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

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/µl 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 ≤350µl/ml, and uptake of EID were gaps along the PMTCT cascade in South Africa in 2011.