Prevention of vertical transmission of HIV in Khayelitsha, South Africa: A contemporary review of services after 20 years
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i10.861Keywords:
HIV, Prevention of Vertical Transmission, Pregnancy, Antiretroviral Therapy, HIV viral load, Khayelitsha, Early Infant DiagnosisAbstract
Background. The first vertical transmission of HIV prevention (VTP) programme in South Africa was launched in 1999 in Khayelitsha, Western Cape Province (WC). Since then, VTP guidelines have expanded in complexity and scope.
Objectives. To describe contemporary VTP uptake in Khayelitsha and quantify vertical transmission (VT) risk factors based on linked routine electronic health data.
Methods. In the WC, all patients at public health facilities have a unique identifier allowing linkage across electronic health platforms through a health information exchange hosted within the WC Department of Health. We conducted a cohort analysis of mother-infant pairs where the mother was living with HIV and attended any obstetric care in Khayelitsha in 2017. Descriptive statistics assessed VTP coverage along the care cascade, including maternal viral load (VL) testing and early infant diagnosis (EID). Logistic regression analysis quantified a priori-defined risk factors associated with VT.
Results. Antenatal HIV prevalence in the cohort was 31.3%, and VT was 1.8% by 12 months. Of women living with HIV, 88.3% knew of their positive status at the first antenatal visit and 77.9% were already receiving antiretroviral therapy (ART). Most women diagnosed prior to delivery (94.5%) were initiated on ART; 85.0% received an antenatal VL test, of whom 88.0% were virologically suppressed. Women who were not virally suppressed had a five-fold (adjusted odds ratio (aOR) 5.3; 95% confidence interval (CI) 2.5 - 12.3) increased VT risk compared with those who were suppressed. Women who attended no antenatal care were at higher risk of VT (aOR 1.6; 95% CI 0.7 - 3.6) than those who did attend. EID coverage was suboptimal: a birth HIV polymerase chain reaction (PCR) test was available for 79.2% of infants, and a low proportion with a negative birth test had a repeat test around 10 weeks (57.9%). Data linkage identified an additional 15 infants living with HIV who were not detected by HIV-PCR testing alone.
Conclusion. Although most women presented to care already knowing their HIV status, ART initiation was suboptimal prior to the first antenatal visit but improved over the course of pregnancy. The VT rate based on laboratory HIV-PCR testing alone underestimated HIV transmission: linked data from multiple sources suggested higher VT than programme-reported rates based on HIV-PCR testing alone.
References
Stinson K, Giddy J, Cox V, et al. Reflections on a decade of delivering PMTCT in Khayelitsha, South Africa. South Afr J HIV Med 2014;15(1):30-32. https://doi.org/10.4102/sajhivmed.v15i1.41
Poolman M, van der Walt N, Luwaca B. Western Cape Provincial Aids Council Annual Progress Report 2015/16. 2017. https://sanac.org.za/wp-content/uploads/2018/08/Western-Cape.pdf (accessed 31 May 2022).
Coetzee D, Hilderbrand K, Boulle A, Draper B, Abdullah F, Goemaere E. Effectiveness of the first district-wide programme for the prevention of mother-to-child transmission of HIV in South Africa. Bull World Health Organ 2005;83(7):489-494.
National Department of Health, South Africa. Implementation of the universal test and treat strategy for HIV positive patients and differentiated care for stable patients. Pretoria: NDoH, 26 August 2016. https://sahivsoc.org/Files/22%208%2016%20Circular%20UTT%20%20%20Decongestion%20 CCMT%20Directorate%20(2).pdf (accessed 31 May 2022).
