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Media statement

9 June 2011

SA PMTCT Evaluation shows that virtual elimination of paediatric HIV is possible with intensified effort

Durban

Study results from a national survey, conducted between June to December 2010, to evaluate the effectiveness of the South African Prevention of Mother To Child Transmission (SA PMTCT) programme at six weeks postpartum show that out of a sample size of 9915 infants, 31,4% were HIV-exposed. The national HIV transmission rate from mother-to-child, measured in these 9915 infants aged 4-8 weeks attending public sector clinics for their (six week DTaP/Pentaxim) immunisation was 3.5%.

This survey was conducted by the Health Systems Research Unit of the Medical Research Council on behalf of the National Department of Health and several other role players including CDC (technical and financial support), Unicef (financial support for the data collection technology), NCID/NHLS, Wits Infant HIV Diagnostics and UWC.

The table below shows the rates of infant HIV-exposure and HIV transmission from mother-to-child transmission measured at 4-8 weeks post-delivery, by province.

(Analysis on 9915 completed interviews with DBS results)

PROVINCE

Infant HIV-Exposed %
(95%CI)

MTCT %
(95%CI)

Eastern Cape

30.0 (26.3-33.7)

3.5* (1.2-5.8)

Free State

31.1 (28.9-33.3)

5.7 (3.5-7.9)

Gauteng

30.2 (27.7-32.8)

2.3 (1.3-3.3)

KwaZulu Natal

43.9 (39.7-48.0)

2.8 (1.7-4.0)

Limpopo

22.6 (20.4-24.8)

3.4 (1.0-5.8)

Mpumalanga

36.2 (33.6-38.9)

6.2 (4.5-7.9)

Northern Cape

15.6 (13.0-18.3)

1.9* (0.0-4.5)

Northwest

30.9 (28.6-33.1)

4.6 (3.0-6.1)

Western Cape

20.8 (16.8-24.9)

3.3 (1.3-5.2)

*Note due to smaller sample size realisation precision is low

Researchers visited 580 facilities across South Africa. Interviews were conducted with consenting caregivers of infants aged 4-8 weeks and dried blood spots (DBS) were collected from enrolled consented infants. DBS were tested for HIV-exposure using ELISA to detect maternal antibody. ELISA positive DBS were then tested for DNA PCR to detect HIV transmission. All infant test results were returned to mothers by the routine health care system and HIV-infected infants were fast-tracked into care. All mothers were encouraged to access HIV counselling and testing services.

“This survey was the first ever rigorous national SA PMTCT evaluation in the nine provinces of South Africa,” said Dr Ameena Goga, MRC, as she spoke on behalf of the survey principal investigators (Dr Goga – MRC; Prof Jackson – UWC and Dr Dinh – CDC) and collaborators. “The survey highlighted the acceptability of routine infant HIV testing once the advantages were explained” said Professor Jackson (UWC).”92% of eligible caregivers agreed to their infants being tested for HIV”. Dr Dinh (CDC) highlighted the fact that 4.1% of infants whose mothers reported being HIV negative were actually exposed to HIV, highlighting the need to strengthen repeat testing in pregnancy and couple testing.

The survey also highlighted gaps in postnatal care and infant follow-up” said Dr Goga, MRC. “This emphasises the importance of tracking MTCT rates until 18 months to measure the effectiveness of the complete PMTCT programme. In 2010 the SAPMTCT Evaluation only measured the effectiveness of the antenatal and intrapartum components of the PMTCT programme. Our sample size was calculated to obtain valid national and provincial level MTCT estimates at 4-8 weeks post-delivery”, said Dr Goga.  “In 2011 and 2012 we plan to repeat the PMTCT Evaluation so that we can track MTCT rates over 3 years. However we will also follow-up infants so that we can also measure HIV transmission rates between six week and 18 months.”

In 2010 the South African government revised the PMTCT guidelines to include AZT from 14 weeks, HAART for all pregnant women with CD4 cell counts less than or equal to 350 and infant nevirapine prophylaxis for six weeks (if mum on HAART or not breastfeeding) or throughout the breastfeeding period. Furthermore the PMTCT guidelines promote the integration of PMTCT services into routine maternal, newborn, and child health services.  The PMTCT Evaluation provides data to track the operational effectiveness of the revised guidelines.

Dr Goga mentioned that the SAPMTCTE data shows that virtual elimination of paediatric HIV could be possible by 2015, with intensified effort. However, we need to address the postnatal component and variabilities in PMTCT service coverage.” She added that:” Reduction in MTCT will contribute towards reduction of incident HIV infections at population level.”

Issued by the South African Medical Research Council (MRC).

For information contact:
Dr Ameena Goga on 082 302 3168 or Julian Jacobs on  082 454 4902.

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Last updated:
9 April, 2014
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