A Window Into a Public Programme for Prevention of Mother-To-Child Transmission of HIV: Evidence from a Prospective Clinical Trial (Original Article) (Human Immunodeficiency Virus) (Clinical Report‪)‬

HIV infection has a high prevalence in antenatal attendees in South Africa. In the annual seroprevalence survey conducted through the National Department of Health from 2005, the prevalence in the Western Cape province was 15.7%. (1) Here, a pilot zidovudine (ZDV)-based prevention of mother-to-child transmission (PMTCT) programme began in 1999, (2) and has gradually been expanded since January 2001. Since April 2003 the PMTCT interventions have been available at all public sector antenatal service facilities in the province (300 antenatal clinics and 53 delivery centres and hospitals) and 350 primary health care clinics where infant follow-up occurs. Attendees are offered voluntary, confidential counselling and testing (VCT) and if HIV positive, antiretrovirals (ARVs) for the mother and infant. Uptake was reported as 97% in 2006 (Status Report--Prevention of Mother-to-Child Transmission Programme, 14 July 2006, HIV/AIDS/STI Directorate, Western Cape). Follow-up of mother and infant, cotrimoxazole from 6 weeks of age and modified infant feeding practices are also important components. The majority of women (95%) choose formula feeding, which is provided free for the first 6 months. The initial ARV intervention was single-dose nevirapine (sd-NVP) to mother and infant, introduced after the success of the HIVNET 012 study. (3) Since mid-2003, ZDV was added from 34 weeks' gestation for the mother and for a week for the neonate. (4) In early 2006, antenatal ZDV from 28 weeks was gradually introduced. With the advent of the national antiretroviral rollout in 2004, all pregnant women with a CD4 count below 200 cells/[micro]l were offered highly active antiretroviral therapy (HAART).