Population–level effectiveness of PMTCT Option A on early mother–to–child (MTCT) transmission of HIV in South Africa: implications for eliminating MTCT

Goga, Ameena; Dinh, Thu–Ha; Jackson, Debra; Lombard, Carl; Puren, Adrian; Sherman, Gayle; Ramokolo, Vundli; Woldesenbet, Selamawit; Doherty, Tanya; Noveve, Nobuntu; Magasana, Vuyolwethu; Singh, Yagespari; Ramraj, Trisha; Bhardwaj, Sanjana; Pillay, Yogan

doi:10.7189/jogh.06.020405

Cited by 69 publications

(60 citation statements)

References 15 publications

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“…[13][14][15][16] Additionally, cross-sectional surveillance data suggest that ART initiation prior to conception or during the first trimester of pregnancy could reduce early MTCT to <1.2%. [14] Despite these national-level successes, interprovincial and inter-district differences in MTCT and maternal ART uptake exist: the provincial in utero percent MTCT risk ranged from 1.4% to 5.9% in 2010 and 0.7 -1.7% in 2015/16; maternal ART uptake ranged from 78% to 98% in 2015/16. [14,15] The district-level early MTCT rate ranged from 2.2% to 8.1% in 2010 and 0% to 3.4% in 2015/16 ( Fig.…”

Section: Researchmentioning

confidence: 99%

“…[14] Despite these national-level successes, interprovincial and inter-district differences in MTCT and maternal ART uptake exist: the provincial in utero percent MTCT risk ranged from 1.4% to 5.9% in 2010 and 0.7 -1.7% in 2015/16; maternal ART uptake ranged from 78% to 98% in 2015/16. [14,15] The district-level early MTCT rate ranged from 2.2% to 8.1% in 2010 and 0% to 3.4% in 2015/16 ( Fig. 2), [15,17,18] while maternal ART uptake varied from 46% to 100% in 2015/16.…”

Section: Researchmentioning

confidence: 99%

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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

et al. 2018

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Ninety percent of the world's HIV-positive pregnant women live in 22 countries. These countries, including South Africa (SA), have prioritised the elimination of mother-to-child transmission of HIV (EMTCT), measured using three coverage and two impact indicators (Fig. 1). [1] The two impact indicators are the percentage motherto-child HIV transmission (MTCT) among HIV-positive mothers (MTCT risk) and the number of new paediatric HIV infections per 100 000 live births (MTCT case rate). The global target is <5% final MTCT in breastfeeding countries and ≤50 new paediatric HIV infections per 100 000 live births. Consequently, to achieve EMTCT, all 22 countries currently recommend lifelong antiretroviral treatment for all HIV-positive pregnant and lactating women. This is known as PMTCT Option B+. Between the 1980s and 2015 the discovery of more effective biomedical interventions to prevent mother-to-child transmission of HIV (PMTCT) accelerated the improvement of global and national PMTCT policies; such rapid advancements in policy required flexible, responsive health systems, services and staff to assure implementation. [1-6] For example, in 2001 the SA national This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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Section: Researchmentioning

confidence: 99%

Section: Researchmentioning

confidence: 99%

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

et al. 2018

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“…Prevention of mother-to-child transmission (PMTCT) is a significant pathway and an effective HIV testing modality for diagnosing and linking women to ART. The first and the second 90 in the PMTCT programme has been reported to be >90% in South Africa (SA), but knowledge of HIV status and ART initiation prior to pregnancy has been reported to be low [4,5]. In 2016, SA adopted the universal test and treat (UTT) strategy, which makes provision for ART initiation immediately after an HIV-positive test [6].…”

Section: Introductionmentioning

confidence: 99%

Awareness of HIV-positive status and linkage to treatment prior to pregnancy in the “test and treat” era: A national antenatal sentinel survey, 2017, South Africa

et al. 2020

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Introduction Knowledge of HIV status in South Africa (SA) is reported to be 90% among people living with HIV. National level estimates could mask population-specific levels, which are critical to monitor program coverage and potential impact. Using data from the 2017 national antenatal sentinel survey, we assessed knowledge of HIV-positive status, initiation of antiretroviral therapy (ART), and socio-demographic characteristics associated with knowledge of HIVpositive status prior to the current pregnancy among women attending antenatal care. Methods Between 1 October and 15 November 2017, a nationally representative sample of 32,716 pregnant women were enrolled from 1,595 public health facilities selected from all districts of SA. Data on age, gravidity, knowledge of HIV-positive status and ART initiation prior to pregnancy were extracted from medical records. A blood sample was collected from each woman regardless of prior knowledge of HIV status or ART history, and tested for HIV in the laboratory. All HIV-positive pregnant women enrolled in the survey were eligible for inclusion in the analysis. Multivariable survey logistic regression was used to examine factors associated with knowledge of HIV-positive status prior to the current pregnancy. Results Of 10,065 eligible HIV-positive women, 60.8% (95% confidence interval (CI):59.9%-61.7%) knew their HIV status prior to the current pregnancy, of whom 91.1% (95% CI: 90.4%-91.7%) initiated ART prior to the current pregnancy. Knowledge of HIV-positive status was lower

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“…1). [6][7][8][9][10] Many of these policy changes were influenced by research led by or associated with SAMRC scientists, [7,[11][12][13][14][15][16][17][18] in a supportive context where government sought to ameliorate the social determinants of health, regulate sugar consumption through a sugar tax and entrench the sin tax on named alcohol and tobacco products. [19,20] Prompted by the realisation that the lives of future generations depend on survival and optimal health, the global child health agenda has shifted to the 'Every Woman Every Child' (EWEC) strategy, which includes the objectives 'survive, thrive and transform' .…”

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Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future

et al. 2019

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This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Although the neonatal mortality rate in South Africa (SA) has remained stagnant at 12 deaths per 1 000 live births, the infant and under-5 mortality rates have significantly declined since peaking in 2003. Policy changes that have influenced this decline include policies to prevent vertical HIV transmission, earlier treatment of children living with HIV, expanded immunisation policies, strengthening breastfeeding practices, and health policies to contain tobacco and sugar use. The Sustainable Development Goals (2016-2030) have shifted the focus from keeping children alive, as expressed in the Millennium Development Goals (1990-2015), to achieving optimal health through the 'Survive, thrive and transform' global agenda. This paper focuses on important remaining causes of childhood mortality and morbidity in SA, specifically respiratory illness, environmental pollution, tuberculosis, malnutrition and vaccine-preventable conditions. The monitoring of maternal and child health (MCH) outcomes is crucial, and has improved in SA through both the District Health Information and Civil Registration and Vital Statistics systems, although gaps remain. Intermittent surveys and research augment the routinely collected data. However, availability and use of local data to inform quality and effectiveness of care is critical, and this requires ownership at the collection point to facilitate local redress. Potential game changers to improve MCH outcomes include mobile health and community-based interventions. In SA, improved MCH remains a crucial factor for human capital development. There is a pressing need to focus beyond childhood mortality and to ensure that each child thrives.

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Population–level effectiveness of PMTCT Option A on early mother–to–child (MTCT) transmission of HIV in South Africa: implications for eliminating MTCT

Cited by 69 publications

References 15 publications

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

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

Awareness of HIV-positive status and linkage to treatment prior to pregnancy in the “test and treat” era: A national antenatal sentinel survey, 2017, South Africa

Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future

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