Laboratory information system data demonstrate successful implementation of the prevention of mother-to-child transmission programme in South Africa

Abstract

Background. Monitoring the prevention of mother-to-child transmission (PMTCT) programme to identify gaps for early intervention is essential as South Africa progresses from prevention to elimination of HIV infection in children. Early infant diagnosis (EID) by an HIV polymerase chain reaction (PCR) test is recommended at 6 weeks of age for all HIV-exposed infants. The National Health Laboratory Service (NHLS) performs the PCR tests for the public health sector and stores test data in a corporate data warehouse (CDW). Objectives. To demonstrate the utility of laboratory data for monitoring trends in EID coverage and early vertical transmission rates and to describe the scale-up of the EID component of the PMTCT programme. Methods. HIV PCR test data from 2003 to 2012 inclusive were extracted from the NHLS CDW by year, province, age of infant tested and test result and used to calculate EID coverage and early vertical transmission rates to provincial level. Results. Rapid scale-up of EID over the first decade of the PMTCT programme was evident from the 100-fold increase in PCR tests to 350 000 by 2012. In 2012, 73% of the estimated 270 000 HIV-exposed infants requiring an early PCR were tested and the early vertical transmission rate had fallen to 2.4% as a result of successful implementation of the PMTCT programme. Conclusions. Laboratory data can provide real time, affordable monitoring of aspects of the PMTCT programme and assist in achieving virtual elimination of paediatric HIV infection in South Africa.

A 10-year cohort analysis of routine paediatric ART data in a rural South African setting

“…In recent years, the number of children initiated on treatment per annum has plateaued and somewhat declined, likely a result of reduced infant infections due to successes in the prevention of mother-to-child transmission programme [17]. We show that 20% of children were LTFU or reported dead by 1 year on treatment, consistent with the 16% 1-year failure estimate at a tertiary children's hospital in South Africa [18], but higher than the 1-year attrition rates of 8–12% in other multi-centre South African cohorts of children aged <16 years [19, 20].…”

The role of quality improvement in achieving effective large-scale prevention of mother-to-child transmission of HIV in South Africa

“…Annual national population-based surveys from 2010 onwards showed steady declines to an average of 2.6% in 2012 (Gaga AE, personal communication, South Africa, November, 2014) [23]. These results were mirrored by the standard PCR results analyzed by the National health Laboratory Services which showed a decline in early mother to child transmission of HIV from 20.9% in 2004 to 2.4% in 2012 [24] (Fig. 2).…”

On the path to reach the SDG targets: Decreasing maternal and child mortality in South Africa

“…Previous improvements in the prevention of mother-to-child transmission of HIV (PMTCT) have been well documented. [8][9][10] In their paper, Goga et al [11] show how there have been further decreases in the rate of early (in utero) transmission of HIV from mother to child. Improvements have occurred as a possible result of use of ward-based outreach teams and community caregivers to trace HIV-exposed infants and connect mothers to care.…”