Impact and Effectiveness of South Africa’s PMTCT

Programs on Perinatal HIV Transmission, 2010-2011: Using data to improve program implementation,

and policy

Yogan Pillay, PhD. (NDOH/DDG, South Africa)Thu-Ha Dinh, MD., MS., US CDC/GAP

Ameena Goga, MD., MS.; Debra Jackson, PhD., RN.,

2012 International AIDS Conference, Washington DC, July 22th -27st , 2012

2008-2010: – HIV-infected pregnant women CD4 > 200 AZT from 28 wks + sd NVP in labour CD4< 200 or WHO clinical stage 4 ART for life

– HIV-exposed infants: sd NVP + AZT (7 - 28 days)2010-present:

– HIV-infected pregnant women CD4 > 350 AZT from 14 wks + sd NVP + TDF/FTC in labour CD4< 350 ART for life

– HIV-exposed infants Mother on ART or non-breastfed infants: 6 wks NVP Breastfed infant: NVP through out breastfeeding

Background: PMTCT guidelines

HIV prevalence in pregnant women by province (sentinel surveillance, 2010)

30.2% (95 CI, 29.4% -30.9%)

District Health Information System (DHIS)– PMTCT programme indicators– Data source were abstracted from clinic registers

using paper-based forms District – Districts cleaned data enter the reported data to the

electronic DHIS databaseNational laboratory database– Electronic database from all labs in the country– Early Infant Diagnosis – coverage ~ 43% in 2010 and

54% in 2011

Background: National routine program databases

Preliminary Findings

• Adjusted for non-response rates• Weighted for population live-birth in 2010• Survey analysis using SAS 9.2

Weighted HIV exposure prevalence and transmission rate measured at

4-8wks postpartum by year

1. Infant HIV-exposure prevalence– 2010: 31.4% (95% CI 30.1% - 32.6%) – 2011: 32.2% (95% CI 30.7% - 33.6%)

2. National perinatal transmission rate – 2010: 3.5% (95% CI 2.9% - 4.1%)– 2011: 2.7% (95% CI 2.1% - 3.2%)

PMTCT cascade by year

.000%30.000%60.000%90.000%

98.8 98.629.4

96.7 99.329.5

2010 2011

HIV infected mothers

.000%10.000%20.000%30.000%40.000%50.000%60.000%70.000%80.000%90.000%

78.358.7

33.1

77.7

42.6 46.2

85.1

Using survey data to support policy• Using the 2010 survey findings

2012 NSP targets 2% MTCT rate at 6 weeks and 5% at 18 months

repeat testing strategy and infant testing strategy have been reviewing toReduce unknown HIV acquisition during pregnancyIncrease coverage of EID at 6 weeks

• Reviewing findings in 2010 and 2011 to– Revise the 2010 PMTCT guidelines– Set a new target for 2012: Early MTCT rate at (2.1%) and significantly higher

than 2010 (95%CI; 1.5% - 2.7)

Using survey data to improve program (2010) PROVINCE HIV-Exposed Early MTCT % (95%CI)

Eastern Cape 30.0 (26.3-33.7) 4.7 (2.4-7.0)*

Free State 31.1 (28.9-33.3) 5.9 (3.8-8.0)

Gauteng 30.2 (27.7-32.8) 2.5 (1.5-3.6)

KwaZulu Natal 43.9 (39.7-48.0) 2.9 (1.7-4.0)

Limpopo 22.6 (20.4-24.8) 3.6 (1.4-5.8)

Mpumalanga 36.2 (33.6-38.9) 5.7 (4.1-7.3)

Northern Cape 15.6 (13.0-18.3) 1.4 (0.1-3.4)*

Northwest 30.9 (28.6-33.1) 4.4 (2.9-5.9)

Western Cape 20.8 (16.8-24.9) 3.9 (1.9-5.8)

* Unstable estimates due to small sample size

Using survey data to improve program

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Perinatal (Early) MTCT rate measured at 4-8 weeks: find-ings in 2010 and preliminary findings in 2011

2010 2011

Using survey data to improve quality of the routine program (cascade)

.000%30.000%60.000%90.000%

98.8 98.629.4

96.7 99.329.5

2010 2011

HIV infected mothers

.000%10.000%20.000%30.000%40.000%50.000%60.000%70.000%80.000%90.000%

78.358.7

33.1

77.7

42.6 46.2

85.1

Acknowledgements

Nurse Data collectorsRoutine health workers Medical Research Council •Carl Lombard (Statistician)• Selamawit Woldesenbet• Wesley Solomon • Vundli Ramokolo•Tanya Doherty• Charles Hongoro• Fred KoopmanNational Department of Health •Nonhlanhla Dlamini•Thabang Mosala•Other members

Provincial Departments of Health

University of the Western Cape• Wondwossen LereboUNICEF (SA)• Siobhan CrowleyCDC• Katherine Robinson/Lorena Espinoza • Jeff Klausner/Thurma Goldman• Mary Mogashoa/Lerato Lesole• CDC South Africa and Atlanta teamsInfant Diagnosis • Gayle Sherman• Adrian PurenTechnical Advisors• Mickey Chopra (UNICEF)• Nathan Shaffer (WHO)

Caregiver-infant pairs