Implementation of prevention of mother-to-child transmission (PMTCT) in South Africa: outcomes from a population-based birth cohort study in Paarl, Western Cape.
Adult
Anti-HIV Agents
/ therapeutic use
Breast Feeding
/ statistics & numerical data
Child, Preschool
Cohort Studies
Communicable Disease Control
/ methods
Female
HIV Infections
/ epidemiology
Humans
Infant
Infant, Newborn
Infectious Disease Transmission, Vertical
/ prevention & control
Pregnancy
Pregnancy Complications, Infectious
/ virology
South Africa
/ epidemiology
Young Adult
HIV
South Africa
cohort studies
global health
implementation science
maternal health
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
15 12 2019
15 12 2019
Historique:
entrez:
18
12
2019
pubmed:
18
12
2019
medline:
15
12
2020
Statut:
epublish
Résumé
The coverage of prevention of mother-to-child transmission (PMTCT) services in South Africa is variable. Identifying gaps in the implementation of these services is necessary to isolate steps needed to further reduce paediatric infections and eliminate transmission. Two primary care clinics in Paarl, South Africa. 1225 pregnant women; inclusion criteria were 18 years or older, clinic attendance and remaining in area for at least 1 year. Data were collected through the Drakenstein Child Health Study, a population-based birth cohort in a periurban area of the Western Cape, South Africa. A combination of clinic records, hospital records, national database searches and maternal self-report were collected during the study. Of the 1225 mothers enrolled in the cohort between 2012 and 2015, 260 (21%) were confirmed HIV infected antenatally and 1 mother tested positive in the postnatal period. Of those with documentation (n=250/260, 96%), the majority (99%) received antiretroviral prophylaxis or therapy (ART) before labour; however, there was a high rate of defaulting from ART noted during pregnancy (20%). All HIV-exposed infants with data received antiretroviral prophylaxis, 35% were exclusively breast fed until 6 weeks and 16% for 6 months. There were two cases of infant HIV infection (0.8%) who were initiated on ART but had complicated histories. Despite the low transmission rate in this cohort, reaching elimination will require further work, and this study illustrates several areas to improve implementation of PMTCT services and reduce paediatric infections including retesting at-risk HIV-negative mothers through the duration of breast feeding, infant HIV testing at any admission in addition to routine testing and improved counselling to prevent defaulting from treatment. Better data surveillance systems are essential for determining the implementation of PMTCT guidelines.
Identifiants
pubmed: 31843848
pii: bmjopen-2019-033259
doi: 10.1136/bmjopen-2019-033259
pmc: PMC6924830
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e033259Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : NIMH NIH HHS
ID : K01 MH112443
Pays : United States
Organisme : Wellcome Trust
ID : 203525/Z/16/Z
Pays : United Kingdom
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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