Tide is turning slowly in HIV battle

• Incidence among pregnant women using state clinics falls to 27.5%

The incidence of HIV among pregnant women attending government clinics in SA fell to 27.5% in 2022, its lowest level in two decades, according to a report issued on Wednesday by the National Institute for Communicable Diseases (NICD).

NICD senior epidemiologist Tendesayi Kufa-Chakeza said that the 2.5% percentage point drop since the 2019 antenatal HIV sentinel survey was “very significant”, and was expected from mathematical modelling of SA’s epidemic.

“However we think the decline would have been greater were it not for the Covid-related disruptions in HIV testing, [starting treatment] and pre-exposure prophylaxis services,” she said. Pre-exposure prophylaxis is a daily pill taken to protect the user from contracting HIV.

Peak HIV among pregnant women was recorded in the 2015 survey, at 30.8%.

While the overall trend is good news, the 2022 survey shows 25.9% of pregnant women on HIV treatment were not achieving viral suppression, raising the risk of transmitting the disease to their babies.

“SA still has an unacceptably high level of mother-to-child transmission of HIV during pregnancy and breastfeeding: 0.7% of babies are born with HIV and about 4% of babies are HIVpositive at 18 months,” said Yogan Pillay, director for HIV and TB delivery at the Bill & Melinda Gates Foundation. He was not involved in the survey.

“We need to do much more to prevent mother-to-child transmission in SA, Nigeria and Mozambique, which account for 80% of Africa’s paediatric HIV burden,” he said.

The health department has conducted antenatal HIV surveys since 1990 to gauge the trajectory of SA’s epidemic and the effect of its interventions.

SA has the world’s biggest HIV burden.

An estimated 7.5-million people have the disease, according to the 2022 survey report.

The nationally representative study included 32,828 pregnant women aged 15 to 49 attending 1,589 government clinics. Participants were asked to participate in interviews, consent to reviews of their medical records and provide blood samples.

In line with previous studies, it found wide variation in HIV incidence in provinces, ranging from 37.2% in KwaZulu-Natal to 16.3% in the Western Cape. The highest, 44%, was recorded in the uMkhanyakude district.

There was a reduction in HIV in all nine provinces.

The survey helps assess SA’s progress towards the UN’s 9595-95 targets, which aim to ensure that by next year 95% of people with HIV know their status, 95% of the people diagnosed with HIV get antiretroviral treatment and that 95% of the people being treated achieve viral suppression, reducing the

risk of transmitting the virus. The survey found that 96% of the 10,726 pregnant women who were HIV positive already knew their status, down from 97.6% in 2019, a reduction that the report’s authors said might have been due to the disruption to health services during the Covid-19 pandemic.

The survey found that only a quarter (25.8%) of the participants paid their first visits to antenatal clinics within the first 12 weeks of pregnancy, in line with World Health Organisation recommendations. Less than two-thirds (61%) of participants had their first antenatal consultation within 20 weeks of conception, a marked drop on the 70% reported in 2019.

The reduction was probably due to the disruption caused by the pandemic, Pillay said.

Of the survey participants who knew their HIV status, 98.8% were on treatment, an improvement on the 96% recorded in 2019.

The proportion of pregnant women on HIV treatment who had achieved viral suppression remained constant between the two surveys, at 74.1%.