BACKGROUND : There is a paucity of data on the national
population-level effectiveness of preventing mother-tochild
transmission (PMTCT) programmes in high-HIVprevalence,
resource-limited settings. We assessed
national PMTCT impact in South Africa (SA), 2010.
METHODS : A facility-based survey was conducted using
a stratified multistage, cluster sampling design. A
nationally representative sample of 10 178 infants aged
4–8 weeks was recruited from 565 clinics. Data
collection included caregiver interviews, record reviews
and infant dried blood spots to identify HIV-exposed
infants (HEI) and HIV-infected infants. During analysis,
self-reported antiretroviral (ARV) use was categorised:
1a: triple ARV treatment; 1b: azidothymidine
>10 weeks; 2a: azidothymidine ≤10 weeks; 2b:
incomplete ARV prophylaxis; 3a: no antenatal ARV and
3b: missing ARV information. Findings were adjusted for
non-response, survey design and weighted for live-birth
RESULTS : Nationally, 32% of live infants were HEI; early
mother-to-child transmission (MTCT) was 3.5% (95% CI
2.9% to 4.1%). In total 29.4% HEI were born to
mothers on triple ARV treatment (category 1a) 55.6%
on prophylaxis (1b, 2a, 2b), 9.5% received no antenatal
ARV (3a) and 5.5% had missing ARV information (3b).
Controlling for other factors groups, 1b and 2a had
similar MTCT to 1a (Ref; adjusted OR (AOR) for 1b,
0.98, 0.52 to 1.83; and 2a, 1.31, 0.69 to 2.48). MTCT
was higher in group 2b (AOR 3.68, 1.69 to 7.97).
Within group 3a, early MTCT was highest among
breastfeeding mothers 11.50% (4.67% to 18.33%) for
exclusive breast feeding, 11.90% (7.45% to 16.35%)
for mixed breast feeding, and 3.45% (0.53% to 6.35%)
for no breast feeding). Antiretroviral therapy or
>10 weeks prophylaxis negated this difference (MTCT
3.94%, 1.98% to 5.90%; 2.07%, 0.55% to 3.60%
and 2.11%, 1.28% to 2.95%, respectively).
CONCLUSIONS : SA, a high-HIV-prevalence middle income
country achieved <5% MTCT by 4–8 weeks post
partum. The long-term impact on PMTCT on HIV-free
survival needs urgent assessment.