South Africa is Securing an AIDS-Free Generation by Preventing Mother-to-Child Transmission of HIV

With MomConnect PMTCT, women living with HIV are experiencing safer childbirths.

In South Africa, nearly 1 in 3 pregnant women are HIV positive.

South Africa has one of the highest rates of HIV infection in the world, with a prevalence of 12.2% in the general population. Women are at particularly high risk. Throughout life, at nearly every age, women experience a higher burden of HIV than men[1]. As of 2012 (the most recent data available), the HIV prevalence is 14.4% among women and 9.9% among men[2]. Among people of reproductive age (15–49), 14.5% of men are HIV positive compared to 23.2% of women[3]. Almost 30% of pregnant South African women are living with HIV[4].

HIV can have social, economic, and emotional implications, but women living with HIV face additional concerns if they become pregnant. Without any interventions, there is a 15% to 45% chance that a baby born to a woman with HIV will also become infected during pregnancy, childbirth, or breastfeeding[5]. Infants and children with HIV often experience more severe effects than adults, and they may be unable to fight common childhood illnesses. However, with access to treatment and support for mothers and their babies, the risk of mother-to-child transmission drops below 5%[6]. Even when the prevalence of HIV is high, new infections are preventable.

Eliminating mother-to-child transmission of HIV is important for public health and for protecting the next generation, but these services also protect the dignity and health of women. For many women, a pregnancy and new baby are causes for celebration. Doctors, friends, and coworkers congratulate women on their growing families. However, for women living with HIV, the experiences of pregnancy, childbirth, and breastfeeding can be very different.

Women living with HIV who become pregnant have the dual responsibilities of managing their own health while undergoing treatment to prevent mother-to-child transmission. Access to the right services and the right drugs at the right times makes transmission rare and pregnancy, childbirth, and breastfeeding reasonably safe.

In reality, women may face significant barriers to accessing care and may feel overwhelmed and scared. Pregnant women living with HIV may also experience stigma and discrimination from health care workers as well as from family members and friends. These negative attitudes and experiences can discourage women from seeking medical care for themselves or their children, consistently taking their prescribed antiretroviral therapy, or disclosing their status to others.

Like all women, women living with HIV have the right to choose the number and timing of their births. They also have the right to safe and joyful childbirth and motherhood experiences if and when they become pregnant.

By providing high-quality care in line with current World Health Organization (WHO) recommendations, along with accurate information and counseling to women, health systems can protect the next generation of children from HIV while supporting the health and human rights of the current generation of women living with HIV.

Mother-to-child transmission of HIV has been on a steady decline in South Africa. One way the country has made significant progress is by expanding the reach of health services and improving access. Annually, 300,000 infants are born to mothers living with HIV, but the number of new pediatric infections has declined 73% — from 33,000 in 2009 to 9,000 in 2014[7].

The progress is encouraging, but more work is still needed. Mother-to-child transmission of HIV is almost completely preventable when mothers have access to modern medicine and services. In fact, WHO has recently completed the official validation process to certify that Thailand, Belarus, and Armenia have eliminated mother-to-child transmission of HIV in June 2016, and validated Cuba’s elimination in June 2015[8]. Although treatment is not 100% effective and a goal of zero new pediatric infections is not yet realistic, WHO considers elimination to be the reduction of transmission such that it no longer constitutes a public health problem[10]. In South Africa, elimination is in sight, and the Department of Health is adopting innovative approaches to reach all women in need to provide critical services.

Maternity clinic in South Africa. Photo courtesy of MomConnect.

In South Africa, the National Department of Health is working with HealthEnabled and the USAID-funded Knowledge for Health (K4Health) Project through a public-private partnership supported by PEPFAR and Johnson & Johnson. The partnership is expanding the national MomConnect initiative, which registers pregnant women across the country and provides maternal and child health information in the 11 official languages via mobile phone throughout pregnancy and the first year after birth. In order to help meet the needs of the 30% of pregnant women who are living with HIV, MomConnect now offers additional weekly messages about managing HIV in pregnancy and preventing vertical transmission. Messages cover the following topics:

● Reminders to consistently take prescribed antiretroviral therapy

● Tips on how to manage treatment side effects

● Breastfeeding guidance

● Reminders to return for recommended testing and care for their infants

Timely messages empower women to make informed decisions about their health, nutrition, and medical care. Women can also contact a professional nurse at a virtual Help Desk to ask questions and seek additional support. With accurate information and customized referrals, women know what to expect from the health system and are better able to take advantage of available services.

Image courtesy of MomConnect.

After launching in July, MomConnect PMTCT aims to reach 27,000 HIV-positive pregnant women and new mothers in five districts during a six-month pilot. The initiative is working with the Department of Health to train at least 200 health workers from the public sector and implementing partners to enroll consenting women and provide support.

The project is active in five of the country’s 52 health districts. Implementers are working with the Wits Reproductive Health and HIV Institute (WRHI) in Johannesburg to conduct a robust evaluation in a single facility, while conducting routine monitoring across all other implementing facilities. With the goal of improving retention in HIV care along with improving maternal and child health outcomes, the team will assess the effect of the program on the rate of return for infant HIV testing. After the pilot, the initiative plans to support the Department of Health and implementing partners in facilitating national scale-up.

Although implementation is challenging at times, this diverse partnership, which engages multiple donors and partners with critical leadership from the National Department of Health, builds on previous successes and positions the MomConnect PMTCT initiative for national scale-up. By engaging the right stakeholders, using an established technology platform, and providing high-quality, vetted information directly to women via their mobile phones, the initiative is designed to have a measurable impact on improving retention in PMTCT care. When women living with HIV are able to access the full cascade of PMTCT services, including early testing, recommended antiretroviral therapy, and appropriate support throughout pregnancy and breastfeeding, the risk of transmission can be minimized.

Every woman, regardless of HIV status, deserves to celebrate her pregnancy and give birth without fear. With accurate information and high-quality, respectful medical care and support, every woman can have a safe and happy motherhood experience.

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The Exchange is a K4Health publication. The Knowledge for Health (K4Health) Project is supported by the United States Agency for International Development (USAID) Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreement #AID-OAA-A-13–00068 with the Johns Hopkins University.

The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the U.S. Government.