Source: Plus News
The rate of mother-to-child HIV transmission has fallen to 3.5 percent according to a national survey by the South African Medical Research Council (MRC) and researchers say the virtual elimination of vertical HIV transmission may now be possible by 2015.

Without access to public services for prevention of mother-to-child transmission (PMTCT), which provide antiretrovirals (ARV) to both mothers and babies to prevent HIV infection, up to 40 percent of babies born to HIV-positive mums could contract the virus before or during birth.

Released at the SA AIDS 2011 Conference in the port city of Durban, the survey results show a drop of at least five percent in HIV transmission rates compared to previous surveys of PMTCT programmes in South Africa.

Researchers from the MRC and partner organizations such as the UN Children's Fund (UNICEF) and South Africa's University of the Western Cape interviewed 9,915 mothers at primary health centres and clinics at the time of their babies' first immunisations.

During the visits, drops of blood from the infants were collected on cards and left to dry before being sent to a laboratory in Johannesburg, where tests then determined whether the babies had been exposed to HIV before birth, and whether they were HIV-positive.

Although 31 percent of mothers were HIV-positive during pregnancy, only a small proportion of infants had contracted the virus from their mothers during that time.

The road to elimination

The survey also showed that mother-to-child HIV transmission rates varied widely among South Africa's nine provinces. In those with problematic PMTCT coverage, such as Free State and the largely rural Mpumalanga, up to nearly 6 percent of infants born to HIV-positive mothers had acquired the virus.

According to MRC researcher Dr Ameena Goga these children have a limited chance of being diagnosed early, as only about 30 percent of mums said they intended to take their child for HIV testing.

Although rates of infant testing have climbed in recent years, child immunisation uptake is almost 99 percent and Goga suggested that provider-initiated infant HIV testing may need to be offered alongside a child's first shots. In an effort to reduce infant and child mortality, all HIV-positive infants under the age of one are eligible for ARVs under South Africa's treatment guidelines.

About 99 percent of women reported they had been tested for HIV as part of PMTCT services during pregnancy, but the survey found a gap in repeat HIV testing in the later stages of pregnancy and couples testing for pregnant women and their partners.

About four percent of women said they were HIV-negative when they were in fact HIV-positive. Goga said this could be because these women may have contracted HIV later in pregnancy, after their initial HIV test.

"Every woman who initially tests HIV-negative has to have the test repeated at 32 weeks, according to our guidelines," said Precious Robinson, PMTCT manager at the national department of health. "Our problem is that our women book [appointments] too late. We need to tell health workers to offer them testing whenever they come."

One-third of South Africa's pregnant women will have their first visit to an antenatal clinic in the third trimester of their pregnancy, said Dr Yogan Pillay, deputy director general of Strategic Health Programmes at the National Department of Health.

Early testing is preferable, but "Those who do come early [to the clinic] are often told to come back later," said Dr Helen Rees, executive director of the Wits Reproductive Health and HIV Institute. "There is a disconnect between the provision of early antenatal care and what women are asking for."

Several presentations at the SA AIDS 2011 Conference highlighted the problem of HIV-infection and Pillay said condom use among expecting couples should be promoted.

Policy problem solving

The MRC and its partners plan to repeat the survey in 2011/12 and again in 2014 to form part of the country's Millennium Development Goals report in 2015, Goga said.

The department of health will also be convening a meeting in early August to discuss clearer messaging on infant feeding practices for HIV-positive mums, because according to the MRC survey about 20 percent are still giving their babies "mixed" feeding of both formula and breast milk. Mixed feeding has been shown to increase a baby's risk of contracting HIV via breast milk up to four times.

Pillay said the department is considering cutting its provision of formula to HIV-positive mums to promote safer, exclusive breastfeeding.

Read more:
Children's healthcare missing the mark
PMTCT could be key to cutting child mortality
Mother knows best
Hospitals failing to treat HIV positive infants

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