First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa
Journal of Epidemiology and Community Health
Background: There is a paucity of data on the national population-level effectiveness of preventing mother-tochild transmission (PMTCT) programmes in high-HIVprevalence, resource-limited settings. We assessed national PMTCT impact in South Africa (SA), 2010. Methods: A facility-based survey was conducted using a stratified multistage, cluster sampling design. A nationally representative sample of 10 178 infants aged 4-8 weeks was recruited from 565 clinics. Data collection included caregiver interviews, record reviews and infant dried blood spots to identify HIV-exposed infants (HEI) and HIV-infected infants. During analysis, self-reported antiretroviral (ARV) use was categorised: 1a: triple ARV treatment; 1b: azidothymidine >10 weeks; 2a: azidothymidine ≤10 weeks; 2b: incomplete ARV prophylaxis; 3a: no antenatal ARV and 3b: missing ARV information. Findings were adjusted for non-response, survey design and weighted for live-birth distributions. Results: Nationally, 32% of live infants were HEI; early mother-to-child transmission (MTCT) was 3.5% (95% CI 2.9% to 4.1%). In total 29.4% HEI were born to mothers on triple ARV treatment (category 1a) 55.6% on prophylaxis (1b, 2a, 2b), 9.5% received no antenatal ARV (3a) and 5.5% had missing ARV information (3b). Controlling for other factors groups, 1b and 2a had similar MTCT to 1a (Ref; adjusted OR (AOR) for 1b, 0.98, 0.52 to 1.83; and 2a, 1.31, 0.69 to 2.48). MTCT was higher in group 2b (AOR 3.68, 1.69 to 7.97). Within group 3a, early MTCT was highest among breastfeeding mothers 11.50% (4.67% to 18.33%) for exclusive breast feeding, 11.90% (7.45% to 16.35%) for mixed breast feeding, and 3.45% (0.53% to 6.35%) for no breast feeding). Antiretroviral therapy or >10 weeks prophylaxis negated this difference (MTCT 3.94%, 1.98% to 5.90%; 2.07%, 0.55% to 3.60% and 2.11%, 1.28% to 2.95%, respectively). Conclusions: SA, a high-HIV-prevalence middle income country achieved <5% MTCT by 4-8 weeks post partum. The long-term impact on PMTCT on HIV-free survival needs urgent assessment.
Goga, A., Dinh, T., Jackson, D., Lombard, C., Delaney, K., Puren, A., Sherman, G., Woldesenbet, S., Ramokolo, V., Crowley, S., Doherty, T., Chopra, M., Shaffer, N., Pillay, Y., Lerebo, W., Solomon, W., Noveve, N., Heyns, L., Kiewitz, J., Mbenenge, P., Xokwe, M., Mboweni, E., Mzolo, S., Molewa, R., Hlabangani, R., Ncedana, T., Sitawutawu, N., Nyati, F., Husselman, C., Robinson, K., Mhlongo, T., Singh, B., & Patel, U. (2015). First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa. Journal of Epidemiology and Community Health, 69 (3), 240-248. https://doi.org/10.1136/jech-2014-204535