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The committee reportedly instructed Tshabalala-Msimang to return when better prepared.

He said that it was impossible for the committee to deal with the issue at hand.

Tshabalala-Msimang reportedly apologised.

Accused of reluctance
Tshabalala-Msimang has been accused by civil society groups of having intentionally delayed the introduction of dual therapy treatment for PMTCT.

When the new dual therapy protocols were released last month, they were widely welcomed, although the Treatment Action Campaign (TAC) pointed out a number of concerns.

Effective treatment overlooked?
The TAC said they regret that the Department of Health’s new protocol, "while better than the 2003 one, is still out of sync with the World Health Organisation’s strongest recommendations for the prevention of mother-to-child-transmission of HIV."

"Specifically, the revised protocol fails to include any mention of the antiretroviral drug lamivudine (aka 3TC), a safe, effective and inexpensive addition to AZT. The 2006 WHO guidelines for preventing HIV infection in infants recommend that lamivudine be administered to the mother, in conjunction with AZT, both during birth as an HIV prophylaxis as well as postpartum as a means of reducing the risk of nevirapine resistance," the TAC said.

They also said that the Minister of Health Tshabalala-Msimang has on several occasions publicly expressed her concern about possible nevirapine resistance in women who have participated in PMTCT programmes.

"It therefore makes little sense that an effective, scientifically-proven method of reducing the likelihood of a mother developing resistance to nevirapine, a seven-day postpartum course of AZT and lamivudine (known as the ‘cover-the-tail’ strategy), has been actively decided against in the new national protocol," the statement said.

"The 'cover-the-tail' strategy was strongly recommended by expert HIV paediatricians who advised the Department of Health on the new protocol; we are disappointed that this well-founded recommendation has been ignored," the TAC said.

Trailing international best practice
Another serious shortcoming in the new PMTCT policy guidelines, according to the TAC, is that pregnant women who test positive for HIV will only be started on antiretroviral therapy once their CD4 count has dropped to/below 200 cells/mm3.

"Once again this puts the new guidelines out of step with current international best practice. Compelling scientific evidence points to significant health advantages for pregnant women who initiate antiretroviral therapy at CD4 cell counts of 350 cells/mm3 rather than 200 cells/mm3. US and European treatment guidelines now recommend that all patients, including pregnant women, with a CD4 cell count of 350 cells/mm3 or below should start anti-HIV treatment. This was also recommended by expert HIV paediatricians who advised the Department of Health on the new protocol," said the TAC.

Dual therapy treatment regimens have been shown to significantly reduce the rate of mother-to-child transmission of HIV. – (Health24)

Source: Business Day.

Read more:
TAC welcomes new HIV guidelines
Manto stalling HIV/Aids guidelines?

February 2008
 

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