Original articles

Mother-to-child transmission of HIV in a community-based antiretroviral clinic in South Africa

Felicity C Fitzgerald, Linda-Gail Bekker, Richard Kaplan, Landon Myer, Stephen D Lawn, Robin Wood

Abstract


Objective. To examine the uptake of ART among pregnant women referred to an ART service and the associated rates and risk factors for vertical HIV transmission.

Method. Retrospective analysis of an observational cohort at a community ART clinic in Cape Town

Results. Between 2002 and 2008, 367 treatment-naive pregnant women accessed the clinic. The median age was 27.5 years, and median gestation at presentation was 28 weeks. The median baseline CD4 count and viral load were 134 cells/µl and 28 282 copies/ml. Two hundred and sixty-five women (72%) commenced ART before giving birth, 73 women (20%) were referred for prevention of mother-to-child transmission therapy (PMTCT), and 29 (8%) received no intervention. Among ART-eligible women, 13% were lost to follow-up. Of those starting ART, median duration of therapy prior to birth was 7.6 weeks (interquartile range (IQR) 4 - 11.9).The HIV transmission rate was 5.1% (95% confidence interval (CI) 2.8 - 9.0%). Factors associated with transmission were advanced maternal WHO disease stage (odds ratio (OR) 9.57, p=0.02), and follow-up viral load above 50 copies/ml (OR 3.64, p=0.03). Each additional week on ART reduced transmission by 20% (p=0.05). There was no HIV transmission among women who received more than 8 weeks’ therapy.

Conclusions. The rate of HIV transmission in this study was higher than reported in high-income countries. Prevention of vertical transmission with ART was hindered by women presenting late in pregnancy and with advanced stage of HIV disease. Interventions that facilitate earlier ART commencement and improve programmatic retention of pregnant women are required.

Authors' affiliations

Felicity C Fitzgerald, Desmond Tutu HIV Foundation

Linda-Gail Bekker, Desmond Tutu HIV Foundation

Richard Kaplan, Desmond Tutu HIV Foundation

Landon Myer, Centre for Infectious Diseases and Epidemiology Research, School of Public Health and Family Medicine, University of Cape Town

Stephen D Lawn, Desmond Tutu HIV Foundation

Robin Wood,

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Keywords

Epidemiology; HIV; Antiretroviral Therapy

Cite this article

South African Medical Journal 2010;100(12):827-831.

Article History

Date submitted: 2010-01-22
Date published: 2010-12-01

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