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Hospital slashes babies?’ HIV infection rate
by Kerry Cullinan & Luke Reid. Republished courtesy of Health-e News (www.health-e.org.za).
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Only 5% of babies born to HIV positive mothers at a small, dedicated hospital get the virus. The parents come out of the counselling room looking a little dazed but delighted, with eyes only for their sleepy six-week-old baby all swaddled in pink. Michael and Lulu Davids* have just been told that their chubby baby daughter is HIV negative.
?“I am very happy. This is a confirmation of how great God is,?” says Lulu, who is HIV positive but her husband is negative. The Durban hospital has one of the longest HIV treatment track records in the country, and first started a Prevention of Mother to Child HIV Transmission (PMTCT) programme nine years ago. Each year, the service improves and this year the hospital aims reduce this transmission rate to two percent.
?“It is usually a happy time when parents come for the results of their babies?’ HIV tests when the babies are six weeks?’ old because we have so few positive babies,?” says Fezile Shabangu, manager of the hospital?’s Mother?’s Programme. Unlike at government hospitals, pregnant HIV positive women at the semi-private, state-aided McCord are offered a variety of antiretroviral treatment options to prevent transmission of the virus to their babies.
Before McCord had developed its comprehensive ARV treatment programme, most pregnant HIV positive women chose to deliver by caesarean section. This reduces the risk of HIV transmission during birth as the baby is exposed to less blood and body fluids.
But caesareans are expensive and more risky for the mothers.
With combination ARV therapy started early to reduce the mother?’s viral load (amount of virus in the body), the hospital has managed to reduce the risk of transmission so substantially that caesareans are no longer necessary to prevent HIV transmission.
The exact combination of the ARV drugs used depends on a number of factors, including the mother?’s CD4 count and viral load. The use of a single dose Nevirapine for the mother and baby is only used where mothers come to the hospital too late for any other intervention.
Research shows that about 30% of pregnant women transmit HIV to their babies without any drug intervention. The use of Nevirapine alone cuts this transmission rate to about 15%. With combination antiretroviral drug therapy, the transmission rate can be reduced to around two percent, which is the case in most developed countries.
Over a year ago, the Medicines Control Council (MCC) recommended that pregnant women should no longer be given Nevirapine alone for PMTCT. However, only government hospitals in the Western Cape offer both AZT and Nevirapine. Shabangu says three-quarters of pregnant women coming to the hospital agree to have an HIV test because counsellors spend a long time explaining issues to them.
About 12% of women who test at McCord are HIV positive, which is far lower than the provincial average of 40.7% according to the latest health department statistics.
The majority of HIV positive mothers also bottle-feed their babies, which also helps to reduce the risk of HIV infection.
For Dr Chantelle Young, the PMTCT doctor, proper counselling makes all the difference in ensuring the success of the Mothers?’ Programme. ?“The general belief is that HIV means death. This is what remains in the mothers?’ heads,?” says Young.
?“If people do not have adequate counselling then they lose hope. Even if you are on antiretrovirals, once you lose hope the battle is almost over. Patients become weak. Adherence goes out the window. Hope is the most important thing. It?’s all in your head.?”
Although the women can attend a support group, most opt for one-on-one counselling. ?“A lot of people from Umlazi come here. They don?’t want to join a group and be seen because they think other people will talk about them,?” says Shabangu.
Lulu Davids, who works as a nurse at a government hospital, could have delivered her baby for free at her place of work. Instead, she and her unemployed husband opted to pay over R5 000 to have a Caesarean section at McCord because she didn?’t want her colleagues to know her HIV status. When she came to McCord, Lulu?’s CD4 count was 112 and she was advised to go onto triple therapy ?– three antiretroviral drugs.
?“I was scared because I thought the drugs might affect the baby. I prayed and I prayed about it. Then at 32 weeks I decided to take the treatment. My baby is well. She already weighs 5kgs. My viral load is undetectable.?” * Names changed at parents?’ request. |
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