N Rasmeni: Prevention of Mother to Child Transmission event

12 September 2007

I am pleased to be with you today as the custodians of our people's health.
We must all agree that we meet here today because of one of the most essential
health programmes in our department. Indeed the Prevention of Mother to Child
Transmission (PMTCT) has become such a critical programme and I suppose we all
know it is because of the AIDS factor in it. We put aside these three days from
the 12th to the 14th of September to come here and specifically focus on
heightening PMTCT awareness in our health institutions (hospitals and clinics)
here in the Southern district. This awareness road show will unfold to other
districts. I am hopeful that, as we engage one another through out these road
shows, we will be able to critically evaluate the work we are doing as a
department in our effort to improve the Prevention of Mother to Child
Transmission.

The National Strategic Plan for HIV and AIDS and Sexually Transmitted
Infection (STI) for 2007-2011, adopted by Cabinet earlier this year, has made
room for the introduction of dual therapy to reduce
Mother-to-child-transmission of HIV. Furthermore, the move from single dose
Nevirapine to dual therapy (Nevirapine and AZT) has been discussed by the
National Health Council (NHC) which is made up of the Minister and MECs for
Health. The discussions centred on the recommendations of the Medical Research
Council (MRC), National Essential Drugs Committee and the Medicines Control
Council (MCC) to move to dual therapy.

The National Health Council took a decision to evaluate the use of
Nevirapine in reducing mother to child transmission of HIV. The NHC also
deliberated on implications for implementation including training and capacity
of health workers, adherence counselling and support to women. Further work is
being done to improve guidelines and facilitate appropriate training for health
workers, stock management, monitoring of resistance and information management
for the introduction of such a therapy.

As a department, we are on course in as far as improving access to HIV
testing and counselling in antenatal clinics. Obviously more work still needs
to be done. There is a need to also improve family planning services to known
HIV positive women, to improve access to comprehensive reproductive health
services for HIV positive women, to train reproductive health providers on HIV
and AIDS counselling and to implement clinical guidelines to reduce the
transmission of HIV during childbirth and labour. We must also look at the
importance of training all relevant midwives and medical practitioners as we
continue to capacitate this programme. All these good intentions are captured
in the National Strategic Plan for HIV and AIDS and it remains our
responsibility to ensure that the province benefit from it.

I am pleased with the district achievements in this regards which
include:

* The fact that PMTCT program has been implemented in all facilities in the
District.
* Nevirapine uptake rate among pregnant women with HIV has improved from 60
percent to 100 percent in 2007.
* Nevirapine uptake rate among babies born to women with HIV has increased
considerably and steadily.
* Nevirapine dose to baby coverage rate has improved.
* HIV PCR positive rate decreased from 9 percent to 5,5 percent

I am also mindful of the challenges that remain. We must note the following
district challenges with a view to work hard and to consult extensively in
ensuring that we improve the situation:

* HIV PCR testing rate has declined in this district due to various factors
which include:

* Babies lost to follow up due to migration and stigma
* Switch over from PCR testing to DBS
* Lack of preparedness during switch (inadequate training)
* Long turn around time for PCR (done at WITS)

* We are still battling to have programs coordinator at District level
* There is a notable inadequate use of data analysis and information for action
at facility, Sub-District and District levels.

Moving forward, we must constantly engage essential requirements and
elements of this programme with a view to improve capacity and to strengthen
it. The appointment of district program coordinators therefore becomes one of
the things we need to prioritise. We must continue to mobilise and educate
communities about PMTCT so that they can begin to get seriously involved and
assisting the situation. In this regard, our antenatal clients (the mothers)
become our primary target. This will also assist the aspect of uptake
improvement.

Ongoing counselling and information during the antenatal and postnatal
period to support infant feeding and other decisions such as disclosing HIV
status remains critical. For pregnant women to make informed decisions about
reducing their risks of transmitting HIV to their infants, they must know their
HIV status. Therefore, counselling and HIV testing is the entry point into the
PMTCT programme. Making counselling and testing services available in our
health institutions and clinics is therefore a key PMTCT programme objective.
Our support groups will also assist a lot. In this regard, the destigmatisation
of HIV and AIDS at both the community level and the health service level may
enable individuals with HIV to feel more comfortable disclosing their status to
health workers. It is important that we emphasise the fact that HIV-infected
women need to receive ongoing counselling and support for whichever infant
feeding choice they make. So, in this case the role of community support or
support groups can also go as far as enfant feeding. We got to learn that
community support is especially important for women's feeding choices in
contexts where decisions are not made by the mother alone, and where cultural
or family practices are highly influential in determining ultimate
practices.

Other key areas of PMTCT include health care infrastructure namely human
resources, training, management, information systems and management of
consumables and supplies. We must really look at ensuring that lay counsellors
training focus not only on counselling skills needed for HIV testing but also
include counselling on infant feeding options. Of course this goes hand in hand
with the supervision, support and mentoring of lay counsellors as well as their
motivation in terms of remuneration. Training here also extend to health
workers in this programme.

It is important that all stakeholders in this programme take seriously the
challenges that still remain so that we may see continuous improvement in the
reduction of mother to child transmission of HIV and AIDS.

I thank you.

Issued by: Department of Health, North West Provincial Government
12 September 2007