Insights from ICASA: EGPAF International Leadership Awardee Shines

By Dr. Jeffrey Safrit | December 12, 2013

The fact that the women are on therapy when they come to a new ANC visit means they are getting treatment for HIV that can keep them healthy and prevent transmission of the virus to their babies.

James Pursey/Tanzania

The 2013 International Conference of AIDS and STIs in Africa (ICASA) is taking place in Cape Town, South Africa this week. On Sunday, I attended a session entitled "Women and Children First - Reverting New Infections among Children and Keeping Mothers Alive,” where Dr. Landon Myer of the University of Cape Town shared his latest research on how best to improve and scale up prevention of mother-to-child transmission of HIV (PMTCT ) efforts in his native South Africa and other African countries.

Dr. Myer’s presentation Sunday focused on the increased number of women coming to antenatal clinics (ANC) who are already taking antiretroviral therapy (ART) for HIV. At first glance, this may not seem to be a problem, but it does raise several important issues for consideration as PMTCT programs evolve and strive to reach zero new infections in infants by 2015. 

It is not known whether the women in Dr. Myer’s study started the therapy for their own health before becoming pregnant or during a PMTCT program for a previous pregnancy. Regardless of the reason, the fact that the women are on therapy when they come to a new ANC visit means they are getting treatment for HIV that can keep them healthy (assuming that there are no adherence issues) and prevent transmission of the virus to their babies.

The main concern raised by this study is that PMTCT programs are not currently equipped to respond to the unique situation these women present. Several questions remain about how they are counseled and how their viral are loads assessed to determine if they are positively responding to their treatment.  If their viral loads are high (thus likely not adhering to therapy), they would be more likely to transmit HIV to their infant and we must address how clinics are offering counseling and services tailored for these women. 

As countries continue to rollout the World Health Organization (WHO)’s new HIV treatment and prevention  guidelines which recommend lifelong ART for all HIV-positive pregnant and breastfeeding women (also known as Option B+), these numbers will certainly increase . In fact, in his study, Dr. Myer found a 600 percent increase in the number of women coming to ANC already on therapy during the last 3 years.

Dr. Myer concluded that as more women seek ANC who are already on ART, new recommendations need to be developed for ANC and PMTCT programs in order to meet our goal of eliminating new pediatric HIV infections.

Dr. Landon Myer is the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)'s current International Leadership Awardee. His award is a result of the generous support EGPAF received from the Stavros Niarchos Foundation.

Dr. Jeffrey Safrit is EGPAF’s Director of Clinical and Basic Research, based in Los Angeles, CA.

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Insights from ICASA is a blog series featuring the stories and thoughts of EGPAF experts and staff participating in and attending the 17th International Conference on STIs in Africa