270950 Identifying Gaps Along the Prevention of Mother-to-Child Transmission of HIV (PMTCT) Cascade to Achieve the Mother-to-Child Transmission (MTCT) Elimination Goals: Results From the South African PMTCT Effectiveness Survey (SAPMTCTE), 2011

Monday, October 29, 2012 : 11:30 AM - 11:45 AM

Selamawit Woldesenbet, MPH , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Debra Jackson, RN MPH DSc , School of Public Health, University of the Western Cape, Cape Town, South Africa
Ameena Goga, MBCHB , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Carl Lombard , Biostatistics Unit, Medical Research Council, Tygerberg, South Africa
Nonhlanhla Dlamini , Strategic Health Programmes, South African National Department of Health, Pretoria, South Africa
Adrien Puren , Nicd, NHLS, Johannesburg, South Africa
Gayle Sherman , HIV Research Unit, WITS Health Consortium, Johannesburg, South Africa
Thabang Mosala , Strategic Health Programmes, South African National Department of Health, Pretoria, South Africa
Siobhan Crowley , South Africa, UNICEF, Pretoria, 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
Fred Koopman , Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
Yogan Pillay, PhD , Strategic Health Programmes, Department of Health, Pretoria, South Africa
Thu-Ha Dinh , Global AIDS Program, Centers for Disease Control & Prevention, Atlanta
Background: This analysis was conducted to identify gaps along the PMTCT cascade and associated factors needing attention to achieve the MTCT-elimination goals. Methods: We analyzed data from a national cross-sectional facility-based survey enrolling 10253 caregivers with infants aged 4-8 weeks 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. HIV testing was offered to all infants regardless of HIV-exposure status. Findings: Of 9933 participating mothers, 94% (9304) reported having antenatal HIV-testing performed during pregnancy; 99% of those received test results. HIV infection was reported in 27% (2653) of mothers, including those knowing their HIV status before pregnancy; 53% (n=3579) of HIV-negative mothers whose last HIV test occurred at <32wks gestation were not offered a repeat test. Of all (2653) HIV-infected mothers, 84% had a CD4 test and 43% received triple antiretrovirals (ARVs); 50% (n=1327) received both maternal zidovudine (AZT) and newborn nevirapine(NVP)/AZT at birth. 71% (n=482) of HIV-infected mothers with a CD4 count ≤350 cell/Ál received triple ARVs. Of known HIV-exposed infants (HEI), 85% (n=2264) received daily NVP-prophylaxis ≥4wks. Of 2653 known HEI, 33% were intentionally brought to the immunization clinic for Early-Infant-Diagnosis (EID) /PCR testing at 4-8wks, while 99% of those offered HIV testing at the clinic visit consented to EID. Conclusion: We found that repeat testing at 32wks of pregnancy, uptake of CD4 testing, triple ARVs for women with CD4 ≤350Ál/ml, and uptake of EID were gaps along the PMTCT cascade in South Africa in 2011.

Learning Areas:
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:
Assess gaps in the PMTCT services cascade in South Africa Evaluate the South African PMTCT program

Keywords: HIV Interventions, Infant Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Co-Principal Investigator, Perinatal Epidemiologist with research experience in MCH, PMTCT and infant health
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.

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