The effectiveness of PMTCT in the Free State - An anonymously linked cord blood survey

• Main Author: Amoo, Marian Ama
• Other Authors: Coetzee, David
• Format: Dissertation
• Language: English
• Published: University of Cape Town 2014
• Subjects: Epidemiology
• Online Access: http://hdl.handle.net/11427/9405

Includes bibliographical references. === [ Background ] PMTCT has become freely available in many African countries however the impact of these interventions at the population level has not been widely estimated. [ Aim ] The aim of this study was to estimate the proportion of HIV infected/exposed mother and infant pairs who received the appropriate prophylaxis. [ Methods ] Cord blood specimens were collected anonymously from women delivering in 10 facilities in the Free State from November 2007 to April 2008. Collected specimens were tested for antibodies to HIV. Specimens found to be seropositive were tested for the presence of nevirapine using chromatography. All PMTCT sites used single dose nevirapine as the minimum prophylaxis, a few used dual therapy including zidovudine and nevirapine and some included nevirapine-based HAART for eligible women. Information was also collected from the clinical records. Maternal PMTCT coverage was determined through cord blood chromatography and infant coverage was determined from documentation of receipt on the clinical records. [ Results ] 1619 specimens were collected from women who gave birth to live infants were collected and tested (3.6% collection rate). 472 specimens tested positive for HIV antibodies on cord blood testing giving an HIV prevalence of 29.2% (95% CI 26.9-31.4%). Only 45.8% (95% CI 41.2-50.4%) of the 472 live infants born to HIV-infected mothers received both the maternal and infant doses of ARV prophylaxis. Reasons for failed dosing included, pre-test counseling not offered, refused testing, positive test resultnot received, prophylaxis was not dispensed, mother did not adhere and infant did not receive the prophylaxis dose. [ Conclusion ] This study showed that coverage in the Free State Province is poor despite the national expansion of PMTCT services to all antenatal sites. Failures occurred at each step of the PMTCT cascade and resulted in low coverage. Interventions should be introduced at each step of the PMTCT cascade to increase coverage.