iClinic - July 28, 2000

Government could save the taxpayer more than R800 million a year and save more than 8 000 children's lives each month if it were to provide antiretrovirals and formula feed to all HIV positive pregnant women, an economist at the university of Cape Town said earlier this week.

Chief Director for HIV/AIDS and STDs Nono Simelela argued in a letter to the Mail & Guardian on Friday that the study is methodologically flawed. "The thrust of the message is not incorrect," Simelela told SABC radio on Friday, "obviously there are enormous costs for heathcare of children who have been infected with HIV. But she builds into her notion that every child who is HIV positive qualifies for a welfare grant." She says that in terms of AZT, the regime talked about is one of 36 weeks, and women don't come to antenatal care until late in their pregnancy. They would have to be followed up to ensure compliance and Simelela says that the healthcare infrastructure cannot cope with this.

In terms of nevirapine, the results of trials in SA was presented at the Durban AIDS conference for the first time and there are questions around the influence of breastfeeding on the drug's efficacy as well as other questions that still need to be answered.

"What we need to aim for ideally is a total package of care for women in the context of this epidemic," Simelela said in the Mail & Guardian.

"The package should include appropriate information on the nature of the infection, access to voluntary counselling and testing even prior to contemplating pregnancy, counselling and continued psychological support throughout, vigorous management opportunistic infections, and appropriate interventions during labour and delivery." This conveys the impression that government is saying that unless we can do everything, we can't do anything, said John Perlman interviewing Simelela on SABC radio on Friday.

A single intervention is not the total answer, responded Simelela, adding that the department of health does agree it could save money if it would provide the drug and will have an intense meeting on August 12 with scientists and other stakeholders on the issue of mother-to-child transmission.

Jolene Scordess, an economist, has found that the ongoing treatment of infants infected with HIV could be between three and seven times higher than the cost of once-off treatment perinatally with AZT or Nevirapine, together with the provision of breast milk substitutes, to prevent mother-to-child transmission of HIV (MTCT).

"My study essentially offers a bird's eye view of a lot of existing research that was out there," she told SABC radio on Monday.

"I pulled together 46 different scientific and clinical studies that were done around the world. I tried to put particular emphasis on studies that were done in developing countries or countries with similar profiles to SA.

"All I did was pull together numbers that were already out there. One of the reasons I have so much confidence in this study is that almost every number that is in it is backed up by more than one existing study." She shows that every HIV positive child over its short life could cost as much R19 000 for ongoing treatment, a figure of R1.7 billion over the life expectancy of these children.

"This is a hugely conservative estimate: it just includes the hospital room for the average number of days these children spend in hospital, and the cost of a welfare payment for these children," she says.

She says that realistically, medicinal costs for the treatment of opportunistic infections such as pneumonia should have been included, as well as the extra costs of taking care of these children, which often means a loss of income, extra costs of transport and funerals.

MTCT with AZT is just under R3 000 - this includes the drug, the HIV test, other clinical procedures and follow up as well as providing formula to mothers. With nevirapine the cost is less than R500.

She thinks one of the reasons government is so cautious may be lack of information.

"The studies that I waded through to pull this together are mostly very scientific in nature and they can be quite intimidating. But the information is largely not that accessible and very often conflicting," she says.