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All babies should have HIV tests, says HIV/AIDS expert
11 September 2006. The Mercury. Republished courtesy of Independent Newspapers (Pty) Ltd.
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The South African government must introduce compulsory HIV/AIDS tests for six-week-old babies to monitor whether prevention of mother-to-child transmission is working, says HIV/AIDS expert Professor Nigel Rollins.
He was one of the guest speakers at an International All 4 Children Congress which was organised by the South African Paediatrics Association and held at Sun City over the weekend.
He delivered a paper "HIV prevalence rates among 6-week-old infants in South Africa: the case for the universal screening at immunisation clinics", in which he appealed to the government to support his initiative. The paper was based on the study he and his team undertook in KwaZulu-Natal.
Rollins said the compulsory HIV/AIDS screening tests would assist the government to establish whether Nevirapine, which is offered to HIV-positive pregnant mothers, stopped the transmission of the virus to the child.
"To do that you need to test the child after delivery. The difficulty is most of the woman undergo the initial prevention of mother-to-child transmission and never return to the clinics after delivery. So you cannot know whether transmission has been avoided."
He said the other difficulty was that some of the pregnant women did not undergo HIV/AIDS or other tests at all, particularly those who visited general practitioners.
Emphasising the importance of the test, Rollins said in some instances women were tested while still being in a "window period", which made it difficult to detect whether they had the virus.
He said other women, even if the initial test had proved negative, might have contracted the disease later during pregnancy.
Rollins told the congress how his team, comprising four other experts - Kirsty Little, Similo Mzolo, Christiane Horwood and Marie Louise Newell of the Nelson R Mandela School of Medicine - had gone to clinics where six-week-old infants were treated. The study was undertaken in four districts in KwaZulu-Natal.
They sampled 2 473 women using finger pricks and dried blood spot samples to determine the transmission rates from mother to child. All the participants, before the tests were conducted, were asked about their status during pregnancy. From the initial sample, 907 women were singled out as being infected with HIV.
A total of 486 confirmed their HIV status and received Nevirapine, 189 said they were negative and 232 did not disclose their status.
Rollins said 37,6 percent (907) of the sampled women had HIV and a total of 189 children (7,6 percent) were infected, which meant the transmission rate stood at 20,8 percent.
Ironically, Rollins said the confirmed HIV mothers had the lowest transmission rate - 15,8 percent - and those who claimed that they were negative had the highest transmission rate of 31,2 percent.
The participants who did not disclose their status had a 22,8 percent transmission rate.
Rollins said the tests would provide a second chance to women to learn their status, as well as that of their children. They would enable health authorities to do immediate referral to HIV care for mother and child.
Rollins told the congress there has been a dramatic increase in infant mortality in the past five years.
He said the rate had almost doubled for the period from 2000 to 2005, compared with the period from 1995 to 1999. The lowest mortality was between 1990 and 1994.
He said not all the deaths were due to HIV/AIDS. Some might have been caused by improper feeding methods, or lack of clean water and electricity for some of the affected families.
He said his findings had already received the support of the provincial government, which wanted to apply them in all 11 regions of the province.
"The KwaZulu-Natal government is undertaking a quality improvement strategy and they want to do surveillance across the province," he said.
In Gauteng, Wits University's Head of the Department of Paediatrics and Child Health, Prof Haroon Saloojee, came out in support of Rollins's proposal. Saloojee said the testing would be easily implemented in the province due to the availability of resources and transport to move from one area to another.
The association's president, Prof Raziya Bobat, also promised to submit Rollins's proposal to the Minister of Health, Manto Tshabalala-Msimang.
The Health Ministry was not available for comment at the time of going to press. |
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