@article {Goga240, author = {Ameena E Goga and Thu-Ha Dinh and Debra J Jackson and Carl Lombard and Kevin P Delaney and Adrian Puren and Gayle Sherman and Selamawit Woldesenbet and Vundli Ramokolo and Siobhan Crowley and Tanya Doherty and Mickey Chopra and Nathan Shaffer and Yogan Pillay}, title = {First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa}, volume = {69}, number = {3}, pages = {240--248}, year = {2015}, doi = {10.1136/jech-2014-204535}, publisher = {BMJ Publishing Group Ltd}, 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{\textendash}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{\textendash}8 weeks post partum. The long-term impact on PMTCT on HIV-free survival needs urgent assessment.}, issn = {0143-005X}, URL = {https://jech.bmj.com/content/69/3/240}, eprint = {https://jech.bmj.com/content/69/3/240.full.pdf}, journal = {Journal of Epidemiology \& Community Health} }