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South Africa: DOH Presents Dual Therapy Plan to Parliament
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Health-e (Cape Town)
5 March 2008
Posted to the web 5 March 2008
Anso Thom
Cape Town
The extension of government's prevention of mother-to-child HIV transmission is on track, says Dr Nomonde Xundu, although no deadlines have been set
The health department returned to Parliament yesterday (Tuesday) to again brief the health committee on the updated Prevention of Mother to Child Transmission (PMTCT) policy and guidelines after the committee chairperson last week reprimanded the health minister for failing to provide a comprehensive report back on the revised plan.
Parliament's usually compliant health committee had reprimanded Health Minister Dr Manto Tshabalala-Msimang for failing to provide MPs with a comprehensive picture of progress in implementing dual therapy for the prevention of mother-to-child transmission of HIV.
Head of the health department's HIV/AIDS programme Dr Nomonde Xundu yesterday briefed MPs on the updated guidelines that were approved by the Tshabalala-Msimang last month.
Dual therapy will see HIV-positive mothers and their newborn infants getting AZT to boost the efficacy of nevirapine, which is used as a single dose treatment in all provinces except Western Cape where dual therapy has been in place since 2004.
Xundu gave a briefing on the updated 83-page guideline document, but was unable to give specific timelines on when the guidelines will be implemented.
The timing hinges on business plans each province has agreed to submit to the Director General Thami Mseleku by March 14, although Mseleku cautioned this could be closer to March 21.
"We will only know the time frames once the business plans are back. For example, Gauteng has indicated that they have been preparing for this, they have trained doctors and nurses and they have been piloting it. It is important that we do everything we can to save babies in the meantime (even if not all the provinces are ready)," said Mseleku.
He also disclosed that the guidelines had been updated because there "is evidence in the world that this (new) policy needs to be implemented to ensure better results".
However there was no engagement on why some parts of the new guidelines were out of step with international practice and the World Health Organisation guidelines.
Criticism of the updated guidelines by HIV experts has centred around the failure to include any mention of the drug 3TC, which has shown to be a safe, effective and inexpensive addition to AZT as part of a "tail regimen". The 2006 WHO guidelines recommend that a short course of 3TC be administered to the mother to reduce the risk of later nevirapine resistance.
The new guidelines were also criticized for continuing to recommend that pregnant HIV positive women should not be referred for HAART until their CD4 count has dropped below 200.
Scientific evidence shows that there are significant health advantages to placing women on HAART once their CD4 count reaches 350. Healthworkers report that if patients wait until their CD4 counts are 200 or below, they often present very ill and very little can be done to save them.
The provincial business plans are expected to identify "service points" where the dual therapy can be implemented, patient target numbers and a 12-month plan indicating a starting date.
Xundu said the health department would in the next six weeks print and distribute the guidelines, a training manual and a facility register. There will also be training of trainers, stakeholder meetings and a review of the budgets.
She cautioned that the department was enhancing an existing programme and not innovating a new one.
Deputy Director General Dr Nthari Matsau said it was important to acknowledge that drug resistance was an issue and had been so since the PMTCT programme was launched using single-dose nevirapine.
She said one of the weakest areas of the PMTCT programme had been pharmacovigilance and that money had to be allocated to this area to ensure "adverse events are recorded".
"Yes, AZT is toxic, but for now we will give it. Maybe the policy will change, maybe it will stay the same, but we need to try to deal with it in a systematic manner," said Matsau.
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"The department has taken on this massive challenge (updated PMTCT programmed) in terms of resource requirements and we are driven by the belief that we can reduce transmission if we do this," Matsau said, adding that a further challenge would be to ensure that HIV negative babies remain negative and are not infected because of poor infant feeding practices.
During her presentation Xundu acknowledged the presence of over 20 Treatment Action Campaign activists stating that she hoped the "TAC will assist us with community based support for drug adherence".
Drug adherence support is an essential component of the updated PMTCT programme as AZT will be administered daily over a period of up to 28 weeks, depending on when a pregnant woman presents to the clinic.
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