Targets set on getting HIV-positive babies tested, treated amid worry over rising infections

The South African National AIDSCouncil (Sanac) says it hopes to ensure that at least 95% of children infected with HIV are tested and “linked to treatment and care” amid concerns about the continued rise in infection rates among infants.

This comes after the City of Tshwane's health department sounded the alarm over “the continued prevalence of mother-to-child transmission (MTCT) of HIV” in the Tshwane district.

“For the period January to June 2024, 232 babies in Gauteng tested positive for HIV, with 39 from Tshwane. This was a marginal decline [for Tshwane] from the total of 211 in the province in the previous six months [July to December 2023] where Tshwane accounted for 43 cases,” the city said.

Mother-to-child transmission refers to the passing of the virus from a mother to her baby either during pregnancy, delivery or breastfeeding.

The city cited several reasons for the continued trend, including HIV-positive mothers defaulting on their antiretroviral (ARV) treatment during breastfeeding, pregnant mothers not having access or reporting late for antenatal care at clinics, and “breastfeeding mothers who tested HIV-negative during pregnancy [later on] contracting HIV and transmitting it to the baby”.

“It's getting better now, but we started from a point where things were really bad, and we [had] dropped the ball in terms of making sure that children are not infected by HIV, especially postnatally and during the breastfeeding period,” said Sanac's technical lead for social and structural drivers of HIV, TB and STIs, Nozuko Majola.

“At birth, we are doing fairly well because the numbers are showing that children are tested. The PCR (test) coverage is quite high ... 98% of the live births are tested. So at that point, we are doing fairly well. Then at six weeks, we drop because we don't know when children do seroconvert [so at that stage] we test about 87% during immunisation. So there are many missed opportunities because of the fragmented healthcare services that are provided to children.”

Seroconversion refers to a period during which the body begins producing detectable levels of HIV antibodies.

Elaborating on immunisation, Majola explained that when a baby goes for immunisation it's a different nurse administering this and one who would not necessarily test for HIV. 

Majola said between 2012 and 2015, South Africa recorded 0.2% HIV infections among babies as pregnant HIV mothers were put on ARVs immediately after testing. This changed for the worse when healthcare officials missed out on taking crucial steps after birth.

“We saw a lot of improvement there because the country at the time ... [wanted to] make sure that no-one child is born with HIV. And then later on, we forgot that by the way, infants will get infected even through breastfeeding. 

“Then we started seeing the rise postnatally of children with HIV. This rise was attributed to mothers getting infected postnatally and there were no retests done when they went for healthcare services in the clinics.”

She said that while new guidelines to prevent vertical transmission were published in 2023, this was a revision of previous guidelines introduced over the years and were an improvement “based on the science presented to us”.

Since then, healthcare providers have been able to track infections better and ensure more children are placed on treatment.

This treatment, dolutegravir (DTG), is a transition from the old method, which was found to be unpalatable for babies and was thus difficult for parents to administer.

“We are still tracking the data and if we look at the transition to DTG, as per the data that was produced in March 2024, our target was 63% in terms of transitioning or the uptake of DTG for children living with HIV nine years and below. In March, we ... reached that target. So there is an improvement in terms of transitioning children to DTG.

“The intention is to ensure that 95% of all children that are infected are tested. So we need to find them. At the current stage we're standing at 82%. We need to make sure that we link all of them to treatment and care,” she said.