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First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa
  1. Ameena E Goga1,2,
  2. Thu-Ha Dinh3,
  3. Debra J Jackson4,5,
  4. Carl Lombard6,7,
  5. Kevin P Delaney8,
  6. Adrian Puren9,
  7. Gayle Sherman9,10,
  8. Selamawit Woldesenbet1,
  9. Vundli Ramokolo1,
  10. Siobhan Crowley11,
  11. Tanya Doherty1,4,12,
  12. Mickey Chopra5,
  13. Nathan Shaffer13,
  14. Yogan Pillay14
  15. for the South Africa PMTCT Evaluation (SAPMCTE) Team
  1. 1Health Systems Research Unit, Medical Research Council, Cape Town, South Africa
  2. 2Department of Paediatrics and Child Health, Kalafong Hospital, University of Pretoria, Hatfield, Pretoria, South Africa
  3. 3Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, Georgia, USA
  4. 4School of Public Health, University of the Western Cape, Bellville, South Africa
  5. 5UNICEF New York, New York, USA
  6. 6Biostatistics Unit, Medical Research Council, Cape Town, South Africa
  7. 7School of Public Health and Family Medicine, Cape Town, South Africa
  8. 8Division of HIV/AID Prevention, Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD, and Tuberculosis Prevention, Atlanta, Georgia, USA
  9. 9Division of National Health Laboratory Services, National institute of Communicable Diseases, Sandringham, Johannesburg, South Africa
  10. 10Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Parktown, Johannesburg, South Africa
  11. 11Affiliated with UNICEF South Africa at the time of the study. Currently affiliated to Elma Philanthropies, New York USA, Pretoria, South Africa
  12. 12School of Public Health, University of the Witwatersrand, Johannesburg South Africa
  13. 13World Health Organization, Geneva, Switzerland
  14. 14National Department of Health, Pretoria, South Africa
  1. Correspondence to Prof Ameena Ebrahim Goga, Francie van Zyl Drive, Parrowvallei, Cape Town 7505, South Africa; Ameena.Goga{at}mrc.ac.za

Abstract

Background There is a paucity of data on the national population-level effectiveness of preventing mother-to-child transmission (PMTCT) programmes in high-HIV-prevalence, resource-limited settings. We assessed national PMTCT impact in South Africa (SA), 2010.

Methods A facility-based survey was conducted using a stratified multistage, cluster sampling design. A nationally representative sample of 10 178 infants aged 4–8 weeks was recruited from 565 clinics. Data collection included caregiver interviews, record reviews and infant dried blood spots to identify HIV-exposed infants (HEI) and HIV-infected infants. During analysis, self-reported antiretroviral (ARV) use was categorised: 1a: triple ARV treatment; 1b: azidothymidine >10 weeks; 2a: azidothymidine ≤10 weeks; 2b: incomplete ARV prophylaxis; 3a: no antenatal ARV and 3b: missing ARV information. Findings were adjusted for non-response, survey design and weighted for live-birth distributions.

Results Nationally, 32% of live infants were HEI; early mother-to-child transmission (MTCT) was 3.5% (95% CI 2.9% to 4.1%). In total 29.4% HEI were born to mothers on triple ARV treatment (category 1a) 55.6% on prophylaxis (1b, 2a, 2b), 9.5% received no antenatal ARV (3a) and 5.5% had missing ARV information (3b). Controlling for other factors groups, 1b and 2a had similar MTCT to 1a (Ref; adjusted OR (AOR) for 1b, 0.98, 0.52 to 1.83; and 2a, 1.31, 0.69 to 2.48). MTCT was higher in group 2b (AOR 3.68, 1.69 to 7.97). Within group 3a, early MTCT was highest among breastfeeding mothers 11.50% (4.67% to 18.33%) for exclusive breast feeding, 11.90% (7.45% to 16.35%) for mixed breast feeding, and 3.45% (0.53% to 6.35%) for no breast feeding). Antiretroviral therapy or >10 weeks prophylaxis negated this difference (MTCT 3.94%, 1.98% to 5.90%; 2.07%, 0.55% to 3.60% and 2.11%, 1.28% to 2.95%, respectively).

Conclusions SA, a high-HIV-prevalence middle income country achieved <5% MTCT by 4–8 weeks post partum. The long-term impact on PMTCT on HIV-free survival needs urgent assessment.

  • CHILD HEALTH
  • HIV
  • PERINATAL EPIDEMIOLOGY
  • PUBLIC HEALTH
  • SURVEILLANCE

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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