Closing the gaps to eliminate mother-to-child transmission of HIV (MTCT) in South Africa: Understanding MTCT case rates, factors that hinder the monitoring and attainment of targets, and potential game changers

Abstract

Ninety percent of the world's HIV-positive pregnant women live in 22 countries. These countries, including South Africa (SA), have prioritised the elimination of mother-to-child transmission of HIV (EMTCT), measured using three coverage and two impact indicators (Fig. 1). [1] The two impact indicators are the percentage motherto-child HIV transmission (MTCT) among HIV-positive mothers (MTCT risk) and the number of new paediatric HIV infections per 100 000 live births (MTCT case rate). The global target is <5% final MTCT in breastfeeding countries and ≤50 new paediatric HIV infections per 100 000 live births. Consequently, to achieve EMTCT, all 22 countries currently recommend lifelong antiretroviral treatment for all HIV-positive pregnant and lactating women. This is known as PMTCT Option B+. Between the 1980s and 2015 the discovery of more effective biomedical interventions to prevent mother-to-child transmission of HIV (PMTCT) accelerated the improvement of global and national PMTCT policies; such rapid advancements in policy required flexible, responsive health systems, services and staff to assure implementation. [1-6] For example, in 2001 the SA national This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Point‐of‐care HIV maternal viral load and early infant diagnosis testing around time of delivery at tertiary obstetric units in South Africa: a prospective study of coverage, results return and turn‐around times

“…The proportion of pregnant women living with HIV (WLHIV) who knew their HIV status at antenatal booking had exceeded 95%, with more than 95% of pregnant WLHIV on antiretroviral therapy (ART) prior to delivery by end of 2017 [1]. The intra‐uterine and intrapartum transmission rates decreased from >20% in 2003 [2], to 1.5% in 2017 [3]. However, this progress is insufficient to meet the targets for elimination of mother‐to‐child transmission of HIV (eMTCT).While the World Health Organisation (WHO) set the 2020 bronze tier target for elimination in high HIV prevalence settings at <750 new paediatric HIV infections per 100,000 live‐births, an estimated >1000 infants per 100,000 live births are infected each year in South Africa [4,5].…”

The geographic distribution of priority population groups for the elimination of mother-to-child transmission of HIV in South Africa

“…However, this figure was five times higher than the World Health Organization (WHO) eMTCT target, defined as �50 cases per 100 000 live births at completion of breastfeeding and an overall mother-to-child transmission (MTCT) rate of <5% in breastfeeding populations [5]. Sub-national level variations in MTCT rates also exist, with some districts reporting almost double the national MTCT rate at birth [6]. This suggests the need for contextualized and tailored responses to maternal and paediatric HIV in South Africa.…”

Tuberculosis and HIV—An Update on the “Cursed Duet” in Children

“…Since implementing and subsequently improving programs to prevent mother to child transmission of HIV, fewer HIV+ infants are being born. The large-scale ART rollout, which began in 2002, and the implementation of the WHO's Option B (ART in pregnancy and during breast feeding) program in 2013 (17), upscaling to Option B+ (uninterrupted ART during pregnancy and thereafter) in 2016, has decreased the early South African perinatal HIV transmission rate to 0.9% (18). However, by 18 months of age the cumulative transmission rate was 4.4%, most likely due to breast-feeding.…”

“…Due to progress in prevention mother to child HIV transmission, there are now more HIV exposed uninfected (HEU) children (18). This population still has higher rates of morbidity and mortality, particularly from infectious diseases than HIV unexposed infants (22,23).…”