Lately, the initiative by South Africa to prevent mother-to-child transmission of Human Immunodeficiency Virus (HIV) has recorded significant success. The success of the program includes; reduction in the risk of transmission of the virus from mother to offspring and an increase in health and life expectancy of pregnant women living with HIV. However, in the battle for the prevention of mother-to-child HIV transmission, what more can be done?
HIV can move from mother to child at three stages of the child’s life namely;
- During pregnancy
- At the time of delivery
- Through breastfeeding
To date, the most important intervention in the prevention of mother-to-child HIV transmission is to ensure undetectable viral load in the mother’s bloodstream. The only way to achieve that is through effective antiretroviral treatment (ART). If it is that simple, then, why is mother-to-child HIV transmission still an issue?
Why South Africa is a Global Leader in the Prevention of Mother-To Child HIV Transmission
The success made by South Africa’s prevention of mother-to-child HIV transmission program is as a result of legislative changes. Pregnant women first gained access to ART in 2004. However, it took over a decade for antenatal services to provide access to lifelong ART for pregnant women. The good news is that when it finally happened in 2015, pregnant women could get ART irrespective of their CD4 count. CD4 cell is a type of white blood cell that moves around the body to find and destroy invading organisms.
Following this change in legislature, over 95 percent of women now get HIV test during antenatal care. Again, more than 90 percent of HIV-positive women now receive ART. This is a huge leap from 57 percent of HIV-expectant mothers with access to the drug in 2007. Consequently, there has been a huge drop in mother-to-child transmission rates. The rate of mother-to-child HIV transmission now stands at 1 percent against the previous 40 percent.
The Next Goal is Total Elimination of the Scourge
With the success of the program to prevent mother-to-child HIV transmission, South Africa can now push for the total eradication of the menace. However, to realize this ambitious goal, the country must think out of the box. Future strategies need to ensure improvement in maternal viral suppression rates. When this is achieved it will have a cascading effect including;
- Reduction in mother-to-child HIV transmission during breastfeeding
- Improvement in maternal health
- Reduction in the risk of HIV transmission to a sexual partner
- Increased viral suppression in future pregnancies
To achieve these goals, the South African Department of Health recently revised its mother-to-child HIV transmission prevention guidelines. The new guideline will focus on the suppression of maternal viral load. The target will be at three stages namely; during antenatal care, at delivery, and postpartum. If properly implemented, there is a slim chance South Africa can win this battle.
A New Drug to the Rescue
One of the strategies to achieve the goal is the introduction of a new drug, dolutegravir. The drug is now the first-line ART in South Africa. Some of the features of dolutegravir that makes it endearing are;
- Lesser side-effects
- Rapid suppression of viral load
- Fewer interactions with other drugs
- The virus doesn’t easily develop resistance to the drug
The majority of mother-to-child HIV transmission now occurs during breastfeeding. Therefore, the improvement of viral load in the postpartum period is crucial. Consequently, South Africa has introduced viral load monitoring at six months after delivery for all women on ART. Also, all exposed HIV-negative infants will get an HIV test at 6 months. Potent ART regimen is most effective when carried out simultaneously with viral load monitoring.
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