South Africa: Lifelong ARVs for Pregnant Women, Says Health Minister

Kerry Cullinan

Health-e [Cape Town]

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Photo: Siegfried Modola/IRIN

All pregnant, HIV positive women will go onto lifelong antiretroviral treatment from January, Health Minister Dr Aaron Motsoaledi announced in his health budget vote yesterday.

In addition, people with HIV will start treatment when their CD4 count, which measures immunity, drops to 500 not 350 as at present.

Currently, pregnant HIV positive women only receive ARVs during pregnancy and breastfeeding if their CD4 count is over 350.

Next month, the health department will also launch MomConnect, an SMS service for pregnant women, which will send mothers-to-be health messages relevant to their stage of pregnancy.

“The women will also be able to send us ‘please call me’ messages to inform us of their concerns and experiences in our healthcare facilities,” said Motsoaledi, while explaining how his R145,7-billion budget will be spent.

However, HIV Clinician Professor Francois Venter and the Treatment Action Campaign (TAC) questioned whether the department would be able to implement these ‘hi-tech” measures when health service delivery was in crisis in many of the provinces.

“The intention behind these announcements is great but, given that there are daily stock-outs of basic TB medicine, ARVs and vaccines at many clinics, the department needs to pay attention to fixing health service delivery in the provinces,” said Venter, deputy director od the Wits Reproductive Health and HIV Institute and head of infectious diseases at Charlotte Maxeke Hospital in Johannesburg.

The TAC’s Marcus Low added that “there are severe problems in many of our provincial healthcare systems. We have for example seen a shocking collapse of services in the Free State in recent months. Failure to deal with under-performing provinces will undermine the effectiveness of any policy changes.”

Low also questioned whether “increasing the treatment threshold to 500” was warranted.

“While this may reduce transmission rates, it is not yet clear whether earlier treatment is in the best interest of individual patients – this question will only be definitively answered by the ongoing START trial,” said Low.

“The intention behind these announcements is great but, given that there are daily stock-outs of basic TB medicine, ARVs and vaccines at many clinics, the department needs to pay attention to fixing health service delivery in the provinces”

Motsoaledi acknowledged that there were “leakages” in the HIV treatment programme. Most significantly, health facilities had lost touch with almost four out of 10 (37%) people on ARVs three years after they started treatment. It is not known whether they have died, stopped ARVs or moved.

Only half of those on ARVs get their viral loads tested to see whether the ARVs are working to suppress the virus.

Only 65 percent of men and children who need ARVs are receiving them, in comparison to 80 percent of women.

Motsoaledi says there will be “mass (HIV) testing in every possible setting, including schools, universities, workplaces, churches and communities” to ensure that everyone knows their HIV status.

Venter said that patients being “lost to follow-up” was an international problem: “Given the level of disease I am seeing now, which is much lower than it was, it is likely that they have moved to other treatment programmes. But we have no data to guide us and there doesn’t seem to be a plan to monitor patients.”

 

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