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Phelanyane FM, Heekes A, Smith M, Jennings K, Mudaly V, Pieters P, Arendse J, Kariem S, Coetzee D, Boulle A, Kalk E. Prevention of vertical transmission of HIV in Khayelitsha, South Africa: A contemporary review of services after 20 years. S Afr Med J 2023; 113:14-19. [PMID: 37881910 DOI: 10.7196/samj.2023.v113i10.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The first vertical transmission of HIV prevention (VTP) programme in South Africa was launched in 1999 in Khayelitsha, Western Cape Province (WC). Since then, VTP guidelines have expanded in complexity and scope. OBJECTIVES To describe contemporary VTP uptake in Khayelitsha and quantify vertical transmission (VT) risk factors based on linked routine electronic health data. METHODS In the WC, all patients at public health facilities have a unique identifier allowing linkage across electronic health platforms through a health information exchange hosted within the WC Department of Health. We conducted a cohort analysis of mother-infant pairs where the mother was living with HIV and attended any obstetric care in Khayelitsha in 2017. Descriptive statistics assessed VTP coverage along the care cascade, including maternal viral load (VL) testing and early infant diagnosis (EID). Logistic regression analysis quantified a priori-defined risk factors associated with VT. RESULTS Antenatal HIV prevalence in the cohort was 31.3%, and VT was 1.8% by 12 months. Of women living with HIV, 88.3% knew of their positive status at the first antenatal visit and 77.9% were already receiving antiretroviral therapy (ART). Most women diagnosed prior to delivery (94.5%) were initiated on ART; 85.0% received an antenatal VL test, of whom 88.0% were virologically suppressed. Women who were not virally suppressed had a five-fold (adjusted odds ratio (aOR) 5.3; 95% confidence interval (CI) 2.5 - 12.3) increased VT risk compared with those who were suppressed. Women who attended no antenatal care were at higher risk of VT (aOR 1.6; 95% CI 0.7 - 3.6) than those who did attend. EID coverage was suboptimal: a birth HIV polymerase chain reaction (PCR) test was available for 79.2% of infants, and a low proportion with a negative birth test had a repeat test around 10 weeks (57.9%). Data linkage identified an additional 15 infants living with HIV who were not detected by HIV-PCR testing alone. CONCLUSION Although most women presented to care already knowing their HIV status, ART initiation was suboptimal prior to the first antenatal visit but improved over the course of pregnancy. The VT rate based on laboratory HIV-PCR testing alone underestimated HIV transmission: linked data from multiple sources suggested higher VT than programme-reported rates based on HIV-PCR testing alone.
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Affiliation(s)
- F M Phelanyane
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa; Health Intelligence Directorate, Western Cape Government: Health and Wellness, Cape Town, South Africa.
| | - A Heekes
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa; Health Intelligence Directorate, Western Cape Government: Health and Wellness, Cape Town, South Africa.
| | - M Smith
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa; Health Intelligence Directorate, Western Cape Government: Health and Wellness, Cape Town, South Africa.
| | - K Jennings
- HIV/AIDS/STI/TB Unit, City Health, Cape Town, South Africa; Western Cape Government: Health and Wellness, Cape Town, South Africa.
| | - V Mudaly
- Services Priorities Coordination Directorate, Western Cape Government: Health and Wellness, Cape Town, South Africa.
| | - P Pieters
- Western Cape Government: Health and Wellness, Cape Town, South Africa.
| | - J Arendse
- Emergency and Clinical Services Support, Western Cape Government: Health and Wellness, Cape Town, South Africa.
| | - S Kariem
- Western Cape Government: Health and Wellness, Cape Town, South Africa.
| | - D Coetzee
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa; Health Intelligence Directorate, Western Cape Government: Health and Wellness, Cape Town, South Africa.
| | - A Boulle
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa; Health Intelligence Directorate, Western Cape Government: Health and Wellness, Cape Town, South Africa.
| | - E Kalk
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa.
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Mohr-Holland E, Hacking D, Daniels J, Scott V, Mudaly V, Furin J, Pfaff C, Reuter A. Diagnosis patterns for rifampicin-resistant TB after onset of COVID-19. Int J Tuberc Lung Dis 2021; 25:772-775. [PMID: 34802503 PMCID: PMC8412107 DOI: 10.5588/ijtld.21.0340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/11/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- E Mohr-Holland
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa, MSF Southern Africa Medical Unit, Cape Town, South Africa
| | - D Hacking
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - J Daniels
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - V Scott
- City of Cape Town Department of Health, Eastern Area, Cape Town, South Africa
| | - V Mudaly
- Provincial Government of the Western Cape, Cape Town, South Africa
| | - J Furin
- Harvard Medical School, Boston, MA, USA
| | - C Pfaff
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - A Reuter
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
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