Page 19 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 8 Guideline

The updated South African National Guideline

for the Prevention of Mother to Child Transmission

of Communicable Infections (2019)

Authors: Introduction
Jeannette Wessels 1
Gayle Sherman South Africa has made great strides in reducing the vertical transmission of human
2,3
Lesley Bamford immunodeficiency virus (HIV) in the first two months of life from 23% (2003) to 0.7% (2019),
4,5
Manala Makua 6 despite a persistently high antenatal HIV prevalence of around 30%. Improving access to
Mathilda Ntloana 6
James Nuttall 7 antiretroviral therapy during antenatal care has significantly contributed to this success, but has
Yogan Pillay 6 led to an increase in the relative proportion of vertical transmissions due to breastfeeding in the
Ameena Goga 8,9,10 first six months post-delivery. Yet, due to the short- and long-term benefits of breastfeeding and
Ute Feucht 1,9,11,12
risks associated with not breastfeeding, mothers need to be supported to breastfeed their infants
Affiliations: for the longest duration possible, while maintaining virological suppression to reduce the vertical
1 Research Centre for transmission risk.
Maternal, Fetal, Newborn
and Child Health Care
Strategies, University of The new South African National Guideline for the Prevention of Mother to Child Transmission of
Pretoria, Pretoria, Communicable Infections (2019) outlines three major strategies for programme improvement.
South Africa These are 1) prevention of primary HIV infection and unintended pregnancies in women of
childbearing potential, 2) improvement of maternal viral suppression rates at delivery and in the
2 Department of Paediatrics &
Child Health, Faculty of post-delivery period through potent, well-tolerated antiretroviral regimens, strategic use of
Health Sciences, University of maternal viral load monitoring, linking of mothers to post-delivery HIV care and integration of
the Witwatersrand, mother-infant health care, and 3) provision of enhanced prophylaxis to infants of mothers with
Johannesburg, South Africa
elevated HIV viral loads in the breastfeeding period, while every effort is made to regain maternal
3 Centre for HIV & STI, viral suppression.
National Institute for
Communicable Diseases, Rigorous implementation of this guideline can potentially move South Africa closer to
Division of the National the goal of eliminating mother-to-child transmission and making an HIV-free generation a
Health Laboratory Services,
Johannesburg, South Africa reality.
4 Child, Youth, and School South Africa’s (SA) programme of prevention of mother-to-child transmission (PMTCT) of HIV
Health Chief Directorate, has achieved remarkable successes in recent years in ensuring good outcomes for pregnant
National Department of
1
Health, Pretoria, South Africa women living with HIV and reducing the risk of vertical HIV transmission to their children. The
most critical intervention to prevent vertical transmission is the maintenance of the undetectable
5 School of Health Systems maternal HIV viral load (VL) levels through effective antiretroviral therapy (ART). This has
2
and Public Health, University necessitated a considerable scale-up of HIV testing services (HTS) within antenatal care to
of Pretoria, Pretoria,
South Africa identify women living with HIV (WLWH). The PMTCT ‘Option B Plus’, namely the provision of
lifelong ART irrespective of CD4 count or clinical disease severity, was implemented in South
6 Communicable and Africa in January 2015, and significantly improved access to ART for pregnant women in the
Non-Communicable Diseases public sector. As a result, more than 95% of women with unknown HIV status are currently
3,4
Branch, National Department
5
of Health, Pretoria tested for HIV during antenatal care, and more than 90% of WLWH are on ART. Vertical
transmission rates within the first two months of life dropped dramatically from 23% in 2003 to
6
7 Department of Paediatrics 0.7% in 2019. 7
and Child Health, Red Cross
War Memorial Children’s 8 Health Systems Research Unit, South African Research Council, Cape Town, South Africa
Hospital, University of Cape 9 Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
Town, Cape Town, South Africa 10 HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa
11 Tshwane District Health Services, Gauteng Department of Health, Tshwane, South Africa
12 Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa
Read online: Corresponding author: Jeannette Wessels, [email protected]
Read online:
Scan this QR Dates: Received: 24 Feb. 2020 | Accepted: 03 May 2020 | Published: 08 July 2020
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Copyright: © 2020. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
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