BEN MACLENNAN, Cape Town | Thursday
A REPORT commissioned by the government and released on Wednesday says there are no good reasons to delay the expansion of programmes for preventing mother-to-child transmission (MTCT) of HIV.
It has also called for the fast-tracking in the interim of nevirapine for women who already know they have the virus.
The report, by the non-government organisation Health Systems Trust, is the first formal review of the 18 national MTCT pilot sites set up last year.
It comes only two days ahead of a renewed court bid by the Treatment Action Campaign (TAC) to force the government and provinces to broaden access to nevirapine.
It also follows weeks of confused signals on whether provinces have the blessing of national government to roll out the MTCT programme.
”Our recommendation talks about making nevirapine accessible to all known pregnant HIV-positive women,” one of the authors of the report, Dr David McCoy, told journalists in a briefing at Parliament.
He said scientific consensus was that toxicity or side effects of the drug in this context ”isn’t a real issue”.
The briefing was also to have been addressed by Health Minister Manto Tshabalala-Msimang, who has come under heavy fire over the policy debacle. However, an aide said she had another appointment and she sent the head of the department’s Aids programme Nono Simelela instead.
The report said the initial focus on two ”learning sites” per province had given national and provincial health management the opportunity to learn from the experience, as well as improve MTCT guidelines.
”With this in mind, there are now no good reasons for delaying the gradual and phased expansion of prevention of MTCT services,” the report said.
”With coherent and committed political and senior management leadership at the national and provincial levels, it should be possible for all provinces to begin implementing prevention of MTCT services in some new sites by the middle of 2002.”
It called on government to develop a ”coherent, transparent and credible plan” for the roll-out.
The report also called a review of policy on infant feeding in the programme, saying there was a danger that providing free formula in the expectation that women would not breast feed did more harm than good in many communities.
A national commission should be urgently set up to review policy and guidelines on this issue.
One option that should receive serious attention was post-natal administration of short-course anti-retroviral treatment to mothers and their babies as a strategy for making breastfeeding safe.
The report said that over 3 100 pregnant women were being tested at the 18 national sites every month, and a total of 1 932 HIV-positive women had delivered with the administration of nevirapine.
McCoy said it was still too early to say how many babies had been saved by the programme.
The report said experience with implementation had varied considerably, with some provinces and sites doing well, while others had struggled.
The uptake of testing varied tremendously between provinces and sites, from 96% in the Western Cape’s Paarl district to 17% at Siloam in the Northern Province.
Many of the difficulties related to the poor functioning of the health care system in general, and to the large inequities in health care infrastructure in the country.
”The systemic weaknesses and infrastructural constraints identified by this evaluation are not reasons for delaying action, but are important for informing the planning and expansion of prevention of MTCT services,” the report said.
The programme had potential to act as an engine or catalyst for the improvement of the health system and of primary health care services in general.
While this systematic expansion of MTCT services was being planned, nevirapine could and should be provided immediately to all pregnant women who were already known to be HIV-positive, with appropriate counselling and information.
”It’s so important that we don’t just have a policy that says prevention of MTCT services are available everywhere but in fact have a reality where for half the population they don’t actually exist because of fundamental problems within the health care system,” said McCoy.
He said that in addition to infrastructure, leadership was clearly important. However he warned against becoming ”too obsessed with national leadership” and not giving enough recognition to other levels of leadership.
Simelela said the report had been sent to all provincial health heads of department.
”We are also looking at the report and looking at the kinds of things we ought to do…the broader issues pertaining to the national level.
”I think it’s a good report,” she said.
However, she could not comment on whether it would influence government’s stand on the nevirapine court case brought against it by the TAC.
On Wednesday the TAC welcomed the report, saying it confirmed much of the experience of women with HIV/Aids, doctors and nurses, counsellors and other health care workers associated with the Aids lobby group.
The delivery of a comprehensive MTCT plan using nevirapine was both necessary and possible. – Sapa