Provincial Government of the Western Cape Department of Health. The Western Cape Consolidated Guidelines for HIV Treatment: Prevention of Mother-to-Child Transmission of HIV (PMTCT), Children, Adolescents and Adults, amended. October 2016. Western Cape Department of Health, Cape Town. https://www.westerncape.gov.za/sites/www.westerncape.gov.za/files/the-western-cape- consolidated-guidelines-for-hiv-treatment-2015-v26012016.pdf (accessed 31 May 2022)
Boulle A, Heekes A, Tiffin N, et al. Data centre profile: The Provincial Health Data Centre of the Western Cape Province, South Africa. Int J Popul Data Sci 2019;4(2):1143. https://doi.org/10.23889/ ijpds.v4i2.1143
Woldesenbet SA, Kufa T, Lombard C, et al. The 2017 National Antenatal Sentinel HIV Survey, South Africa. Pretoria: National Department of Health, 2019. https://doi.org/10.13140/RG.2.2.25252.01928
Joint United Nations Programme on HIV/AIDS (UNAIDS). Understanding fast-track: Accelerating action to end the AIDS epidemic by 2030. Geneva: UNAIDS, 2015. https://www.unaids.org/sites/ default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf (accessed 31 May 2022).
Moyo F, Haeri Mazanderani A, Murray T, et al. Characterizing viral load burden among HIV-infected women around the time of delivery. J Acquir Immune Defic Syndr 2020;83(4):390-396. https://doi. org/10.1097/QAI.0000000000002267
Goga A, Chirinda W, Ngandu NK, et al. Closing the gaps to eliminate mother-to-child transmission of HIV (MTCT) in South Africa: Understanding MTCT case rates, factors that hinder the monitoring and attainment of targets, and potential game changers. S Afr Med J 2018;108(3a):s17-s24. https://doi. org/10.7196/SAMJ.2017.v108i3b.12817
Radebe L, Haeri Mazanderani A, Sherman GG. Evaluating patient data quality in South Africa’s National Health Laboratory Service Data Warehouse, 2017 - 2020: Implications for monitoring child health programmes. BMC Public Health 2022;22:1266. https://doi.org/10.1186/s12889-022-13508-y
Kalk E, Kroon M, Boulle A, et al. Neonatal and infant diagnostic HIV-PCR uptake and associations during three sequential policy periods in Cape Town, South Africa: A longitudinal analysis. J Int AIDS Soc 2018;21(11):e25212. https://doi.org/10.1002/jia2.25212
Moyo F, Haeri Mazanderani A, Barron P, et al. Introduction of routine HIV birth testing in the South African National Consolidated Guidelines. Pediatr Infect Dis J 2018;37(6):559-563. https://doi. org/10.1097/INF.0000000000001840
Ibeto M, Giddy J, Cox V. Closing the gaps: Steps towards elimination of mother-to-child transmission of HIV. South Afr J HIV Med 2014;15(3):108-109. https://doi.org/10.7196/SAJHIVMED.1047
Johnson LF, Stinson K, Newell ML, et al. The contribution of maternal HIV seroconversion during late pregnancy and breastfeeding to mother-to-child transmission of HIV. J Acquir Immune Defic Syndr 2012;59(4):417-425. https://doi.org/10.1097/QAI.0b013e3182432f27
Myer L, Phillips TK, Hsiao N-Y, et al. Plasma viraemia in HIV-positive pregnant women entering antenatal care in South Africa. J Int AIDS Soc 2015;18(1):20045. https://doi.org/10.7448/IAS.18.1.20045 17. Sherman GG, Haeri Mazanderani A, Barron P, et al. Toward elimination of mother-to-child transmission of HIV in South Africa: How best to monitor early infant infections within the Prevention of Mother-to-Child Transmission Program. J Glob Health 2017;7(1):010701. https://doi.
org/10.7189/jogh.07.010701
Anglewicz P, VanLandingham M, Manda-Taylor L, Kohler HP. Migration and HIV infection in Malawi. AIDS 2016;30(13):2099-2105. https://doi.org/10.1097/QAD.0000000000001150
Statistics South Africa. General Household Survey 2017. Statistical release P0318. Pretoria: Stats SA, 2018. http://www.statssa.gov.za/publications/P0318/P03182017.pdf (accessed 15 March 2020).
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Florence Phelanyane, Alexa Heekes, Mariette Smith, Karen Jennings, Vanessa Mudaly, Pauline Pieters, Juanita Arendse, Saadiq Kariem, David Coetzee, Andrew Boulle, Emma Kalk
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
