Awareness of HIV-positive status and linkage to treatment prior to pregnancy in the “test and treat” era: A national antenatal sentinel survey, 2017, South Africa

Abstract

Introduction Knowledge of HIV status in South Africa (SA) is reported to be 90% among people living with HIV. National level estimates could mask population-specific levels, which are critical to monitor program coverage and potential impact. Using data from the 2017 national antenatal sentinel survey, we assessed knowledge of HIV-positive status, initiation of antiretroviral therapy (ART), and socio-demographic characteristics associated with knowledge of HIVpositive status prior to the current pregnancy among women attending antenatal care. Methods Between 1 October and 15 November 2017, a nationally representative sample of 32,716 pregnant women were enrolled from 1,595 public health facilities selected from all districts of SA. Data on age, gravidity, knowledge of HIV-positive status and ART initiation prior to pregnancy were extracted from medical records. A blood sample was collected from each woman regardless of prior knowledge of HIV status or ART history, and tested for HIV in the laboratory. All HIV-positive pregnant women enrolled in the survey were eligible for inclusion in the analysis. Multivariable survey logistic regression was used to examine factors associated with knowledge of HIV-positive status prior to the current pregnancy. Results Of 10,065 eligible HIV-positive women, 60.8% (95% confidence interval (CI):59.9%-61.7%) knew their HIV status prior to the current pregnancy, of whom 91.1% (95% CI: 90.4%-91.7%) initiated ART prior to the current pregnancy. Knowledge of HIV-positive status was lower

Impact of breastfeeding, maternal antiretroviral treatment and health service factors on 18-month vertical transmission of HIV and HIV-free survival: results from a nationally representative HIV-exposed infant cohort, South Africa

“…We demonstrate that cumulative (6 weeks to 18 months) MTCT and ‘MTCT-or-death’ was 4.3% (95% CI 3.7% to 5%) and 6.3% (95% CI 5.5% to 7.3%), respectively, in the South African national PMTCT programme by 2014. While this meets the <5% WHO final MTCT impact criterion, the 30% antenatal HIV prevalence 14 translates into a case rate of 1290 new paediatric HIV infections per 100 000 live births—more than 25 times the target. In previous analyses, we demonstrated that maternal HIV prevalence drives the paediatric case rate.…”

Integrating gestational diabetes and type 2 diabetes care into primary health care: Lessons from prevention of mother-to-child transmission of HIV in South Africa - A mixed methods study

“…Most provinces generally succeeded to reduce and control vertical transmission but some, and regions within provinces, still struggle in terms of some PMTCT indicators, due to historical health system inequities, and are considered a setback to the country’s overall good PMTCT performance [ 50 , 51 ]. The WC province is one of the highest-performing provinces in SA across most health care indexes, especially HIV-related indicators [ 52 – 54 ]. The WC data revealed significant positive outcomes over the period of implementation of the PMTCT policies and guidelines since its initial rollout in 2002 but especially with the 2015 guidelines.…”

Determinants of Gender Disparities in Scaling Up the First 90 Towards the UNAIDS&nbsp;90-90-90 Targets in South Africa: Findings From the 2017 Household-based National Cross-sectional Survey

“…This study also con rmed that the proportion of youth and adults diagnosed and aware of their HIV positive status was signi cantly higher among females compared to males for all the above sociodemographic and socio-behavioural factors. Evidence shows that Black African females are more likely to have an HIV test in their lifetime than their male counterparts, due to their exposure to sexual reproductive health services [5,8,11,12]. This suggests that greater exposure to HIV testing is associated with higher awareness of HIV status [8].…”