Goga A.E., Dinh T.-H., Jackson D.J., Lombard C., Delaney K.P., Puren A., Sherman G., Woldesenbet S., Ramokolo V., Crowley S., Doherty T., Chopra M., Shaffer N., Pillay Y., Lerebo W., Solomon W., Noveve N., Heyns L., Kiewitz J., Mbenenge P., Xokwe M., Mbow
Health Systems Research Unit, Medical Research Council, Cape Town, South Africa; Department of Paediatrics and Child Health, Kalafong Hospital, University of Pretoria, Hatfield, Pretoria, South Africa; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States; School of Public Health, University of the Western Cape, Bellville, South Africa; UNICEF, New York, NY, United States; Biostatistics Unit, Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Cape Town, South Africa; Division of HIV/AID Prevention, Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD, and Tuberculosis Prevention, Atlanta, GA, United States; Division of National Health Laboratory Services, National institute of Communicable Diseases, Sandringham, Johannesburg, South Africa; Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Parktown, Johannesburg, South Africa; Elma Philanthropies, New York, United States; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; World Health Organization, Geneva, Switzerland; National Department of Health, Pretoria, South Africa; University of the Western Cape, South Africa; National Institute for Communicable Diseases, South Africa
Goga, A.E., Health Systems Research Unit, Medical Research Council, Cape Town, South Africa, Department of Paediatrics and Child Health, Kalafong Hospital, University of Pretoria, Hatfield, Pretoria, South Africa; Dinh, T.-H., Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States; Jackson, D.J., School of Public Health, University of the Western Cape, Bellville, South Africa, UNICEF, New York, NY, United States; Lombard, C., Biostatistics Unit, Medical Research Council, Cape Town, South Africa, School of Public Health and Family Medicine, Cape Town, South Africa; Delaney, K.P., Division of HIV/AID Prevention, Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD, and Tuberculosis Prevention, Atlanta, GA, United States; Puren, A., Division of National Health Laboratory Services, National institute of Communicable Diseases, Sandringham, Johannesburg, South Africa; Sherman, G., Division of National Health Laboratory Services, National institute of Communicable Diseases, Sandringham, Johannesburg, South Africa, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Parktown, Johannesburg, South Africa; Woldesenbet, S., Health Systems Research Unit, Medical Research Council, Cape Town, South Africa; Ramokolo, V., Health Systems Research Unit, Medical Research Council, Cape Town, South Africa; Crowley, S., Elma Philanthropies, New York, United States; Doherty, T., Health Systems Research Unit, Medical Research Council, Cape Town, South Africa, School of Public Health, University of the Western Cape, Bellville, South Africa, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Chopra, M., UNICEF, New York, NY, United States; Shaffer, N., World Health Organization, Geneva, Switzerland; Pillay, Y., National Department of Health, Pretoria, South Africa; Lerebo, W., University of the Western Cape, South Africa; Solomon, W.; Noveve, N.; Heyns, L.; Kiewitz, J.; Mbenenge, P.; Xokwe, M.; Mboweni, E.; Mzolo, S.; Molewa, R.; Hlabangani, R.; Ncedana, T.; Sitawutawu, N.; Nyati, F.; Husselman, C.; Robinson, K.; Mhlongo, T.; Singh, B., National Institute for Communicable Diseases, South Africa; Patel, U., National Institute for Communicable Diseases, South Africa; Cutler, E., National Institute for Communicable Diseases, South Africa
Background: There is a paucity of data on the national population-level effectiveness of preventing mother-tochild transmission (PMTCT) programmes in high-HIVprevalence, 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.