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
"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.