South Africa has stepped up the game to end mother-to-child transmission of HIV with undetectable antiretroviral treatment (ART), a remarkable success achieved in recent times which has improved the life expectancy for pregnant women living with the virus.

Associate professor in paediatrics, Ute Feucht and Jeannette Wessels, a researcher at the Centre for Maternal, Fetal, Newborn, and Child Health Care Strategies, both at the University of Pretoria, said eliminating mother-to-child HIV transmission in the country requires innovative strategies and continuous quality improvement.

“To achieve these outcomes the South African Department of Health has revised the guidelines for the prevention of mother-to-child transmission,” Ute said, adding that they now include “a strong focus on maternal viral suppression during antenatal care, delivery, and in the period after birth.”

If implemented effectively, the approach set out in the guidelines would put South Africa within reach of eliminating mother-to-child transmission. “Creating an environment that enables the rigorous implementation of this guideline will move South Africa closer to the goal of eliminating mother-to-child transmission of HIV and making an HIV-free generation a reality,” added Ute.

South Africa is said to have the biggest and most high-profile HIV epidemic in the world. In 2018, 7.7 million people were living with HIV in South Africa out of which 62.67 percent were women, according to a UNAIDS report.

ART was first introduced in 2004 and has played a significant impact on mother-to-child HIV transmission rates in particular.

More than 90 percent of HIV-positive women are now being initiated on ART, a huge improvement from only 57 percent accessing ART in 2007. Mother-to-child transmission rates have dropped dramatically.

Without any intervention, the HIV-infection rate was around 40 percent. With these interventions, the HIV-infection rate at birth is currently around 1 percent. 

What this means is that South Africa aims to eliminate mother to child transmission completely. But realizing this ambitious target also requires that maternal viral suppression rates be improved, particularly in the period after the mother gives birth. 

This would lead to reduced HIV transmission during breastfeeding, improved maternal health, and viral suppression in future pregnancies as well as reduced HIV transmission to sexual partners.

By Ahmed Iyanda.