PMTCT from research to reality--results from a routine service.
OBJECTIVE
Assessment of the efficacy of a prevention of mother-to-child transmission (PMTCT) programme in a routine service setting in comparison to a research environment.


METHODS
Descriptive study over a 13-month period utilising retrospective data obtained from hospital records complemented by prospective data on a sample of patients enrolled in a study to determine an affordable HIV diagnostic protocol for infants.


METHODS
Routine PMTCT service at Coronation Women and Children's Hospital (CWCH) situated in Johannesburg and affiliated to the University of the Witwatersrand.


METHODS
Pregnant women known to be HIV infected who delivered at CWCH from 1 October 2001 to 31 October 2002.


METHODS
The HIV transmission rate to infants, which reflects nevirapine (NVP) delivery and infant feeding practices, and follow-up rates of perinatally exposed children.


RESULTS
Of the 8,221 deliveries, 1,234 (15%) occurred in women known to be HIV infected. HIV transmission rates of 8.7% at 6 weeks and 8.9% at 3 months of age in the study population verifies the high rate of NVP administration and the ability of women to formula-feed their babies and abstain from breast-feeding. More than one-third of infants never return for follow-up and more than 70% are lost to follow-up by 4 months of age.


CONCLUSIONS
The low HIV transmission rate confirms the efficacy of this routine service PMTCT programme. HIV-infected children are not being identified for medical management as part of PMTCT follow-up. It is imperative that record keeping is improved to facilitate ongoing monitoring.
Sherman
G G
GG
Department of Molecular Medicine and Haematology, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa.
Jones
S A
SA
Coovadia
A H
AH
Urban
M F
MF
Bolton
K D
KD
D019380:Anti-HIV Agents / Q000627:therapeutic use; D001942:Breast Feeding / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data*; D019829:Nevirapine / Q000627:therapeutic use; D011247:Pregnancy; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology
D019380:Anti-HIV Agents; D019829:Nevirapine