A grave delay for South Africa's mothers and infants

Abstract

On Jan 25, South Africa's National Health Council finally adopted new guidelines for the prevention of mother-to-child transmission (MTCT) of HIV, following increasing pressure from AIDS activists and clinicians. This positive move is long overdue.In 2006, WHO recommended switching from a one-off single dose of nevirapine to more effective dual antiretroviral prophylaxis beginning in the third trimester of pregnancy. Botswana and South Africa's Western Cape province have seen declines in paediatric HIV since rolling-out the new recommendations. But health workers in the rest of South Africa were left waiting for the health ministry to publish and disseminate the new guidelines. When the South African National AIDS Council last met on Nov 29, 2007, it said that the new protocol would be announced within 2 weeks. But nothing followed.AIDS activists have pointed the blame for the delay at the health ministry's leader—Manto Tshabalala-Msimang—infamous for her unscientific promotion of garlic and beetroot for HIV treatment. Rumours have been circulating that she allegedly failed to sign the necessary documents to implement the changes. A ministry official has denied the accusations, telling local news media that costing the new regimen was the reason behind the hold-up. Either way, South Africa's doctors and HIV-positive pregnant mothers have had to wait for the health ministry to get its act together and children have been infected unnecessarily as a result.South Africa is a middle-income country with a high rate of antenatal attendance and health-facility births but where around 60 000 infants are infected with HIV each year. Tshabalala-Msimang's failure to quickly deliver a relatively simple, evidence-based policy change in this setting demonstrates her inability to effectively deal with South Africa's health challenges. Personnel changes are clearly needed at the health ministry following this grave delay for mothers and infants, starting with the removal of Tshabalala-Msimang. On Jan 25, South Africa's National Health Council finally adopted new guidelines for the prevention of mother-to-child transmission (MTCT) of HIV, following increasing pressure from AIDS activists and clinicians. This positive move is long overdue. In 2006, WHO recommended switching from a one-off single dose of nevirapine to more effective dual antiretroviral prophylaxis beginning in the third trimester of pregnancy. Botswana and South Africa's Western Cape province have seen declines in paediatric HIV since rolling-out the new recommendations. But health workers in the rest of South Africa were left waiting for the health ministry to publish and disseminate the new guidelines. When the South African National AIDS Council last met on Nov 29, 2007, it said that the new protocol would be announced within 2 weeks. But nothing followed. AIDS activists have pointed the blame for the delay at the health ministry's leader—Manto Tshabalala-Msimang—infamous for her unscientific promotion of garlic and beetroot for HIV treatment. Rumours have been circulating that she allegedly failed to sign the necessary documents to implement the changes. A ministry official has denied the accusations, telling local news media that costing the new regimen was the reason behind the hold-up. Either way, South Africa's doctors and HIV-positive pregnant mothers have had to wait for the health ministry to get its act together and children have been infected unnecessarily as a result. South Africa is a middle-income country with a high rate of antenatal attendance and health-facility births but where around 60 000 infants are infected with HIV each year. Tshabalala-Msimang's failure to quickly deliver a relatively simple, evidence-based policy change in this setting demonstrates her inability to effectively deal with South Africa's health challenges. Personnel changes are clearly needed at the health ministry following this grave delay for mothers and infants, starting with the removal of Tshabalala-Msimang.