Abstract
Background. With significant reductions in the rate of HIV mother-to-child transmission (MTCT) in South Africa, each case of failed prevention of MTCT (PMTCT) should be investigated. Objective. To establish the cause(s) of MTCT at Khayelitsha’s Community Health Centre (CHC) in order to identify obstacles to MTCT elimination.Methods. Routinely collected data were reviewed for all HIV-infected infants identified at Khayelitsha Site B CHC from January 2012 to April 2013.Results. A total of 926/1 158 (80%) of exposed infants had polymerase chain reaction (PCR) results, with 15/926 (1.6%) PCR-positive. Median (interquartile range (IQR)) values for the maternal indicators were as follows: maternal age, 27 (23 - 31) years; parity, 2 (1 - 3); gestational age at antenatal presentation, 21.5 (17.5 - 30.5) weeks; CD4+, 377(219 - 446) cells/µl. Of the 15 PCR-positive infants, five received ART, five received AZT and five received no prophylaxis. Viral loads were not monitored for any of the women receiving antenatal ART. Nine of the 15 (60%) delivered in hospital, with 6/9 requiring caesarean section. The median (IQR) infant birth weight was 3.0 (2.6 - 3.5) kg. All received prophylactic nevirapine post exposure. Two of the 15 were clinically unwell at birth, and 14 (86.7%) were breastfed, with 10 (66.7%) recorded as exclusively breastfed. Median (IQR) time between delivery and PCR results was 6.6 (6.1 - 7.3) weeks. Discussion. PMTCT programmes must consider each PCR-positive infant as a sentinel event that can provide valuable insight into correcting ongoing clinical and programmatic reasons for HIV transmission. The main risk factors for MTCT identified in this study were late presentation for antenatal care, inadequate antenatal PMTCT prophylaxis and a lack of viral load monitoring.
Highlights
With significant reductions in the rate of HIV mother-to-child transmission (MTCT) in South Africa, each case of failed prevention of MTCT (PMTCT) should be investigated
Median (IQR) time between delivery and polymerase chain reaction (PCR) results was 6.6 (6.1 - 7.3) weeks. This case series points to several critical gaps in the PMTCT cascade in this setting
This finding is of particular concern when considered in the context of the South Africa (SA) PMTCT evaluation study reported intention to obtain infant PCR testing at 6 weeks; the study found that only 35% of HIV-positive mothers indicated that they planned to obtain early infant diagnosis for their infant during their 6-week immunisation visit
Summary
With significant reductions in the rate of HIV mother-to-child transmission (MTCT) in South Africa, each case of failed prevention of MTCT (PMTCT) should be investigated. A total of 926/1 158 (80%) of exposed infants had polymerase chain reaction (PCR) results, with 15/926 (1.6%) PCR-positive. Of the 15 PCR-positive infants, five received ART, five received AZT and five received no prophylaxis. Viral loads were not monitored for any of the women receiving antenatal ART. The median (IQR) infant birth weight was 3.0 (2.6 - 3.5) kg. Median (IQR) time between delivery and PCR results was 6.6 (6.1 - 7.3) weeks. PMTCT programmes must consider each PCR-positive infant as a sentinel event that can provide valuable insight into correcting ongoing clinical and programmatic reasons for HIV transmission. The main risk factors for MTCT identified in this study were late presentation for antenatal care, inadequate antenatal PMTCT prophylaxis and a lack of viral load monitoring
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
