270938 Impact of the National Prevention of Mother to Child Transmission of HIV (PMTCT) Program on Perinatal Mother-to-Child Transmission of HIV (MTCT) Measured at 6 weeks Postpartum, South Africa (SA): Results of the First Year of Implementation of the 2010 PMTCT Guidelines Recommended by the World Health Organization (WHO)

Wednesday, October 31, 2012 : 1:45 PM - 2:00 PM

Ameena Goga, MBCHB , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Thu-Ha Dinh , Global AIDS Program, Centers for Disease Control & Prevention, Atlanta
Debra Jackson, RN MPH DSc , School of Public Health, University of the Western Cape, Cape Town, South Africa
Nonhlanhla Dlamini , Strategic Health Programmes, South African National Department of Health, Pretoria, South Africa
Thabang Mosala , Strategic Health Programmes, South African National Department of Health, Pretoria, South Africa
Carl Lombard , Biostatistics Unit, Medical Research Council, Tygerberg, South Africa
Adrien Puren , Nicd, NHLS, Johannesburg, South Africa
Gayle Sherman , HIV Research Unit, WITS Health Consortium, Johannesburg, South Africa
Siobhan Crowley , South Africa, UNICEF, Pretoria, South Africa
Selamawit Woldesenbet, MPH , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Wesley Solomon, MPH , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Vundli Ramokolo , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Yogan Pillay, PhD , Strategic Health Programmes, Department of Health, Pretoria, South Africa
Background: Effectiveness of implementing the 2010 WHO PMTCT recommendations has not been assessed at population level. SA began implementation of the WHO PMTCT Option-A recommendation in April 2010. We assessed the impact of the first year of implementation of Option-A on perinatal MTCT measured at 4-8wks postpartum. Methods: We conducted a nationally representative, cross-sectional facility-based survey of infant-caregiver pairs attending the first immunization visit using a stratified multi-stage sampling design. Data were collected through caregiver interviews and/or from Road-to-Health cards between August 2011 and February 2012. HIV-exposed infants (HEI) were identified if their dried-blood-spot (DBS) specimens collected at 4-8wks were HIV-antibody positive. DBS specimens of HEI were then tested for HIV infection using DNA-PCR. Results: Of 9793 enrolled caregiver-infant pairs, 2914 (29.8%) HEI were identified. Of 2454 HEI whose mothers knew their own infection status, triple-antiretrovirals were provided to 1075 (43.8%) mothers of whom 72% with CD4 counts ≤350 cell/Ál and 25.5% with CD4 counts >350 cell/Ál. The unweighted national MTCT rate measured at 4-8wks postpartum was 3.0%. Controlling for maternal CD4, odds of MTCT were higher in mother-HEI pairs receiving ≤10wks of maternal-AZT and infant-NVP at birth compared with those receiving >10wks of the same regimen (AOR=2.4; 95%CI 1.1-5.5). Conclusion: After one year implementing the 2010 WHO Option-A PMTCT recommendations, SA has decreased MTCT measured at 4-8wks postpartum to 3%. Data suggest that early antiretroviral initiation is likely to increase effectiveness. Overall MTCT and survival rates around 18-months are needed to estimate the effectiveness of extended NVP-prophylaxis during breastfeeding.

Learning Areas:
Epidemiology
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Evaluate the South African National PMTCT Program Analyze the predictors of MTCT in South Africa

Keywords: HIV Interventions, Infant Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Co-Principal Investigator, CDC Specialist in PMTCT
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.