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CMScript 1 of 2024: Focus on Vertical Transmission

Human immunodeficiency virus (HIV) continues to be a significant cause of death for pregnant women and children in South Africa. It is crucial to take care of the health of women with HIV and prevent the passing of the virus from mother to child. Vertical transmission will be used to describe mother-to-child transmission.

Overall, the risk of vertical transmission of HIV is ~40% in the absence of any intervention. Timing of such transmission is as follows: in utero – 5% (with increasing risk in the third trimester); during delivery – 15–20%; up to 24 months of breastfeeding – 20%.

The most common way young children contract HIV is through vertical transmission. Vertical transmission of HIV refers to the transmission of the virus from an HIV-positive mother to her child during pregnancy, childbirth, or breastfeeding. HIV is a virus that attacks the body’s immune system. If HIV is not treated, it can lead to acquired immunodeficiency syndrome (AIDS). According to recent global estimates by the United Nations Programme on HIV/AIDS (UNAIDS), women carry the burden of HIV, and AIDS is still the leading cause of death for women of reproductive age. For every additional week of suppressive antiretroviral treatment (ART) during pregnancy, vertical transmission is reduced by 10%.

The prevention of vertical transmission is categorised as a Prescribed Minimum Benefit (PMB) under the Diagnostic Treatment Pair (DTP) code 168S, specifically focusing on HIV infection. This PMB code encompasses various essential services related to HIV management and prevention. The treatments specified under this code include:

  • HIV voluntary counselling and testing.
  • Co-trimoxazole as preventative therapy.
  • Screening and preventative therapy for TB
  • Diagnosis and treatment of sexually transmitted infections.
  • Pain management in palliative care.
  • Treatment of opportunistic infections.
  • Prevention of vertical transmission of HIV.
  • Post-exposure prophylaxis following occupational exposure or sexual assault.
  • Medical management and medication, including the provision of anti-retroviral therapy (ART).
  • Ongoing monitoring for medicine effectiveness and safety, following national guidelines applicable in the public sector.

Medical schemes are obligated to fund the diagnosis, treatment, and care of HIV, aligning with the latest National Guideline for the Prevention of Vertical Transmission. This ensures comprehensive and accessible healthcare services for individuals at risk of or living with HIV, particularly focusing on preventing transmission from mothers to their children.

Download the CMScript here

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