Prevention of mother-to-child transmission of HIV programme: low vertical transmission in KwaZulu-Natal, South Africa.
OBJECTIVE
To describe the operational effectiveness of the prevention of mother-to-child transmission (PMTCT) of HIV programme at McCord Hospital during the period 1 March 2004 - 31 August 2005.


METHODS
Observational cohort study.


METHODS
McCord Hospital, Durban, South Africa.


METHODS
Antenatal patients attending the PMTCT clinic.


RESULTS
During the 18 months all 2 624 women (100%) attending the antenatal clinic received HIV counselling, resulting in 91% (2 388) being tested for HIV. The prevalence of HIV in the total cohort was 13% (95% confidence interval (CI) 11.6 - 14.2). Of the HIV-positive mothers 302 (89%) completed their pregnancy at the hospital, and in this group there were 3 intrauterine deaths, 1 miscarriage, 1 maternal death (with the baby in utero) and 297 live births with 1 early neonatal death. Only 11% (36 out of 338) were lost to follow-up. A quarter (668) of the partners of all women attending the antenatal clinic were tested for HIV. Delivery in 70% (209) of live births was by caesarean section. Nevirapine was administered to 98% (290) of live babies and 75% (224) received zidovudine (AZT) as well. The 6-week polymerase chain reaction (PCR) baby test uptake was 81% (239 out of 296 live babies). Of those tested, 2.9% (95% CI 1.3 - 6.2) tested HIV positive.


CONCLUSIONS
Despite challenges faced by PMTCT providers in a resource-constrained setting, this state-aided hospital provides a comprehensive and integrated service and has achieved outcomes that compare favourably with those in the developed world.
Geddes
Rosemary
R
Department of Public Health, School of Family and Public Health Medicine, University of KwaZulu-Natal. murose@saol.com
Knight
Stephen
S
Reid
Sandy
S
Giddy
Janet
J
Esterhuizen
Tonya
T
Roberts
Candice
C
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data*; D011247:Pregnancy; D015397:Program Evaluation; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents