Race is on to provide Nevirapine

Health minister Dr Manto Tshabalala-Msimang has indicated that role-players are “working with a sense of urgency to apply our minds reasonably and carefully to the possibility of providing drug therapy to HIV positive pregnant women”.

Speaking at the opening of the Reproductive Health Priorities Conference in Cape Town this week, the minister urged her audience not to believe everything they read in the newspapers.

Mark Heywood of the Treatment Action Campaign said they were expecting a definite response from Government by close of business today (Friday).

“Otherwise we will proceed with legal action,” he said.

She said Government had not yet reached any policy decision regarding the provision of Nevirapine. “Above all, I have not said, at any point, that we will never provide drug therapy to pregnant women,” Tshabalala-Msimang said.

Department of Health officials, the Health minister and Health MECs from the nine provinces met last weekend with economists and scientists to discuss the research done in South Africa into Nevirapine as a prevention measure in mother-to-child-tranmission.

Tshabalala-Msimang announced afterwards that pilot implementation programmes would be set up.

She said in Cape Town that the Medicines Control Council was currently reviewing the results of both the PETRA and SAINT studies with a view to possible registration of Nevirapine for use in mother to child transmission.

“Until they reach a decision, Nevirapine cannot be used alone outside approved research environments”.

The minister said Government was also studying the research results and the economic projections from its own perspective, “in order to finalise policy decisions”.

Tshabalala-Msimang once again expressed concern over reports that breastfeeding could reverse the gains of Nevirapine, World Health Organisation reservations about the drug and the development of resistance in some cases.

“With regard to the provision of anti-retroviral therapy to pregnant women, there are many infra-structural and operational challenges to be considered and plans have to be made to address those challenges, hence the necessity for pilot implementation programmes.”

She said the focus of mother to child transmission had so far been mainly on preventing infection of the unborn foetus. She said, however, that whatever efforts Government put in place to reduce mother-to-child transmission, including the possible use of drug therapy, would be fruitless if there were not supportive structures and mechanisms in place for the mother to survive.

“This was clearly demonstrated by work done in Kenya where the risk of babies dying was shown to be seven to eight fold increased after the mother died,” Tshabalala-Msimang said.

Heywood said the minister was erecting artificial obstacles and that pilot projects were not merited any further.

“Pilots are not satisfactory, they need to roll out programmes on a phased basis,” he said.

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