BackgroundFollow up of Human Immunodeficiency Virus (HIV)-exposed infants is an important component of Prevention of Mother-to-Child Transmission (PMTCT) programmes in order to ascertain infant outcomes post delivery. We determined HIV transmission, mortality and loss to follow-up (LTFU) of HIV-exposed infants attending a postnatal clinic in an urban hospital in Durban, South Africa.MethodsWe conducted a retrospective cohort study of infants born to women in the PMTCT programme at McCord Hospital, where mothers paid a fee for service. Data were abstracted from patient records for live-born infants delivered between 1 May 2008 and 31 May 2009. The infants’ LTFU status and age was based on the date of the last visit. HIV transmission was calculated as a proportion of infants followed and tested at six weeks. Mortality rates were analyzed using Kaplan-Meier (K-M), with censoring on 15 January 2010, LTFU or death.ResultsOf 260 infants, 155 (59.6%) remained in care at McCord beyond 28 weeks: one died at < 28 days, three died between one to six months; 34 were LTFU within seven days, 60 were LTFU by six months. K-M mortality rate: 1.7% at six months (95% confidence interval (CI): 0.6% to 4.3%). Of 220 (83%) infants tested for HIV at six weeks, six (2.7%, 95% CI: 1.1% to 5.8%) were HIV-infected. In Cox regression analysis, late antenatal attendance (≥ 28 weeks gestation) relative to attending in the first trimester was a predictor for infant LTFU (adjusted hazards ratio = 2.3; 95% CI: 1.0 to 5.1; p = 0.044).ConclusionThis urban PMTCT programme achieved low transmission rates at six weeks, but LTFU in the first six months limited our ability to examine HIV transmission up to 18 months and determinants of mortality. The LTFU of infants born to women who attended antenatal care at 28 weeks gestation or later emphasizes the need to identify late antenatal attendees for follow up care to educate and support them regarding the importance of follow up care for themselves and their infants.

BackgroundThe evidence on the effect of pregnancy on acquiring HIV is conflicting, with studies reporting both higher and lower HIV acquisition risk during pregnancy when prolonged antiretroviral therapy was accessible. The aim of this study was to assess the pregnancy effect on HIV acquisition where antiretroviral therapy was widely available in a high HIV prevalence setting.MethodsThis is a retrospective cohort study nested within a population-based surveillance to determine HIV incidence in HIV-uninfected women from 15 to 49 years from 2010 through 2015 in rural KwaZulu-Natal. HIV incidence per 100 person-years according to pregnancy status (not pregnant, pregnant, to eight weeks postpartum) were measured in 5260 HIV-uninfected women. Hazard ratios (HR) were estimated by Cox proportional hazards regression with pregnancy included as a time varying variable.ResultsOverall, pregnancy HIV incidence was 4.5 per 100 person-years (95% CI 3.4–5.8), higher than non-pregnancy (4.0; 95% CI 3.7–4.3) and postpartum incidences (4.2 per 100 person-years; 95% CI 2.3–7.6). However, adjusting for age, and demographic factors, pregnant women had a lower risk of acquiring HIV (HR 0.4; 95% CI 0.2–0.9, P = 0.032) than non-pregnant women; there were no differences between postpartum and non-pregnant women (HR 1.2; 95% CI 0.4–3.2; P = 0.744). In models adjusting for the interaction of age and gravidity, pregnant women under 25 years with two or more pregnancies had a 2.3 times greater risk of acquiring HIV than their older counterparts (95% CI 1.3–4.3; P = 0.008).ConclusionsPregnancy had a protective effect on HIV acquisition. Elevated HIV incidence in younger women appeared to be driven by those with higher gravidity. The sexual and biological factors in younger women should be explored further in order to design appropriate HIV prevention interventions.

The first confirmed case of COVID-19 in South Africa (SA) was reported on 5 March 2020. [1,2] Since then, SA has become the most affected country in Africa, with 2.9 million cases and >89 000 deaths due to COVID-19 as at 1 November 2021. [3] SA experienced a high number of COVID-19 infections in the first wave, peaking in July. The daily cases then declined before a major surge in December, when the country experienced its second wave of increased cases, probably fuelled by a new variant of the virus. [4] Like many other countries globally, SA implemented an unprecedented national shutdown to combat the spread of the virus. [2,5] The implementation of the National State of Disaster on 15 March gave the government the power to carry out and implement what later became a five-level COVID-19 alert system. Of the five levels of restrictions, the highest, most restrictive is alert level 5 and the lowest alert level 1. Level 5 lockdown measures included drastic restrictions on movement and the closure of all non-essential activities. During level 1, most normal activities were allowed to take place with precautions and adhering to health guidelines. [6] At the onset, on 27 March, SA went into alert level 5 and over the months that followed gradually eased to level 1 in September (at the end of the first wave) and then back to level 3 in December (during the second wave). [1,7] SA is described as having a quadruple burden of disease resulting from non-communicable diseases (such as diabetes and hypertension), communicable diseases (such as HIV/AIDS and TB), an epidemic of maternal, newborn and child illnesses, and violence and injury. [8] The emergence of COVID-19 has placed additional pressure on an already strained healthcare system and has resulted in changes both in demand for and supply of healthcare generally. [9,10] On the demand side, public anxiety and fear of contracting COVID-19 have resulted in patients postponing care. Lockdown restrictions disrupted public transport services that clients use to access health facilities, and the indirect effects of the economic downturn have made healthseeking less manageable. With regard to supply, there has been a shift of resources from other healthcare issues, as hospital wards This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

While undetectable viral load before pregnancy through post-partum was common, the UNAIDS goal to suppress viraemia in 90% of women was not met. Women on preconception ART remain vulnerable to viraemia; additional support is required to prevent mother-to-child HIV transmission and maintain maternal health.