Abstract:
BACKGROUND : Elimination of mother-to-child transmission of HIV
requires sustained viral load suppression during pregnancy and
breastfeeding among women living with HIV (WLHIV). Antenatal
antiretroviral therapy coverage is reported at .95% in South Africa,
but viral load suppression rates are unknown. We describe maternal
VL burden around time of delivery at 4 tertiary obstetric units
(TOUs) in Gauteng Province.
METHODS : Between June 2018 and March 2019, routine point-ofcare
(PoC) maternal HIV VL and early infant diagnosis (EID) testing
were implemented at 3 TOUs in Johannesburg and 1 in Tshwane
district. WLHIV and HIV-exposed neonates were eligible for HIV
VL (Xpert HIV-1 VL) and EID (Xpert HIV-1 EID or m-PIMA
HIV1/2 detection) testing around time of delivery, respectively.
Proportions of viremic women and intrauterine (IU)-infected neonates
were calculated among valid PoC results.
RESULTS : Among 8147 live births to WLHIV, 2769 (34.0%) women
and 4333 (53.2%) neonates had valid PoC results. Median VL at
delivery was ,40 copies/mL (interquartile range: 0–398). The
proportion of women with a VL , 50, 50 to ,1000, and $1000
copies/mL was 63.6%, 13.9% and 22.4%, respectively. There were
65/4333 (1.5%) IU-infected neonates. Among 1449 mother–neonate
pairs with both VL and EID results, IU transmission by VL threshold
was 3/946 (0.3%), 6/187 (3.2%), and 25/316 (7.9%) for VL , 50, 50
to ,1000, and $1000 copies/mL, respectively (P , 0.001).
CONCLUSIONS : Despite high antiretroviral therapy coverage, .1/3
of WLHIV had a VL $50 copies/mL at delivery. Among
mother–neonate pairs, maternal VL $50 copies/mL accounted for
31/34 (91%) IU infections. Improvement in the quality of HIV care
among WLHIV is essential if South Africa is to achieve elimination
of mother-to-child transmission.
