ObjectivesDrawing from a baseline sample of a cohort study, the study examines the extent and correlates of serostatus non-disclosure to sex partners and family members, and reasons for non-disclosure among HIV-infected pregnant women in the Eastern Cape Province, South Africa.MethodsThis longitudinal cohort study recruited 1709 pregnant women living with HIV who attended three of the largest maternity centres in the Eastern Cape, South Africa, for delivery between September 2015 and May 2016. Relevant items on demographics, serostatus awareness, disclosure to sex partners and family members, and lifestyle behaviours were obtained using structured interviews. Age-stratified binary logistic regression models were used to determine the significant correlates of non-disclosure among the participants.ResultsA higher rate of HIV serostatus non-disclosure to sex partners (25.6%) in comparison to family members (20%) was reported by the participants. Younger age, not living with partners and alcohol use were significantly associated with non-disclosure of HIV serostatus to sex partners. Non-disclosure of HIV serostatus to sex partners was significantly (p<0.05) associated with poor adherence to the highly active anti-retroviral therapy (HAART), failure to keep clinic appointments and high viral load at the delivery of the baby. Perceived fear of intimate partner violence, fear of rejection, guilt of not disclosing at the onset of the relationship, sex partner’s non-disclosure of HIV serostatus, and guilt of unfaithfulness were some of the reasons for non-disclosure of HIV serostatus to sex partners.ConclusionsNon-disclosure of HIV serostatus is a public health concern with serious implications for both mother-to-child transmission, as well as horizontal transmission, in our setting. Strategic efforts toward ending the epidemic of HIV and AIDS in South Africa should address the sociocultural and behavioural determinants of non-disclosure.

BackgroundHIV-associated tuberculosis (TB) is a major cause of death among pregnant women in South Africa. Isoniazid prevention therapy (IPT) strategy was implemented in South Africa concurrently with life-long antiretroviral therapy (ART) to reduce the TB-associated morbidity and mortality in individuals living with HIV. This study assessed the extent of the implementation of IPT and the performance of the Mantoux test by geographic settings of health facilities and residences of pregnant women living with HIV in the Eastern Cape, South Africa.MethodsWe conducted a data analysis of 1709 pregnant women enrolled in the new electronic database of the prevention of mother-to-child transmission programme of the East London Prospective Cohort Study. Relevant data on place of residence and antenatal care, performance of the Mantoux test and subsequent initiation of IPT were obtained. Descriptive and inferential statistics were employed to analyse the geographical variations and accessibility to Mantoux test and IPT.ResultsThe analysis shows that Mantoux test was performed on 803 pregnant women (47%) with significant geographical variation. After controlling for relevant covariates, pregnant women who resided in rural areas (AOR:0.63; CI: 0.47–0.84) compared to those who resided in urban areas were significantly less likely to receive Mantoux test. The rate of uptake of IPT was 79% with significant geographic variations. In the unadjusted model, rural place of residence (UOR:0.68; CI: 0.49–0.96) was independently associated with lower likelihood of uptake of INH prophylaxis; however, the effect was not significant after controlling for important covariates.ConclusionsThe high uptake rate of isoniazid prevention therapy in pregnant women living with HIV at the study sites is commendable; however, concerted efforts are needed to address the inequality gaps in the roll-out of IPT. Poor performance of Mantoux test is a serious concern and requires the attention of TB programme managers and other relevant authorities.

Background This study describes the characteristics of pregnant women on ART and the rate of peripartum virologic suppression in a large PMTCT cohort who delivered in some selected maternity centres in the Eastern Cape Province, South Africa. In addition, the study examines the factors associated with virologic suppression in the cohort. Methods This multi-centre retrospective cross-sectional analysis included medical data of 1709 women with HIV between September 2015 – May 2016 in the Eastern Cape Province. The main outcome measure was the rate of peripartum virologic suppression defined as viral load (VL) &lt;1000 copies/mL and undetectable viraemia (VL &lt;20 copies/mL). Correlates of peripartum virologic suppression and undetectable viraemia were examined by fitting logistic regression model analysis. Results Out of 1463 women with available VL results, the overall rate of peripartum suppression was 82%, and undetectable viraemia was 56.9%. Being aged 24 years or below [AOR=0.68, CI=0.48-0.94], smoking during pregnancy [AOR=0.50, CI=0.28-0.90], and starting ART in the first trimester were associated with lower odds of viral suppression (&lt;1000 copies/mL). Women who had never defaulted ART had an increased odds of having an undetectable viral load [AOR=3.09, CI=2.12-4.49] and virologic suppression [AOR=3.88, CI=2.62-5.74] compared to those who defaulted. Conclusions Over half of the women achieved undetectable viral load, and four in five women achieved viral suppression at delivery in the region. Early antenatal booking combined with enhanced adherence support for pregnant women on ART would be crucial towards achieving the goal of elimination of MTCT in the region.