Closing the gaps to eliminate mother-to-child transmission of HIV (MTCT) in South Africa : understanding MTCT case rates, factors that hinder the monitoring and attainment of targets, and potential game changers

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dc.contributor.author Goga, Ameena Ebrahim
dc.contributor.author Chirinda, Witness
dc.contributor.author Ngandu, N.K.
dc.contributor.author Ngoma, K.
dc.contributor.author Bhardwaj, S.
dc.contributor.author Feucht, Ute Dagmar
dc.contributor.author Davies, N.
dc.contributor.author Ntloana, M.
dc.contributor.author Mhlongo, O
dc.contributor.author Silere-Maqetseba, T.
dc.contributor.author Moyo, F.
dc.contributor.author Sherman, G.
dc.date.accessioned 2019-07-31T11:24:46Z
dc.date.available 2019-07-31T11:24:46Z
dc.date.issued 2018-03
dc.description.abstract BACKGROUND. Ninety percent of the world’s HIV-positive pregnant women live in 22 countries. These 22 countries, including South Africa (SA) have prioritised the elimination of mother-to-child transmission of HIV (EMTCT). Since 2016 all 22 countries recommend lifelong antiretroviral treatment for all HIV-positive pregnant and lactating women. To measure South African national, provincial and district-level progress towards attaining EMTCT, we analysed the number of in utero (IU) paedatric HIV infections per 100 000 live births (IU case rate), and synthesised factors hindering the monitoring of EMTCT progress and attainment from the viewpoint of provincial and district-level healthcare managers and implementers. We highlight potential innovations to strengthen health systems and improve EMTCT programme delivery. METHODS. We reviewed national-, provincial- and district-level birth HIV testing data from routine National Health Laboratory Services (NHLS) records between April 2016 and March 2017. To obtain a qualitative perspective from healthcare managers and implementers, we synthesised information from the nine 2016 provincial-level EMTCT stock-taking workshops. These workshops involve key provincial and district-level staff, mentors and supporting partners. Lastly, we highlight potential innovations presented at these workshops to overcome operational challenges. RESULTS. The national IU mother-to-child transmission (MTCT) rate was 0.9%, which translated to an IU case rate of 245 HIV-positive neonates per 100 000 live births. Provincial IU percent MTCT risk ranged from 0.6% to 1.3%, with IU case rates ranging between 168 and 325 cases per 100 000 live births. District-level IU percent MTCT risk ranged from 0.4% to 1.9%. Potential game changers include: pre-conception counselling to optimise maternal-partner health, weekly dissemination of HIV polymerase chain reaction (PCR) and viral load reports from the NHLS to specific individuals who trace mothers and infants needing care, use of ward-based outreach teams and community caregivers to trace HIV-infected mothers and their infants to link them into care, inclusion of a unique identifier in patient-held infant Road to Health booklets to facilitate infant tracing and continuous quality improvement (CQI) processes within facilities and districts and implementation of an HIV-positive baby tool to understand the characteristics and risks of HIV-positive infants. On an ecological level, provinces and districts using community-based approaches and CQI methodology seemed to have lower MTCT and IU case rates. CONCLUSIONS. More quantitative analyses are needed to understand what proportion of the success can be attributed to community-based and CQI approaches and the impact of the potential game changers on progress towards EMTCT. en_ZA
dc.description.department Paediatrics and Child Health en_ZA
dc.description.librarian am2019 en_ZA
dc.description.sponsorship The South African Medical Research Council paid for the time of AG, WC and NN, and, in partnership with UNICEF, covered the cost of this publication. en_ZA
dc.description.uri http://www.samj.org.za en_ZA
dc.identifier.citation Goga, A.E., Chirinda, W., Ngandu, N.K. et al. 2018, 'Closing the gaps to eliminate mother-to-child transmission of HIV (MTCT) in South Africa : understanding MTCT case rates, factors that hinder the monitoring and attainment of targets, and potential game changers', South African Medical Journal, vol. 108, suppl. 1, pp. S17-S24. en_ZA
dc.identifier.issn 0256-9574 (print)
dc.identifier.issn 2078-5135 (online)
dc.identifier.other 10.7196/SAMJ.2018.v108i3.12817
dc.identifier.uri http://hdl.handle.net/2263/70842
dc.language.iso en en_ZA
dc.publisher Health and Medical Publishing Group en_ZA
dc.rights © 2019, South African Medical Association. All rights reserved. This article is licensed under a Creative Commons Attribution-NonCommercial Works License (CC BY-NC 3.0). en_ZA
dc.subject Pregnant women en_ZA
dc.subject Mother-to child transmission (MTCT) en_ZA
dc.subject South Africa (SA) en_ZA
dc.subject Antiretroviral treatment (ART) en_ZA
dc.subject Human immunodeficiency virus (HIV) en_ZA
dc.subject Elimination of mother-to-child transmission of HIV (EMTCT) en_ZA
dc.title Closing the gaps to eliminate mother-to-child transmission of HIV (MTCT) in South Africa : understanding MTCT case rates, factors that hinder the monitoring and attainment of targets, and potential game changers en_ZA
dc.type Article en_ZA


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