Dual and triple therapy to prevent mother-to-child transmission of HIV in a resource-limited setting - lessons from a South African programme
Method. We retrospectively examined records of all pregnant women attending McCord Hospital for their first antenatal visit between 1 March 2004 and 28 February 2007. Uptake of HIV testing and HIV prevalence were determined, and clinical, immunological and virological outcomes of HIV-positive women and their infants, followed through to 6 months after delivery, were described.
Results. The antenatal clinic was attended by 5 303 women; 4 891 (92%) had an HIV test, and 703 (14%) were HIV positive. The HIV-positive women were subsequently followed up: 653 (93%) received antiretroviral therapy or prophylaxis, including 424 (60%) who received triple therapy. Of the 699 live babies delivered, 661 (94%) received prophylaxis. At 6 weeks 571 babies (82%) were brought back for HIV testing; 16 (2.8%) were HIV positive. After 6 months, only 150 women (21%) were receiving follow-up care at the adult HIV clinic.
Conclusion. Where a tailored approach to prevention of mother-to-child transmission (PMTCT) is used, which attempts to maximise available technology and resources, good short-term transmission outcomes can be achieved. However, longer-term follow-up of mothers’ and babies’ health presents a challenge. Successful strategies to link women to ongoing care are crucial to sustain the gains of PMTCT programmes.
Rosemary Geddes, Medical Research Council
Janet Giddy, McCord Hospital, Durban, South Africa
Lisa M Butler, Department of Epidemiology and Biostatistics, and Global Health Sciences, University of California, San Francisco, San Francisco, USA
Erika van Wyk, McCord Hospital, Durban
Tamaryn Crankshaw, McCord Hospital, Durban
Tonya M Esterhuizen, University of KwaZulu-Natal, Durban
Stephen Knight, Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
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Date published: 2011-09-05
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