Following on other important speeches in recent months, President Zuma’s World AIDS Day address reaffirmed government’s new-found commitment to fighting HIV/AIDS in an open, serious, and evidence-based manner. TAC welcomes the president’s call for people to get tested and his public admission of having taken HIV tests himself.
Some key changes announced by the president include:
1) Providing ART to all people co-infected with TB/HIV at a CD4-count of 350.
While we welcome the decision to initiate treatment for all people co-infected with HIV and TB with a CD4 count of 350 cells/mm3 or lower, TAC will continue to campaign for the provision of treatment to all HIV-positive people with a CD4 count of 350 cells/mm3 or lower irrespective of their TB status. This is in accordance with World Health Organisation recommendations.
2) Providing all infants under 12 months with antiretroviral treatment (ART)
TAC welcomes the changes made to the paediatric treatment guidelines. Following the compelling findings of the Children with HIV Early Treatment study, TAC has been campaigning for the provision of antiretroviral treatment for all infants under one year of age.
3) Providing pregnant women with CD4 counts above 350 with prevention
of mother-to-child treatment from 14 weeks.
The changes to the PMTCT regimen indicate government's commitment to eradicating new paediatric infections. However, in addition to improving the prenatal regimen, policy improvements are also needed for postpartum vertical transmission. Various options are possible here which TAC will address in more detail in a PMTCT briefing that we will release early in 2010.
While we welcome the new guidelines, they do not address the urgent need to update the current first-line treatment regimen. TAC will continue to campaign to have tenofovir-based three-in-one once-daily pills introduced as part of the standard first-line regimen by July 2010.
As the new guidelines are implemented in facilities across the country it is critical to improve the monitoring and evaluation of both the HAART and PMTCT programmes. At a minimum we must aim for complete quarterly district-level information on the numbers of people initiated on these programmes, median baseline CD4 count, median change in CD4 count, number of people lost-to-follow-up, number of deaths and number of children born to HIV-positive women who have been tested.
President Zuma will face challenges ahead to ensure that these are not just changes to policy but are implemented in all facilities across the country. We call on government to strengthen health systems to implement the improved treatment guidelines.
TAC is committed to working with government to address capacity constraints to improve the response to HIV. TAC further supports government’s call for all South Africans to take responsibility for their own health and get tested and access treatment for HIV. Knowing your status will allow you to make informed decisions to protect your own health, the health of your sexual partner and the health of your baby.