Reasons for failure of prevention of mother-to-child HIV transmission in a rural South African district hospital

Clifford Kendall,Lore Claessens,Kelly Gate,Jienchi Dorward,Gloria Mfeka

doi:10.4102/hivmed.v16i1.365

Abstract

Reasons for failure of prevention of mother-to-child HIV transmission in a rural South African district hospital

Highlights

In 2010, the South African Department of Health (DoH) prevention of mother-to-child transmission (PMTCT) guidelines recommended World Health Organization Option A.[1]
Option B was introduced in April 2013.2 Using these guidelines, mother-to-child transmission (MTCT) in KwaZulu-Natal, South Africa, dropped from 20.8% at 6 weeks postpartum in 2005 to 2.1% in 2011,3,4 with a national target of less than 2% by 2016.5 Further reduction will require a better understanding of the reasons for PMTCT failure in local facilities
Seroconversion in pregnancy or breastfeeding, HIV diagnosis in pregnancy compared with diagnosis prior to conception, and health system-related factors have all been found to play a role in PMTCT failure.[6,7,8]

Summary

Introduction

In 2010, the South African Department of Health (DoH) prevention of mother-to-child transmission (PMTCT) guidelines recommended World Health Organization Option A (prophylactic zidovudine [AZT] for women with a CD4+ count > 350 cells/μL and combination antiretroviral therapy [cART] for all pregnant women with CD4 < 350 cells/μL, with subsequent infant nevirapine [NVP] for a minimum of 6 weeks).[1] Option B (cART for all pregnant and breastfeeding women irrespective of CD4 count and postnatal infant NVP prophylaxis) was introduced in April 2013.2 Using these guidelines, mother-to-child transmission (MTCT) in KwaZulu-Natal, South Africa, dropped from 20.8% at 6 weeks postpartum in 2005 to 2.1% in 2011,3,4 with a national target of less than 2% by 2016.5 Further reduction will require a better understanding of the reasons for PMTCT failure in local facilities. Seroconversion in pregnancy or breastfeeding, HIV diagnosis in pregnancy compared with diagnosis prior to conception, and health system-related factors have all been found to play a role in PMTCT failure.[6,7,8]. Our aim was to identify reasons for these PMTCT failures

Objectives

Results

Discussion

Conclusion