The impact of revised PMTCT guidelines : a view from a public sector ARV clinic in Cape Town, South Africa
Date
2013-06
Authors
Van Schalkwyk, Marije
Andersson, Monique Ingrid
Zeier, Michele Desire
La Grange, Marina
Taljaard, Johannes Jakobus
Theron, Gerhard Barnard
Journal Title
Journal ISSN
Volume Title
Publisher
Lippincott Williams & Wilkins
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.
Description
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at www.jaids.com
The original publication is available at www.jaids.com
Keywords
AIDS (Disease) -- Transmission -- Prevention, AIDS (Disease) in pregnancy -- Transmission -- Prevention, Highly active antiretroviral therapy
Citation
Van Schalkwyk, M et al. 2013. The Impact of Revised PMTCT Guidelines: A View From a Public Sector ARV Clinic in Cape Town, South Africa. JAIDS Journal of Acquired Immune Deficiency Syndrome, 63(2): 234-238, doi: 10.1097/QAI.0b013e31828bb721.