title: The impact of revised PMTCT guidelines: a view from a public sector ARV clinic in Cape Town, South Africa.
abstract: BACKGROUND
  In April 2010, revised Prevention of Mother-to-Child Transmission guidelines were implemented in South Africa, advising fast-tracked lifelong highly active antiretroviral therapy (HAART) initiation at a higher CD4 count (≤350 cells per microliter). This study describes the impact of these changes on the management of pregnant women who initiated HAART at Tygerberg Hospital, Cape Town.
  
  
  METHODS
  We conducted a retrospective review of all women who initiated HAART in pregnancy at the Tygerberg Hospital between January 2008 and December 2010. Year cohorts were compared.
  
  
  RESULTS
  Two hundred and fifty HIV-infected women were included in the study and stratified by HAART initiation year: 2008:N = 82, 2009:N = 71, 2010:N = 97. There were no differences between the groups in age or parity. Median booking CD4 count was 155 cells per microliter [interquartile range (IQR) 107-187], 157 cells per microliter (IQR 104-206) and 208 cells per microliter (IQR 138-270), respectively (P < 0.001). Median gestation at HAART initiation was 31 weeks (IQR 27-35), 30 weeks (IQR 26-34), and 25 weeks (IQR 21-31; P < 0.001). HIV transmission rates were 3/65 (4.6%), 4/57 (7.0%), and 0/90 (0.0%; P = 0.021). Women <8 weeks on HAART before delivery were more likely to transmit than women ≥8 weeks [odds ratio 9.69; 95% confidence interval 1.66 to 56.58; P = 0.017]. Ninety-four (37.6%) women were lost to follow-up, 18.4% within 28 days of delivery.
  
  
  CONCLUSIONS
  The positive impact of the new Prevention of Mother-to-Child Transmission program is evident. A longer duration of HAART before delivery was associated with less transmission. However, the lost to follow-up rates remain concerning. Further research is needed to better understand the reasons for nonadherence and mechanisms to improve support for these women.
authors: Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa. marije@sun.ac.za
authors: Marije
authors: M
authors: Van Schalkwyk
authors: Monique Ingrid
authors: MI
authors: Andersson
authors: Michèle Desiré
authors: MD
authors: Zeier
authors: Marina
authors: M
authors: La Grange
authors: Johannes Jakobus
authors: JJ
authors: Taljaard
authors: Gerhard Barnard
authors: GB
authors: Theron
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D017408:Guidelines as Topic; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D059012:Lost to Follow-Up; D010349:Patient Compliance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D012189:Retrospective Studies; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents