Impact of the National PMTCT Program Measured at Six Weeks Postpartum in South Africa, 2010 Thu-Ha Dinh, MD., MS., US CDC/GAP Ameena Goga, MD., MS., MRC/HSRU, South Africa Debra Jackson, PhD., RN., UWC, MRC/HSRU, South Africa and other co-authors IAS 2011, Rome, July 17 to 20
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Impact of the National PMTCT Program Measured at Six Weeks Postpartum in South Africa, 2010 Thu-Ha Dinh, MD., MS., US CDC/GAP Ameena Goga, MD., MS., MRC/HSRU,
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Impact of the National PMTCT Program Measured at Six Weeks Postpartum in
South Africa, 2010
Thu-Ha Dinh, MD., MS., US CDC/GAP
Ameena Goga, MD., MS., MRC/HSRU, South Africa Debra Jackson, PhD., RN., UWC, MRC/HSRU, South Africa
PMTCT at > 98% of facilities Decentralized ARV provision, nurse initiates ARV
2008: – Mothers: CD4 > 200 AZT from 28 wks + sd NVP in labour CD4< 200 ART/HAART
– Infant: sd NVP + AZT (7 - 28 days)– DNA PCR at 4-6 weeks of age - 1st immunization
2010: – Mothers CD4 > 350 AZT from 14 wks + sd NVP + TDF/FTC in labour CD4< 350 ART/HAART
– Infant: NVP throughout breastfeeding
2008 – present: DNA PCR at 4-6 weeks of age at the 1st immunization
Background: PMTCT guidelines
ObjectivesPrimary objectives• To estimate national and provincial perinatal MTCT
rates in 2009 and early 2010 • To identify associated factors with the MTCTSecondary questions • To estimate number of HIV acquisition during pregnancy
(poster # MOPE300; Mon 12.30 – 14:30)• To describe and identify re PMTCT missed opportunities –
Factors associated with perinatal MTCTFactors Adj OR 95% CIARV prophylaxis or ART/HAART
Maternal ART (HAART) 1.0 --
Either maternal ARV OR infant ARV 5.2 2.7-10.0
≤10 week maternal ARV AND infant ARV 2.4 1.2-5.1
11-30 week maternal ARV AND infant ARV 1.7 0.9-3.5
Feeding practices (last 8 days)
EBF or no breast-milk 1.0 --
Mixed breast-feeding 1.6 1.0-2.5
Planned pregnancy Yes 1.0 --
No 1.4 0.8-2.3
Delivery method C-section 1.0 --
Not C-section
1.1 0.4-2.9
Birth attendant Non-doctor 1.0 --
Doctor 1.2 0.5-2.9
Limitations
• Selection bias – Representative population attending primary health
care – Excluded sick infants needing emergency care
• Potential recall bias bias associated factors• Sample realization in 3 provinces <75%
estimates were not stable in that 3 provinces (NC, EC and LP)
Conclusions
1. Nationally, the perinatal MTCT rate was < 4% in South Africa
2. C-section and having birth attendant as a doctor may not be optimal options to reduce MTCT
3. Mixed feeding is a strong indicator to increase MTCT in this population
4. No breast-milk feeding to exposed infants (62%) can reduce MTCT but will increase mortality
5. HIV test uptake in infant was high (92%) if offered to all infants at routine immunisation services
“The findings and conclusions on this report are those of the authors and do not necessarily present the official position of the US Centers for Disease Control and Prevention”
Acknowledgements
Nurse Data collectorsRoutine health workers
Medical Research Council: •Carl Lombard (Statistician)• Selamawit Woldesenbet• Wesley Solomon • Vundli Ramokolo• Nothemba Kula•Tanya Doherty
National Department of Health: • Yogan Pillay, • Nonhlanhla Dlamini•Thabang Mosala
Provincial Departments of Health
University of the Western Cape: • Wondwossen LereboUNICEF (SA): • Siobhan CrowleyCDC: • Katherine Robinson• Jeff Klausner• Thurma GoldmanInfant Diagnosis: • Gayle Sherman• Adrian PurenTechnical Advisors:• Mickey Chopra (UNICEF)• Nathan Shaffer (WHO)