Thesis (MBA)--Stellenbosch University, 2003. / Some digitised pages may appear illegible due to the condition of the original hard copy / ENGLISH ABSTRACT: After sexual transmission of HIV, mother-to-child (MTCT) transmission is the most
common cause of HIV infection in South Africa. The Western Cape government,
through the Premier, has committed itself to providing access for all HIV positive women
in the province attending antenatal clinics to MTCT prevention programmes by the end
of 2003.
The MTCT prevention programme is aimed at intervening transmission during
pregnancy, during the birth of the baby and post delivery during breast-feeding of the
newborn baby.
The HIV virus attacks and destroys the cells of the immune system by being incorporated
into the reproductive cycle of the cell. Antiretroviral drugs in the fight against HIV target
two aspects of this replication cycle of the virus and as such do not halt the infection but
slow it down by preventing the replication of the virus.
MTCT internationally has been reduced dramatically by the use of antiretroviral drugs
(AZT) antenatally, during birth and post-natally for mother and baby. However this
regimen was found to be not suitable for resource-poor countries due to the complexity in
administration, compliance and costs. Poor countries have developed alternative MTCT
prevention programmes based on shorter course regimens and on alternative antiretroviral
drugs.
MTCT prevention In South Africa initially did not have the support of the national
government. However, the -Western Cape Administration had developed a regional
programme phasing in MTCT prevention at all state clinics within the province. The cost drivers associated with the MTCT prevention programme include costs
associated with the HIV tests, costs for pre- and post-test counselling, costs for the
antiretroviral drugs and costs for substitute feeding to replace breast-feeding to prevent
viral transmission during breast-feeding. Depending on the option exercised, costs can be
calculated per HIV positive baby averted.
As regards substitute feeding, which is a substantial cost driver and a major disadvantage
to the newborn baby as regards protection from common childhood diseases such as
diarrhea, research from Tanzania showed that ARV therapy during childbirth could
suppress HIV transmission through breast-feeding during the first few weeks after
childbirth, thus enabling an optimal combination of breast-feeding in the first few crucial
weeks of the newborn's life for the protective benefits of breast-milk and formula feeding
thereafter to ensure protection for the infant from HIV transmission through breastfeeding.
The data were subjected to a sensitivity or a "what-if' analysis usmg an Excel
spreadsheet. Costs per HIV averted were calculated for each assumed parameter in the
model that was developed. As regards prevalence, the MTCT prevention programme is
most cost effective at the lower levels of the seroprevalence of HIV in the population
served. If the seroprevalence is above the "cross-over" or "optimal" point for the
regimen an alternative regimen should be assessed.
As regards levels of identification and number accepting intervention the principle of an
economy of scale applies and therefore, a level of 100 percent in both cases should be
targeted. This will be dependent on wide scale advertisements and support for the
programme with active efforts to destigmatise the infection. Innovative programmes
such as the mothers-to-mothers-to-be (M2M2B) programme must be encouraged. / AFRIKAANSE OPSOMMING: Na seksuele oordraging van HIV is moeder tot kind (MTK) oordraging die algemeenste
rede van HIV infeksie in Suid Afrika. Die Wes-Kaapse regering, deur die Premier, het
hulself verbind om toegang vir alle HIV positiewe vroue in die provinsie, wat
voorgeboorte klinieke bywoon, tot MTK voorkomingsprogramme voor die einde van
2003 moontlik te maak.
Die MTK voorkomingsprogram is gerig op die tussenkoms van transmissie gedurende
swangerskap, gedurende die geboorte en die nasorg tydens die borsvoeding periode van
die pasgebore baba.
Die HIV virus val die selle van die immuun sisteem aan en' vernietig dit. Die virus word
geïnkorporeer tot die reproduksie siklus van die sel. Antiretrovirale wat teen die virus
gerig is, is gerig teen twee aspekte van die replikasie siklus van die virus en sodoende sal
die medikasie die infeksie nie staak nie, maar eerder vertraag as gevolg van die
voorkoming van die replikasie.
Moeder-tot-kind infeksie is internasionaal drasties verminder deur die gebruik van
antiretrovirale (AZT) gedurende die tydperk voor geboorte, gedurende die geboorte en
gedurende nasorg van die moeder en baba. Hierdie regimen is egter nie altyd moontlik in
arm lande nie vanweë die kompleksiteit van die administratiewe toepassing en kostes.
Arm lande het alternatiewe MTK voorkomingsprogramme ontwikkel, gebaseer op korter
kursusse en alternatiewe antiretrovirale.
Die voorkoming van MTK infeksie in Suid-Afrika het eers nie die ondersteuning van die
nasionale regering geniet nie. Die Wes-Kaapse Adminstrasie het onafhanklik van die nasionale regering, streeksprogramme ontwikkel vir die infasering van MTK voorkoming
in alle klinieke in die Provinsie.
Die kostedrywers wat met MTK voorkomingsprogramme geassosieer word, sluit in die
koste van HIV toetse, koste van voor-en-na toets berading, koste van die antiretrovirale
en alternatiewe voeding om virale transmissie te voorkom gedurende die tydperk van
borsvoeding. Afhangende van die opsies wat gebruik is, kan die koste van elke baba wat
nie HIV opdoen nie, bereken word.
Sover dit alternatiewe voeding aangaan, wat 'n belangrike kostedrywer is en 'n nadeel
vir elke baba is sover dit teen beskerming van algemene kindersiekte soos diarrhea gaan
het navorsing in Tanzanië bewys dat ARV terapie gedurende geboorte ook HIV
transmissie deur borsvoeding gedurende die eerste paar weke na geboorte onderdruk wat
'n optimale kombinasie van borsvoeding in die eerste paar kritiese weke van die
nuutgebore baba se lewe vir die beskermende voordele van moedersmelk en formulêre
voeding daarna te versterk met beskerming van die baba teen HIV transmissie deur
borsvoeding.
Deur die gebruik van 'n Excel werkblad en 'n "wat as" metode van analiese koste van
HIV opdoen in bereken word vir elke aanvaarding. Sover dit voorkoms betref is die
MTK voorkomingsprogramme die mees effektief hoe laer die "seroprevalence" van HIV
in die populasie gedien word. As die "seroprevalence" hoër as die optimale punt is,
moet 'n ander metode bereken word.
Sover dit die mate van identifisering en hoeveelheid die tussenkoms aanvaar in 'n mate
van 100 persent moet in beide gevalle die mikpunt wees.
Dit sal afhang van grootskaalse advertensies en ondersteuning van die programme met
bedrywige pogings om die' infeksie te destigmatiseer. Nuwe programme soos die
moeder tot nuwe moeder (M2M2B) program moet aangemoedig word.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/49791 |
| Date | 12 1900 |
| Creators | Osman, Yusuf Ismail |
| Contributors | Roux, A., Stellenbosch University. Faculty of Economic & Management Sciences. Graduate School of Business. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 127 p. : ill. |
| Rights | Stellenbosch University |
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