title: Coverage of the prevention of mother-to-child transmission program in the Western Cape, South Africa using cord blood surveillance.
abstract: BACKGROUND
  The effectiveness of prevention of mother-to-child transmission of HIV (PMTCT) programs depends on the successful coverage of a series of interventions through pregnancy, intrapartum, and postpartum. Routine monitoring systems based on service data and limited to women on the PMTCT program may overestimate intervention coverage at multiple points along this cascade.
  
  
  METHODS
  Cord blood specimens with individually linked anonymous demographic and pregnancy data were collected from 3 delivery services in the Western Cape Province, South Africa, and screened for HIV. Seropositive specimens were tested for the presence of antiretrovirals. Comparisons were drawn between documented service data and cord blood findings for HIV seroprevalence and antenatal antiretroviral coverage.
  
  
  RESULTS
  A total of 3034 specimens were tested for HIV, 507 (16.7%) of which were HIV seropositive. Of these, 470 (92.7%) were tested for the presence of antiretrovirals, of whom 58.1% had evidence of a standard of care maternal antiretroviral regimen and 73.6% some form of antenatal antiretroviral prophylaxis. Cord blood antiretroviral coverage was lower than that reported by service data. Incomplete antenatal HIV testing accounted for an estimated 46.2% of missed opportunities for transmission reduction.
  
  
  CONCLUSIONS
  Even in this well-resourced setting, HIV screening and ensuring antenatal compliance with prescribed regimens were the most immediate priorities for reducing vertical transmission. Cord blood surveillance offers a unique opportunity to explore missed opportunities using methods not currently possible from routine antenatal and PMTCT program reporting.
authors.affiliation: Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. kathryn.stinson@uct.ac.za
authors.forename: Kathryn
authors.initials: K
authors.lastname: Stinson
authors.forename: Andrew
authors.initials: A
authors.lastname: Boulle
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Smith
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Stringer
authors.forename: Jeffrey S A
authors.initials: JS
authors.lastname: Stringer
authors.forename: David
authors.initials: D
authors.lastname: Coetzee
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000097:blood; D005260:Female; D005312:Fetal Blood / Q000821:virology*; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D010949:Plasma / Q000737:chemistry; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D013019:South Africa; D014766:Viremia / Q000175:diagnosis; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents