NDLI: Mother-to-child transmission of HIV in a community-based antiretroviral clinic in South Africa.

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Mother-to-child transmission of HIV in a community-based antiretroviral clinic in South Africa.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Fitzgerald, Felicity C. Bekker, Linda-Gail Kaplan, Richard Myer, Landon Lawn, Stephen D. Wood, Robin
Spatial Coverage	South Africa
Description	Author Affiliation: Fitzgerald FC ( Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town.)
Abstract	OBJECTIVE: To examine the uptake of ART among pregnant women referred to an ART service and the associated rates and risk factors for vertical HIV transmission. METHOD: Retrospective analysis of an observational cohort at a community ART clinic in Cape Town. RESULTS: Between 2002 and 2008, 367 treatment-naive pregnant women accessed the clinic. The median age was 27.5 years, and median gestation at presentation was 28 weeks. The median baseline CD4 count and viral load were 134 cells/µl and 28 282 copies/ml. Two hundred and sixty-five women (72%) commenced ART before giving birth, 73 women (20%) were referred for prevention of mother-to-child transmission therapy (PMTCT), and 29 (8%) received no intervention. Among ART-eligible women, 13% were lost to follow-up. Of those starting ART, median duration of therapy prior to birth was 7.6 weeks (interquartile range (IQR) 4 - 11.9).The HIV transmission rate was 5.1% (95% confidence interval (CI) 2.8 - 9.0%). Factors associated with transmission were advanced maternal WHO disease stage (odds ratio (OR) 9.57, p=0.02), and follow-up viral load above 50 copies/ml (OR 3.64, p=0.03). Each additional week on ART reduced transmission by 20% (p=0.05). There was no HIV transmission among women who received more than 8 weeks' therapy. CONCLUSIONS: The rate of HIV transmission in this study was higher than reported in high-income countries. Prevention of vertical transmission with ART was hindered by women presenting late in pregnancy and with advanced stage of HIV disease. Interventions that facilitate earlier ART commencement and improve programmatic retention of pregnant women are required.
File Format	HTM / HTML
ISSN	02569574
e-ISSN	20785135
Journal	South African Medical Journal
Issue Number	12
Volume Number	100
Language	English
Publisher	Health & Medical Publishing Group
Publisher Date	2010-12-01
Publisher Place	South Africa
Access Restriction	Open
Subject Keyword	Discipline Medicine Anti-hiv Agents Therapeutic Use Hiv Infections Transmission Hiv Hospitals, Special Infectious Disease Transmission, Vertical Prevention & Control Pregnancy Complications, Infectious Epidemiology Infant, Newborn Pregnancy Pregnancy Outcome Retrospective Studies Comparative Study Research Support, N.i.h., Extramural
Content Type	Text
Resource Type	Article
Subject	Medicine

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