Public health lessons from a pilot programme to reduce mother-to-child transmission of HIV-1 in Khayelitsha.
OBJECTIVE
Short-course antiretroviral therapy (ART) has been shown to be effective in reducing mother-to-child transmission (MTCT) of HIV-1. This article details the public health lessons learnt from a district-based pilot programme where a short-course zidovudine (ZDV) regimen has been used in a typical South African peri-urban setting.


METHODS
The pilot programme was initiated at two midwife obstetric units in January 1999. Lay counsellors conducted pre- and post-test counselling and nurses took blood for HIV enzyme-linked immunosorbent assay (ELISA) testing. Short-course ZDV was administered antenatally (from 36 weeks' gestation) and during labour. Mother-infant pairs were followed up at eight child health clinics where free formula feed was dispensed weekly. Infants received co-trimoxazole prophylaxis and were ELISA tested for HIV at 9 and 18 months. After 17 months protocol changes aimed at eliminating weaknesses included initiation of ZDV at 34 weeks, self-administration of the first dose of ZDV with the onset of labour, and rapid HIV testing for both mothers and infants.


RESULTS
Voluntary counselling and testing was shown to be highly acceptable, with individual counselling more effective than group counselling. Based on less than optimal availability of records, ZDV utilisation was encouraging with up to 59% of subjects initiating treatment, 3 weeks' median duration of ZDV use, and up to 88% receiving at least one intrapartum ZDV dose. Self-administration of the intrapartum dose reached 41%.


CONCLUSIONS
Short-course antenatal and intrapartum ART to prevent MTCT of HIV1 was shown to be feasible.
Abdullah
M F
MF
Department of Public Health and Primary Health Care, Faculty of Health Sciences, University of Cape Town.
Young
T
T
Bitalo
L
L
Coetzee
N
N
Myers
J E
JE
D015492:AIDS Serodiagnosis; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission; D006284:Health Plan Implementation; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011247:Pregnancy; D011295:Prenatal Care; D013019:South Africa; D015215:Zidovudine / Q000008:administration & dosage*
D019380:Anti-HIV Agents; D015215:Zidovudine