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APHA Scientific Session and Event Listing

Debra J. Jackson, MPH DSc¹, Mickey Chopra, MSc², Tanya Doherty, MPH³, Mark Colvin, MBCHB⁴, Jonathan Levin, PhD⁵, Juana Willumsen, PhD¹, Ameena Goga, MBCHB⁶, and Pravi Moodley, MBCHB⁷. (1) School of Public Health, University of the Western Cape, P.O. Box 16239, Vlaeberg, Cape Town, 8018, South Africa, 27-83-327-7331, bessrfam@iafrica.com, (2) Health Systems Research Unit, Medical Research Council, PO Box 19070, Parowvallei, Tygerberg, 7505, South Africa, (3) Health Systems Trust, Riverside Centre, Main Road, Rondebosch, Cape Town, 7700, South Africa, (4) CADRE, 750 Francois Rd, Inthuthuko Building (2nd Floor, HSRC), Durban, 4001, South Africa, (5) Biostatistics Unit, Medical Research Council, PB X385, Pretoria, 0001, South Africa, (6) Mailman School of Public Health, Columbia University, 60 Haven Avenue, #5F, New York, NY 10032, (7) Nelson Mandela Medical School, University of Kwa-Zulu Natal, PB 7, Congella, Durban, 4013, South Africa

Introduction: In 2001 the South African National Prevention of Mother-to-Child-Transmission (PMTCT) of HIV-1 Program was initiated. There is little data on the operational effectiveness of PMTCT programs in Africa. The aim of the study was to determine the impact of a PMTCT program on infant HIV-free survival. Methods: A prospective cohort study of 665 HIV-positive mothers and their infants participating in the South African National PMTCT Program in three sites. Data were collected using semi-structured interviews. Eleven home-visits were made between 3-36 weeks post-delivery. Infant HIV infection was determined by qualitative HIV-1 DNA-PCR. Results: HIV-free survival at 36 weeks varied significantly across sites - 84% in peri-urban, 74% in urban and 65% in rural (p=0.0003). Results in the urban and peri-urban sites compare favorably to clinical trials, while results in the rural site are similar to the placebo arm in these trials. Maternal viral load was the most important factor associated with HIV-transmission or death (HR 1.54, p<0.001). Adjusting for health system variables (<4 antenatal visits and no antenatal syphilis test) explained the difference between rural and peri-urban sites (HR 2.27, p=0.002 vs 1.81, p=0.08). While exposure to breastmilk feeding explained the difference between urban and peri-urban sites (HR 1.74, p=0.027 vs 1.41, p=0.23). Conclusion: These findings suggest that expanded anti-viral regimens are needed to reduce maternal viral load. In addition, ever breastfeeding and underlying inequities in health care quality within South Africa are predictors of PMTCT program performance and will need to be addressed to assure optimal program effectiveness.

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