A Review of the Prevention of Mother-to-Child Transmission Program of the Western Cape Province 2003 – 2004

Abstract

Mother-to-child transmission (MTCT) of HIV remains the most significant source of HIV infection in children and therefore constitutes an important part of the overall HIV/AIDS epidemic in South Africa. The national antenatal sero-prevalence survey in South Africa in 2005 showed that 30.2% of pregnant women were HIV positive, which implies enormous potential for mother-to-child transmission of the virus. Research has shown that effective interventions exist that can dramatically reduce the rate of transmission from HIV positive mothers to their infants. The challenge is to implement effective, affordable, safe and acceptable interventions, at scale, in resource-constrained settings that will significantly lower the rate of MTCT. This article demonstrates the upgrading of the existing Prevention of Mother-to-Child Transmission (PMTCT) service in the Western Cape, and the impact of program changes upon the management of HIV positive pregnant women and the infant transmission rate. It illustrates the use of operational data as a service indicator of the PMTCT program. This includes counselling and HIV testing of pregnant women, administration of antiretrovirals and monitoring transmission. One major change included the institution of routine CD4 counts on all women testing HIV positive, which improved identification of high risk patients that could be followed up with appropriate referral for antiretroviral treatment. The improvements in the testing and transmission rates of infants as recorded in the Metropole district is the most significant improvement from 2003 to 2004. This provincial PMTCT program has made significant strides and has shown that it is possible to move forward in new approaches to prevent mother-to-child transmission in South Africa.