A report commissioned by the South African government shows that nevirapine is a safe and effective drug to prevent mother-to-baby transmission of HIV and should be provided to all pregnant women who need it.
Campaigners are hoping that this will finally put an end to government's refusal to provide the drug to HIV-positive mothers, other than those participating in a clinical trial at 18 state run hospitals. The Treatment Action Campaign, which along with other AIDS activist groups, won a court case at the end of 2001 ordering the government to provide nevirapine, has welcomed the report. TAC spokesman Nathan Geffen told Reuters news agency that: "The government has no further excuses."
Five of South Africa's nine provincial governments have already started nevirapine access schemes for HIV-positive pregnant women, and although the report highlights that capacity to deliver the drug varies between provinces, it concludes that: "There are now no good reasons for delaying the gradual and phased expansion of prevention of mother-to-child transmission (PMTCT) services," adding a "phased and systematic expansion of comprehensive PMTCT services should be combined with the immediate provision of [nevirapine] to pregnant women already known to be HIV-positive."
Activists are hopeful that plans will be in place by the summer for the provision of the drug to pregnant women nationwide.
Overview of the pilot programme
193 health facilities (hospitals, midwife obstetric units, community health centers and clinics) are currently part of the national PMTCT pilot programme. They cover approximately 6,090 ante-natal bookings per month, which translates to about 9% of the total number of country-wide bookings.
The full figure for access to PMTCT in South Africa is considerably more. Some provinces have already begun to expand their services, and together with a number of clinical research sites, the full proportion of pregnant women in this country with access to HIV counselling, testing and NVP may be as high as 15%.
The rate at which pregnant women agree to be tested for HIV is currently 51% in the national PMTCT sites. This translates to about 3,133 pregnant women being tested per month, which is a very positive achievement. The testing uptake rate varies tremendously between provinces and sites (ranging from 17% to 90%), and the reasons for these differences are described in this report. Overall, the HIV testing uptake rate is likely to improve over time.
Of the women agreeing to HIV testing, about 30% are HIV positive. On the basis of these VCT uptake and sero-positivity rates, it is estimated that 6,343 HIV positive pregnant women have been identified in the national PMTCT sites. However, the recorded number of HIV positive women who have delivered with the administration of NVP to both mother and baby is 1,932. Some of the reasons for this large difference in numbers are:
- Because HIV testing usually occurs several months before delivery, at any given point in time, the cumulative number of identified HIV positive pregnant women will be more than the cumulative number of deliveries (especially at the beginning of a programme)
- Women accessing the PMTCT service ante-natally may deliver elsewhere.
- An under-recording of statistics in the labour wards.
The full report and further exective summary points can be viewed at the Health Systems Trust website