Mother-to-child HIV prevention - the science, the costs, the pilot programme

The Treatment Action Campaign's (TAC) decision to turn to the courts comes after four years of campaigning for a national programme to prevent mother to child transmission (MTCT).

TAC was officially formed in December 1998 with the explicit aim to ensure that government implement a MTCT programme nationally, that government treat HIV/AIDS and that drug companies lower the prices of anti-retroviral drugs.

In South Africa the Medical Research Council has estimated that 11% of new infections are as a result of mother to child transmission of HIV. In 1994 the findings of the Paediatric AIDS Clinical Trials Group found that the provision of AZT after the first 14 weeks in pregnancy reduced the rate or MTCT by 67,5%. Consensus between government and civil society was that the regimen was unaffordable in the South African context at then prevailing market prices.

The SAINT study

In 1999/2000, 1 306 pregnant women with HIV/AIDS participated in the South African Intrapartum Nevirapine Trial (SAINT study), which demonstrated that HIV transmission from mother to child during birth could be reduced by more than 50%.

A follow-up to the Uganda study showed that there might be a problem with resistance in a minority of women who take single dose Nevirapine. The SAINT study confirmed that the drug costs for Nevirapine would be less than R30 per woman and child. Since then nevirapine's manufacturer, Boehringer Ingelheim has offered the drug free to all SADC countries for a period of five years.

Looking at the costs of implementing MTCT programmes, researchers and scientists have found it to be a cost-effective and cost saving intervention. In 1999, Abt Associates wrote that evidence strongly suggested that these programmes, while involving substantial cost, represented good value for money in both the private and public healthcare sectors.

Cost effective

In 1998 Neil Soderlund and Glenda Gray prepared a paper which stated that short-course AZT and formula feed was not only cost effective, but potentially also cost saving. Critically, the authors argued that an intervention that included counselling, testing, anti-retroviral medication and formula feed would cost the government less than 1% of the health budget.

A costing study commissioned by the health department and released last year showed that a country-wide programme of nevirapine provision for MTCT would potentially save 14 000 babies from acquiring HIV at a cost of R87,5 million per year. The Hlabisa district MTCT prevention programme was costed by David Galbraith, and Michael Bennish, of the Africa Centre for Health and Population Studies.

Results indicated that an incremental start-up cost of approximately R 1.19 million and ongoing annual costs of R1.34 million is required for such a programme. 66% of annual costs are attributable to the VCT component of the program, with counselor salaries comprising most of these costs. Drugs account for 1.6% of annual costs.

Annual incremental costs for the centralized VCT and the universal provision alternatives were estimated to be R635,000 and R70,000, respectively.


The Medicines Control Council approved nevirapine for use in MTCT programmes on April 18. Provinces received the go-head in June to give HIV positive women the drug, nevirapine at 18 pilot sites (two per province), to prevent them from passing the virus on to their babies. The following sites are currently running government's MTCT pilots:

  • Eastern Cape: Cecilia Makiwane, Frere and Rietvlei;
  • Free State: Frankfort and Virgina;
  • Gauteng: J Dumane, Natalspruit, Pretoria West and Kalafong;
  • KwaZulu-Natal: King Edward, Prince Mshiyeni, Greys/Northdale, Edendale and Church of Scotland;
  • Mpumalanga: Evander and Nkomazi sub-district;
  • Northern Cape: De Aar and Galashewe;
  • NorthWest: Tlhabane and Lehurutshe;
  • Western Cape: Paarl and Gugulethu;
  • Northern Province

These pilots are scheduled to run for two years before expansion is considered.

(Source: Health-E, 22 August 2001)

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