The health department of Tshwane City has raised concerns about the ongoing occurrence of HIV transmission from mothers to their children.
The South African National AIDS Council (Sanac) aims to ensure that at least 95% of HIV-infected children are tested and connected to treatment and care amid concerns about rising infection rates among infants. This follows the Tshwane City health department’s warning about the ongoing prevalence of mother-to-child HIV transmission in the district.
In the period from January to June 2024, 232 infants in Gauteng tested positive for HIV, with 39 cases reported in Tshwane. This represents a slight decrease compared to the previous six months (July to December 2023), during which there were 211 cases province-wide, including 43 in Tshwane.
Mother-to-child transmission occurs when the HIV virus is passed from a mother to her baby during pregnancy, delivery, or breastfeeding.
The city provided several reasons for this ongoing issue, including HIV-positive mothers not consistently adhering to antiretroviral (ARV) treatment during breastfeeding, pregnant women facing barriers to accessing timely antenatal care at clinics, and instances where mothers initially tested HIV-negative during pregnancy but later contracted the virus and transmitted it to their babies.
According to NozukoMajola, Sanac’s technical lead for social and structural drivers of HIV, TB, and STIs, “improvements have been noted, but initial challenges were significant in preventing HIV transmission to children, especially postnatally and during breastfeeding.”
“At birth, our performance is relatively strong, with high PCR test coverage indicating that 98% of live births are tested. However, testing rates drop to about 87% during immunization at six weeks due to uncertainties surrounding seroconversion in infants. This underscores missed opportunities resulting from fragmented healthcare services for children.”
Seroconversion refers to the period when the body starts producing measurable levels of HIV antibodies.
Explaining further about immunization, Majola mentioned that during immunization appointments, HIV testing is not routinely conducted by the administering nurse.
Majola highlighted a concerning trend from 2012 to 2015 in South Africa, where the rate of HIV infections among infants was 0.2%. This rate initially decreased when pregnant women diagnosed with HIV began receiving immediate ARV treatment. However, the situation deteriorated when healthcare providers missed critical steps in postnatal care.
“At birth, we are achieving satisfactory results as indicated by high testing rates among children. However, at six weeks, testing rates decline because we can not predict when children will start producing detectable HIV antibodies. During immunization appointments, approximately 87% of children are tested, “as stated by NozukoMajola from Sanac.
“We witnessed considerable improvement initially as the country focused on ensuring no child was born with HIV. However, later on, we neglected the fact that infants could still acquire HIV through breastfeeding.
“As a result, we started noticing an increase in HIV infections among children after birth. This increase was linked to mothers acquiring HIV postnatally, without subsequent retesting during their clinic visits.”
She noted that the updated guidelines implemented in 2023 to prevent vertical HIV transmission were a refinement of previous protocols, incorporating advancements supported by current scientific understanding.
Since then, healthcare providers have enhanced their ability to track infections and ensure more children receive treatment. The introduction of dolutegravir (DTG) as a new treatment option has replaced the previous method, which was challenging for parents to administer to infants due to poor palatability.
“We continue to monitor the data, and as of March 2024, our target was to achieve a 63% transition rate to DTG for children aged nine and below living with HIV. By March, we successfully met this target, indicating improved uptake of DTG among children.”
“The goal is to ensure that 95% of all infected children undergo testing so we can identify them. Currently, we are at 82%, and our objective is to connect all of them to treatment and care,” she explained.
