Online Program

Postnatal mother-to-child transmission of HIV and HIV-free survival in an HIV-exposed national cohort, South Africa, December 2012-September 2014

Tuesday, November 3, 2015

Debra Jackson, RN MPH DSc, Health Section, UNICEF, New York, NY
Ameena Goga, MD, Health Systems Research Unit, Medical Research Council, SA, Pretoria,, South Africa
Thu-Ha Dinh, MD MS, Global AIDS Program, Centers for Disease Control & Prevention, Atlanta
Carl Lombard, PhD, Biostatistics Unit, Medical Research Council, Tygerberg, South Africa
For the South African PMTCT Evaluation Study Group, Medical Research Council, SA, Pretoria,, South Africa
Background: Global targets for eliminating mother-to-child transmission of HIV (MTCT) are <2% by six weeks and <5% by 18 months postpartum. We measured population-level MTCT and infant HIV-free survival (HFS) from 4-8 weeks to 18 months (when Option A was policy) in South Africa.

Method:  A nationally representative cross-sectional survey was conducted in 580 public health facilities randomly selected using multistage probability proportional to size. We interviewed caregivers of infants aged 4-8 weeks receiving their six week immunisation and tested infant dried blood spots for HIV exposure (antibody) and infection. A closed cohort of HIV-exposed infants were invited for follow-up. At each visit we interviewed primary caregivers and tested infants for HIV infection.

Results: At 4-8 weeks, data from 9120 infants were analysed, showing 33.1% (95% Confidence Interval (CI) 31.8-34.3%) infant HIV-exposure and 2.6% (CI 2.0-3.2%) early MTCT. Of 2787 infants in the cohort, 1069 (38.3%) were lost to follow-up (LTFU) by 18 months. Cumulative (from birth) preliminary unweighted MTCT  by 3, 6, 9, 12, 15, and 18 months was 2.65%, 3.41%, 3.73%, 3.93%, 4.08% and 4.19%, respectively; preliminary HFS was 97.3%, 95.6%, 94.4%, 93.7%  93.2% and 92.9%..

Conclusions: Although preliminary unweighted 18-month MTCT was <5%, there is potential that global targets were not achieved as our data excludes early infections/deaths prior to 6 weeks postpartum and outcomes amongst LTFU infants. Our findings highlight the need for continued improvements in antenatal and perinatal PMTCT programmes and intense postnatal follow-up to remove bottlenecks and reach global targets.

Learning Areas:

Administer health education strategies, interventions and programs
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Evaluate the South African PMTCT programme Describe postnatal HIV transmission and HIV free survival in a South African cohort of HIV exposed infants.

Keyword(s): HIV Interventions, MCH Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Principal Investigator
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.