested HIV-positive did not get a CD4 count, which measures their level of immunity. The CD4 count is crucial as women with CD4 counts below 200 are supposed to be put on triple therapy immediately as they are at great risk of dying in childbirth and are also most likely to pass HIV to their babies.

The study also found that six out of 10 HIV-positive mothers opted to use formula food rather than breastfeeding, which is a concern as formula-fed babies are more susceptible to gastrointestinal illnesses.

Last week, the World Health Organisation revised its HIV/Aids guidelines to recommend that it is safe for HIV-positive women on antiretroviral therapy to breastfeed.

Horwood praised the many health workers who had “worked very hard” to make the prevention of mother-to-child HIV infection programme a success.

However, the introduction of dual therapy has not been without a struggle.

Last year, former Health MEC Peggy Nkonyeni had a bruising battle with doctors in the Um­khanyakude District who had been trying for most of 2007 to get the provincial department to give them the go-ahead to introduce dual therapy.

Manguzi doctor Colin Pfaff was charged in January 2008 for “wilfully and unlawfully without prior permission of [his] superiors [rolling] out dual therapy to the pregnant mothers and newborns”, after he raised private funds to buy AZT for his patients.

Charges against Pfaff were later withdrawn after huge protests, but relations between rural doctors and the Department of Health were severely strained.

What is dual therapy?Pregnant HIV-positive mothers receive the antiretroviral drug AZT from 28 weeks of pregnancy as well as the current single dose of Nevirapine administered during labour.

Their babies will then receive AZT for seven days after birth, as well as a single dose of nevirapine syrup. However, if the mother received AZT for fewer than four weeks the infant will be given AZT for 28 days.

Mothers will also be tested for HIV at their first visit to the antenatal clinic. If they test negative, the test will be repeated by 36 weeks. CD4 counts will be done on women who test HIV-positive. — Health-e News

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