PMTCT and paediatric ART

Preventing the transmission of HIV from mothers to their children is a key intervention in curbing the spread of HIV. Because HIV transmission can happen during pregnancy, during labour and delivery and through unsafe breastfeeding, prevention of mother-to-child transmission (PMTCT) of HIV must begin early in pregnancy and continue until the child stops breastfeeding.

In South Africa, PMTCT is built on: antiretroviral treatment (ART) prophylaxis or lifelong ART for the mother; infants being given the ARV neviripine until breastfeeding stops completely; and exclusive breastfeeding i.e. no other substances other than breast milk for the first six month’s of the baby’s life.

Anova’s PMTCT programme has received wide acclaim for its low transmission rates. Anova’s PMTCT programme has been receiving USAID funding since 2001. During this time, hundreds of thousands of women have been through the programme and transmission rates have dropped steadily from 35% to below 4%.

In 2014, Anova’s assisted in the roll-out of government’s national pregnancy registry, MomConnect, in the Cape Winelands and the City of Johannesburg. MomConnect uses SMS text messages to remind pregnant women of critical appointments for tests and check-ups, and to deliver health and childcare information. It is ultimately aimed at improving the maternal and under-five mortality rate in South Africa by providing essential information via SMS during pregnancy and for a year after, for free. MomConnect also functions as a registry, which allows it to do the job of providing government with feedback on key maternal and child health indicators.

In the Cape Winelands, Anova is a key partner in supporting and strengthening the district’s PMTCT programme with the goal of reducing the HIV transmission rate to zero. The transmission rate from mother to child stands at 1.7% in the Winelands in 2014, and as such the district is a leader in PMTCT care and practice.

Most recently, Anova has assisted in smoothing the Western Cape’s transition to the PMTCT policy of initiating all HIV-positive pregnant mothers on lifelong ART by providing training and mentoring for healthcare workers based at clinics and in labour wards. Management of the high-risk infant has been a particular focus point of Anova’s PMTCT support, and has since been adopted into policy.

In 2011 in the Cape Winelands project fewer than 2% of all babies born to mothers who were enrolled in PMTCT programmes at Anova-supported clinics, contracted HIV. This is in line with globally accepted standards and represents a significant drop compared to transmission rates of 9% five years ago.

In Gauteng, Anova focuses on all aspects of PMTCT, including counselling and voluntary HIV testing of pregnant women; CD4-count testing; referral for treatment; screening and testing for TB; provision of AZT prophylaxis; guidance on infant feeding; PCR testing of infants; coding of the HIV status of pregnant women; and monitoring and evaluation.

The programme boasts a good uptake of PMTCT services, with 99% of pregnant women testing for HIV at their first visit to the clinic.

In 2011 mother-to-child HIV transmission rates were at an all time low of below 2% across all Anova-supported clinic in Soweto.

Anova helps facilitate paediatric HIV/AIDS management and the initiation of children on ART. In Gauteng there has been a reduction in the morbidity and the mortality rate by 80% in children started on antiretrovirals at an early stage.

Anova is also involved in researching the side-effects of HIV treatment in children, in order to better understand how to manage HIV treatment among this age group. Treating children with HIV is more complex given that less is knows about the side-effects of ART in children and young adolescents. This is further complicated by young children’s difficulty in effectively communicating their symptoms.

In Mopani, Limpopo, with funding from Orange Babies, Anova has established the only psychosocial support and education programme aimed at children in the province.

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