The updated South African National Guideline for the Prevention of Mother to Child Transmission of Communicable Infections (2019).

Jeannette Wessels,James Nuttall,Gayle Sherman,Ute Feucht,Manala Makua,Lesley Bamford,Ameena Goga,Yogan Pillay,Mathilda Ntloana

doi:10.4102/sajhivmed.v21i1.1079

Abstract

The updated South African National Guideline for the Prevention of Mother to Child Transmission of Communicable Infections (2019).

Highlights

South Africa has made great strides in reducing the vertical transmission of human immunodeficiency virus (HIV) in the first two months of life from 23% (2003) to 0.7% (2019), despite a persistently high antenatal HIV prevalence of around 30%
More than 95% of women with unknown HIV status are currently tested for HIV during antenatal care, and more than 90% of women living with HIV (WLWH) are on antiretroviral therapy (ART).[5]
With pre-treatment resistance to non-nucleoside reverse transcriptase inhibitors documented to be on the increase, and the high likelihood of viral resistance in the mother with an elevated viral load (VL) on ART,[29,30] these infants should receive high-risk prophylaxis consisting of AZT twice daily for six weeks, and NVP daily for a minimum of 12 weeks, with infant NVP only stopped after confirmed maternal HIV VL < 1000 c/mL, or breastfeeding cessation

Summary

Introduction

South Africa has made great strides in reducing the vertical transmission of human immunodeficiency virus (HIV) in the first two months of life from 23% (2003) to 0.7% (2019), despite a persistently high antenatal HIV prevalence of around 30%. A concerted effort has been made to ensure alignment between these guidelines and other national guidelines, including the Standard Treatment Guidelines and Essential Medicines List for South Africa It includes a strong focus on the prevention of HIV and unintended pregnancies in women of childbearing potential, maternal viral suppression, preventing MTCT during the breastfeeding period, and care integration for the mother-infant pair. The prescription of antiretroviral drugs that rapidly and safely achieve and sustain maternal viral suppression during pregnancy and the breastfeeding period is of greatest importance to the prevention of vertical transmission In this regard, the newly introduced integrase inhibitor dolutegravir (DTG) offers improved tolerability, few drug interactions, and the reduced risk of viral drug resistance.[18] The time to viral suppression is approximately halved by DTG when compared to the currently administered drug efavirenz (EFV).[18]. Antenatal care usually occurs at a different facility from delivery, and antenatal VL results may not be available at the delivery site

A VL done at the actual time of delivery has the following advantages:

Conclusions

Findings

Data availability statement