Implementation of prevention of mother-to-child transmission (PMTCT) in South Africa: outcomes from a population-based birth cohort study in Paarl, Western Cape

Abstract

ObjectivesThe coverage of prevention of mother-to-child transmission (PMTCT) services in South Africa is variable. Identifying gaps in the implementation of these services is necessary to isolate steps needed to further reduce paediatric infections and eliminate transmission.SettingTwo primary care clinics in Paarl, South Africa.Participants1225 pregnant women; inclusion criteria were 18 years or older, clinic attendance and remaining in area for at least 1 year.MethodsData were collected through the Drakenstein Child Health Study, a population-based birth cohort in a periurban area of the Western Cape, South Africa. A combination of clinic records, hospital records, national database searches and maternal self-report were collected during the study.ResultsOf the 1225 mothers enrolled in the cohort between 2012 and 2015, 260 (21%) were confirmed HIV infected antenatally and 1 mother tested positive in the postnatal period. Of those with documentation (n=250/260, 96%), the majority (99%) received antiretroviral prophylaxis or therapy (ART) before labour; however, there was a high rate of defaulting from ART noted during pregnancy (20%). All HIV-exposed infants with data received antiretroviral prophylaxis, 35% were exclusively breast fed until 6 weeks and 16% for 6 months. There were two cases of infant HIV infection (0.8%) who were initiated on ART but had complicated histories.ConclusionDespite the low transmission rate in this cohort, reaching elimination will require further work, and this study illustrates several areas to improve implementation of PMTCT services and reduce paediatric infections including retesting at-risk HIV-negative mothers through the duration of breast feeding, infant HIV testing at any admission in addition to routine testing and improved counselling to prevent defaulting from treatment. Better data surveillance systems are essential for determining the implementation of PMTCT guidelines.

<p>Mother-to-Child Transmission of HIV and Its Predictors Among HIV-Exposed Infants at an Outpatient Clinic for HIV/AIDS in Vietnam</p>

“…This study shows the overall rate of MTCTof HIV was 8.9% in our setting from 2007 to 2018. This rate is higher than that of many recent studies done across the world; [12][13][14][15][16][17] however, the rate of MTCT, which was reduced from 27.9% in 2007 to 0% in 2018, achieved the MTCT elimination target of 2% by 2020 as recommended by WHO and by the Vietnam National Strategy on HIV/AIDS Prevention and Control. 18 In our study, the rate of MTCT has been decreasing through time in parallel with the increased coverage of ART intervention for women during pregnancy.…”

“…This figure is consistent with other studies in African countries. 12,22 Nevertheless, the coverage of ART (81%) intervention for pregnant women in our setting has not yet met the target of >90% using ARV, which was lower than the number in many countries in Africa 12,14,16 and in Asia, 19,20 where the coverage of ART intervention for pregnant women ranged from 91-96%. Maintenance and a gradual increase in maternal ARV coverage to attain the elimination target of zero transmission of HIV from mother to child by 2030 are challenging.…”

“…Many studies worldwide showed that the adoption of Option B+ had contributed to a decrease in the rate of MTCT of HIV. 16,[25][26][27][28][29] During the 12-year follow-up of this cohort, of 229 women who were on ART before or during pregnancy, only one child (0.43%) whose mother received AZT monotherapy (Option A) had HIV-positive at the age of 18 months. This finding is consistent with the study of Kesho Bora Group; they found that the mothers who received AZT monotherapy were less effective in PMTCT than those receiving triple ARV.…”

Association of maternal and infant inflammation with neurodevelopment in HIV-exposed uninfected children in a South African birth cohort

“…However, exposure to HIV in utero may impair the health of these children, including their neurodevelopment (Evans et al, 2016;McHenry et al, 2018;Wedderburn et al, 2019).…”

“…A recent meta-analysis found poorer cognitive and motor neurodevelopment in HEU children (McHenry et al, 2018). Additionally, we have found adverse language outcomes at 2 years in HEU infants in the Drakenstein Child Health Study (DCHS) in South Africa (Wedderburn et al, 2019) but the biological mechanisms underlying this remain largely unknown. Studies suggest that maternal immune activation and increased levels of certain inflammatory markers during pregnancy may contribute to poor foetal brain development (Bilbo and Schwarz, 2012;Hsiao and Patterson, 2012;Morelli S, 2015;White et al, 2020).…”