How SA saved its babies

Monday, July 18, 2016

In a country with over one million pregnant women each year and with an HIV prevalence of nearly 30 per cent, South Africa has made notable strides towards the prevention of mother to child HIV infections, writes Chris Bathembu.

Certainly, the country’s prevention of mother to child (PMTC) infection programme has been one of the flagship programmes in government’s efforts to curb the spread of HIV, particular among the vulnerable of society - women and children.

As the focus of the world’s attention is set on Durban for the International Aids Conference, there is no doubt that the South African government wants to highlight these intervention programmes which many say have been bearing fruit since 2009, when Pretoria revised its Aids policy to focus on a rigorous treatment and prevention campaign. The prevention of HIV infection from mother to child is likely to remain high on government’s agenda for the next few years because the number of people receiving life-long antiretroviral therapy (ART) in South Africa is still increasing and is predicted to rise at around three million this year.

2009 signalled a big policy shift

Although the burden of HIV infection in South Africa had been large for many years, the country did not implement a PMTCT programme until 2002. But, President Jacob Zuma’s speech on World AIDS Day in 2009 signalled far-reaching changes to be implemented in 2010.

In that year, the Department of Health revised the PMTCT policy again to include lifelong HAART for HIV-positive women with a CD4+ T-cell count of 350 and dual ART from 14 weeks onwards in the pregnancy for HIV-positive women with a CD4+ T-cell count of 350. This is line with the World Health Organisation guidelines. HAART is a customised combination of different classes of medications.

For 33-year-old Anna Moganya from Limpopo, who was diagnosed with HIV in 2006, the PMTC programme meant that her positive status could not mean an automatic infection to her unborn child like it had been the case for many women years earlier.

When she was told of her HIV status during the 28th week of her pregnancy, the first thing Moganya thought of was her unborn baby.

“I was so scared and angry. I concluded that my baby would be HIV positive. Back then I didn’t know of anyone who had HIV and it was very secretive. But I am happy to say that the treatment prevented my child from getting HIV. He is now a healthy 9-year-old child and is HIV negative,” a teary Moganya said as she shared her story at the International Aids conference underway at Durban’s International Convention Centre.

Moganya certainly represents the hopes of millions of women in South Africa who find themselves in the position of being HIV positive while expecting babies.

HIV prevalence among new born babies fell from 8.5 per cent in 2008 to below 2.4 per cent in 2015. As a result, more than 100 000 babies were protected from HIV infection.

Universal testing meant more women access treatment

In 2005, slightly fewer than 50% of all pregnant women were routinely tested for HIV infection. By 2009, this had changed. Testing became universal and maternal treatment regimen used for PMTCT has also changed over the past 10 years, from single-dose Nevirapine to either dual therapy with Nevirapine and Azidothymidine from the 14th week of pregnancy onward or highly active antiretroviral therapy.

In line with changes in policy, Health Minister, Dr Aaron Motsoaledi, says continuous efforts were also being made to improve the quality of the programme.

“Our PMTC has been one of the most successful programme in our administration and we are certainly working on it to ensure that it improves the quality of life for women with HIV and saves the lives of unborn children,” the Minister says.

Some challenges remain

Despite the remarkably successful implementation of the PMTCT programme in South Africa, many challenges remain.

Many of the 2.5 million children currently living with HIV have no access to treatment, due in large part to a lack of tailored screening and treatment options.

“We want to accelerate our efforts and make sure that mother to child transmission of HIV ceases to exist in our country. This has been a marathon and we are saying now the winning post is in sight,” says Minister Motsoaledi.

The minister is pinning his hope on the number of exciting innovations that government has embarked on in its Aids response, particularly the prevention of mother to child infections. One of the flagship programmes which Minister Motsoaledi is passionate about is what has been named, including MomConnect, a mobile platform which creates awareness among pregnant women about available health services for their infants. MomConnect was first rolled out in KwaZulu-Natal and has a robust presence in the province.

Motsoaledi speaks fondly about the programme.

“Through MomConnect, we have managed to achieve amazing thing. We have connected women from all over and currently we have more than 800 000 women on the programme and that is very impressive for us.”

Government has been emphasising that young women and girls between the ages of 15-24 remain disproportionately affected by the HIV epidemic. They account for one quarter of all new HIV infections in South Africa and urgent action is needed to scale up HIV prevention and sexual and reproductive services, especially family planning.

The good news is that South Africa is implementing a national action framework for PMTCT that covers the five years from 2012 to 2016. In addition, there are on-going efforts to increase the ability of local health-care workers to collect high-quality data and use those data to improve the PMTCT programme. Government has said it is committed to reaching the target of a zero infection rate by 2030. 

It’s certainly programmes like these that will continue to set South Africa apart in the fight against the HIV epidemic and restore the hopes of many pregnant HIV positive women who want to give birth to healthy babies. –


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