PMTCT: integration of HAART into public sector antenatal care services in a high prevalence HIV setting in South Africa

M. Ramdhial, A. Ramkissoon

Background: South African public sector ART is largely hospital-based and separate from antenatal/PMTCT services, MTCT rates are high (15-30%). Preliminary data from a hospital in KwaZulu-Natal revealed that women attending ANC who were eligible for HAART were not accessing treatment when referred to ART initiation clinics; with only 46% being initiated. Moreover, there was minimal post-natal follow-up of these women. In response, a pilot project to integrate ART into ANC was implemented. This included triple therapy; antenatal & postnatal care and infant PCR testing. Women identified in labour ward were initiated post-partum.
Methods: Maternal & child outcomes were assessed, as were health system barriers to PMTCT .Case reviews were conducted retrospectively on 103 maternal files & their infants at 6 weeks.
Results: Findings illustrated that HAART uptake had increased by 31% to 77% following implementation of the integrated service. There was 3.8 % MTCT in those on triple therapy; and 6.9% transmission when mothers who were initiated late on triple therapy (post delivery) were included. Average exposure to HAART was 3 weeks prior to delivery in women initiated in ANC who had PCR positive infants, most had normal deliveries. The mean CD4 was 145 and VL 95499 at initiation compared to 131 & 78495 respectively in MTCT negative group. There was 100% disclosure to partners amongst women with positive infants. All but one woman opted to formula feed their babies. Factors associated with PCR positive results included non adherence to treatment (12.7 %,) traumatic vaginal delivery; late HAART initiation (mean: 36.2 weeks gestation) and 8.7% HBV or TB co-infection.
Conclusions: Service integration resulted in more women accessing care and significantly reduced MTCT, highlighting the need to strengthen HIV/MTCT integration & expand coverage. Concerted efforts are required to ensure pregnant women access care early. Increasing community awareness and postnatal maternal and infant follow-up is required.





5th IAS Conference on HIV Pathogenesis and Treatment
Abstract no. WEPDD104


Suggested Citation
"M.Ramdhial, et al. PMTCT: integration of HAART into public sector antenatal care services in a high prevalence HIV setting in South Africa . : 5th IAS Conference on HIV Pathogenesis and Treatment: Abstract no. WEPDD104 "