BACKGROUND: The effectiveness of prevention of mother-to-child transmission of HIV (PMTCT) programs depends on the successful coverage of a series of interventions through pregnancy, intrapartum, and postpartum. Routine monitoring systems based on service data and limited to women on the PMTCT program may overestimate intervention coverage at multiple points along this cascade. METHODS: Cord blood specimens with individually linked anonymous demographic and pregnancy data were collected from 3 delivery services in the Western Cape Province, South Africa, and screened for HIV. Seropositive specimens were tested for the presence of antiretrovirals. Comparisons were drawn between documented service data and cord blood findings for HIV seroprevalence and antenatal antiretroviral coverage. RESULTS: A total of 3034 specimens were tested for HIV, 507 (16.7%) of which were HIV seropositive. Of these, 470 (92.7%) were tested for the presence of antiretrovirals, of whom 58.1% had evidence of a standard of care maternal antiretroviral regimen and 73.6% some form of antenatal antiretroviral prophylaxis. Cord blood antiretroviral coverage was lower than that reported by service data. Incomplete antenatal HIV testing accounted for an estimated 46.2% of missed opportunities for transmission reduction. DISCUSSION: Even in this well-resourced setting, HIV screening and ensuring antenatal compliance with prescribed regimens were the most immediate priorities for reducing vertical transmission. Cord blood surveillance offers a unique opportunity to explore missed opportunities using methods not currently possible from routine antenatal and PMTCT program reporting.
BACKGROUND: The effectiveness of prevention of mother-to-child transmission of HIV (PMTCT) programs depends on the successful coverage of a series of interventions through pregnancy, intrapartum, and postpartum. Routine monitoring systems based on service data and limited to women on the PMTCT program may overestimate intervention coverage at multiple points along this cascade. METHODS: Cord blood specimens with individually linked anonymous demographic and pregnancy data were collected from 3 delivery services in the Western Cape Province, South Africa, and screened for HIV. Seropositive specimens were tested for the presence of antiretrovirals. Comparisons were drawn between documented service data and cord blood findings for HIV seroprevalence and antenatal antiretroviral coverage. RESULTS: A total of 3034 specimens were tested for HIV, 507 (16.7%) of which were HIV seropositive. Of these, 470 (92.7%) were tested for the presence of antiretrovirals, of whom 58.1% had evidence of a standard of care maternal antiretroviral regimen and 73.6% some form of antenatal antiretroviral prophylaxis. Cord blood antiretroviral coverage was lower than that reported by service data. Incomplete antenatal HIV testing accounted for an estimated 46.2% of missed opportunities for transmission reduction. DISCUSSION: Even in this well-resourced setting, HIV screening and ensuring antenatal compliance with prescribed regimens were the most immediate priorities for reducing vertical transmission. Cord blood surveillance offers a unique opportunity to explore missed opportunities using methods not currently possible from routine antenatal and PMTCT program reporting.
Authors: Gerhard B Theron; Mae P Cababasay; Russell B Van Dyke; David E Shapiro; Jeanne Louw; D Heather Watts; Marc Bulterys; Linda M Styer; Robert Maupin Journal: Int J Gynaecol Obstet Date: 2012-11-09 Impact factor: 3.561
Authors: Benjamin H Chi; Pius M Tih; Arianna Zanolini; Kathryn Stinson; Didier K Ekouevi; David Coetzee; Thomas K Welty; Maximillian Bweupe; Nathan Shaffer; Francois Dabis; Elizabeth M Stringer; Jeffrey S A Stringer Journal: J Acquir Immune Defic Syndr Date: 2015-09-01 Impact factor: 3.731
Authors: Shani de Beer; Emma Kalk; Max Kroon; Andrew Boulle; Meg Osler; Jonathan Euvrard; Venessa Timmerman; Mary-Ann Davies Journal: J Int AIDS Soc Date: 2020-01 Impact factor: 5.396
Authors: Jeffrey S A Stringer; Kathryn Stinson; Pius M Tih; Mark J Giganti; Didier K Ekouevi; Tracy L Creek; Thomas K Welty; Benjamin H Chi; Catherine M Wilfert; Nathan Shaffer; Elizabeth M Stringer; Francois Dabis; David Coetzee Journal: PLoS Med Date: 2013-05-07 Impact factor: 11.069
Authors: Sarah Gimbel; Joachim Voss; Alison Rustagi; Mary Anne Mercer; Brenda Zierler; Stephen Gloyd; Maria de Joana Coutinho; Maria de Fatima Cuembelo; Kenneth Sherr Journal: J Int AIDS Soc Date: 2014-03-24 Impact factor: 5.396