Abstract:
BACKGROUND
Women of reproductive age living with HIV (WRLHIV), HIV-positive pregnant women, adolescent
girls and young women (AGYW) are key populations for eliminating mother-to-child
of HIV (eMTCT) in South Africa. We describe the geographical distribution of WRLHIV, their
pregnant counterparts and AGYW for risk-adjusted allocation of eMTCT interventions.
METHODS
For the year 2018, we triangulated data from the Thembisa Model with five routine HIVrelated
and demographic data sources to determine the distribution of WRLHIV (15–49
years) and AGYW (15–24 years) nationally and by province. Data analysed included total
population estimates, number of live-births, live-births to HIV-positive women, age-specific
HIV prevalence rates, intrauterine (IU)-transmission rates and IU-case rates/100 000 livebirths.
IU-transmission rates and IU-case rates were calculated from de-duplicated routine
HIV test-data for neonates (aged <7days). Data de-duplication was achieved by a patientlinking
algorithm that uses probabilistic matching of demographics (name, surname, date of
birth), supplemented by manual matching to account for spelling errors.
RESULTS
There were 58 million people in South Africa in 2018. Females (all ages) constituted 51% of
the population. Women of reproductive age constituted 27% and AGYW constituted 8% of
the total population. WRLHIV, AGYW living with HIV and HIV-positive pregnant women accounted for 7%, 0.8% and 0.4% of the total population respectively. Gauteng was the
most populous province followed by KwaZulu-Natal, with Western Cape and Eastern Cape in third and fourth positions. The distribution of WRLHIV and AGYW followed a similar trend.
However, Mpumalanga and Limpopo provinces had higher proportions of WRLHIV and
AGYW living with HIV ahead of Western Cape. KwaZulu-Natal had the highest number of
live-births to HIV-positive women. The national IU-transmission rate of <1% translated into
241 cases/100 000. While provincial IU-case rates were fairly similar at 179–325, districts
IU-case rates varied, ranging from 87–415 cases/100 000 live-births.
CONCLUSION
Findings suggest that the need for eMTCT interventions is greatest in Gauteng, KwaZulu-
Natal, Western Cape and Eastern Cape. Limpopo and Mpumalanga provinces may require
more HIV prevention and family planning services because of high fertility rates, high number
of WRLHIV and AGYW living with HIV. eMTCT will require robust viral load monitoring
among WRLHIV, pregnant and breastfeeding women. The national laboratory database
can provide this service near-real time.
