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Guideline for the Prevention of Mother to Child Transmission of Communicable Infections

Guideline for the Prevention of Mother to Child Transmission of Communicable Infections
Publication date: 
Nov 2019

FOREWORD

It is my pleasure to present the Guidelines for the Prevention of Transmission of Communicable infections from mother to child (HIV, Hepatitis, Listeriosis, Malaria, Syphilis and TB).

While the WHO calls for dual elimination of HIV and syphilis, South Africa aspires to eliminate all infections that are transmittable from mother to child by promoting the prevention of such infections, early diagnosis and proper management in order to reduce maternal, neonatal and child morbidity and mortality.

In 2015 Option B+ (lifelong ART irrespective of CD4 count or WHO staging) and birth PCR testing were implemented. The birth PCR test provides an opportunity for early identification of babies who acquired HIV in utero and linking them to HIV care and treatment as early as possible. Monitoring of the infant PCR test positive around 10 weeks rate indicated a reduction in the MTCT rate from 1.3% in the FY 2016/17 to 0.9% in the FY 2017/18.

As we are approaching the milestones to elimination of MTCT for HIV, we are now being challenged by the rising of other transmittable diseases from mother to child. It is therefore important that in this guideline other infections such as Hepatitis, Malaria, Syphilis and TB, in addition to HIV, be given due attention. In the period 2014 – 2016, TB was responsible for 9% of all maternal deaths, hepatitis contributed 1.1% and malaria 1.7%. In 2017, the STI sentinel sites survey reported an increase in syphilis amongst pregnant woman to 2% and the recent outbreak of Listeriosis resulted in fatalities in neonates. The integrated approach will allow clinicians to comprehensively screen all pregnant women and their newborn babies and promptly manage those who are diagnosed with these infections.

The challenge that PMTCT is currently facing is an increasing number of babies who acquire HIV infection during the postnatal period. To address this challenge, the guidelines provide guidance on the following:

  • Strengthening antenatal and postnatal care for both HIV negative and positive mothers.
  • The introduction of a dolutegravir-based ART regimen which is more efficacious in reducing the risks of transmission of HIV.
  • Promoting integrated management of the mother-baby pair by aligning PMTCT interventions with BANC visits during antenatal period and EPI visits during postnatal period.

These guidelines provide a framework for a service benefits package steering us towards the implementation of NHI. Therefore, we urge all clinicians, working in both public and private health facilities, to use these guidelines to offer quality, comprehensive services to the public.

Ms MP Matsoso
Director –General: Health