@article{6f8fbd147c824741bf79fb1a68930e30,
title = "Implementation of a PMTCT programme in a high HIV prevalence setting in Johannesburg, South Africa: 2002-2015",
abstract = "Background: Great strides have been made in decreasing paediatric human immunodeficiency virus (HIV) infections, especially in sub-Saharan Africa. In South Africa, new paediatric HIV infections decreased by 84% between 2009 and 2015. This achievement is a result of a strong political will and the rapid evolution of the country's prevention of mother-to-child transmission (PMTCT) guidelines.Objectives: In this paper we report on the implementation of a large PMTCT programme in Soweto, South Africa.Methods: We reviewed routinely collected PMTCT data from 13 healthcare facilities, for the period 2002-2015. Antiretroviral therapy (ART) coverage among pregnant women living with HIV (PWLHIV) and the mother-to-child transmission (MTCT) rate at early infant diagnosis were evaluated.Results: In total, 360 751 pregnant women attended the facilities during the review period, and the HIV prevalence remained high throughout at around 30%. The proportion of PWLHIV presenting with a known HIV status increased from 14.3% in 2009 when the indicator was first collected to 45% in 2015, p < 0.001. In 2006, less than 10% of the PWLHIV were initiated on ART, increasing to 88% by 2011. The MTCT rate decreased from 6.9% in 2007 to under 1% from 2013 to 2015, p < 0.001.Conclusion: The achievements in decreasing paediatric HIV infections have been hailed as one of the greatest public health achievements of our times. While there are inherent limitations with using routinely collected aggregate data, the Soweto data reflect progress made in the implementation of PMTCT programmes in South Africa. Progress with PMTCT has, however, not been accompanied by a decline in HIV prevalence among pregnant women.",
keywords = "elimination, health systems, initiation, lamivudine, mother-to-child, paediatric hiv infection, pmtct, pregnant women living with hiv (pwlhiv), prevention, quality, regimens, south africa, transition, transmission, zidovudine, QUALITY, ELIMINATION, REGIMENS, LAMIVUDINE, MOTHER-TO-CHILD, paediatric HIV infection, PMTCT, INITIATION, PREVENTION, pregnant women living with HIV (PWLHIV), TRANSITION, TRANSMISSION, ZIDOVUDINE, South Africa",
author = "C.N. Mnyani and C.L. Tait and R.P.H. Peters and H. Struthers and A. Violari and G. Gray and E.J. Buchmann and M.F. Chersich and J.A. McIntyre",
note = "Funding Information: The Soweto PMTCT programme was established in 2000 as the Demonstration of Antiretroviral Treatment (DART) programme initiated by the Perinatal HIV Research Unit (PHRU).14 The programme was initially funded by the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) with funding from the United States Agency for International Development (USAID), the Fonds De Solidarit{\'e} Th{\'e}rapeutique International (FSTI) and the Gauteng Department of Health, and from 2004 it was funded by PEPFAR, through the USAID.14As part of the DART programme, pregnant women were offered voluntary counselling and testing for HIV and, if found to be HIV-positive, were issued a single-dose nevirapine (NVP) to be taken intrapartum, and also a single-dose NVP to be given to the infant immediately after birth. A free 6-month supply of infant formula was also available for women living with HIV who elected not to breastfeed. Funding Information: This study was funded by the US PEPFAR through the USAID under Cooperative Agreement number 674-A-12-00015 to the Anova Health Institute, Carnegie Corporation of New York PhD Fellowship (Grant number: B 8749.RO1) and SACEMA (DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis), Stellenbosch University. Funding Information: The Soweto PMTCT programme was initially funded by the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) with funding from the United States Agency for International Development (USAID), the Fonds De Solidarit{\'e} Th{\'e}rapeutique International (FSTI) and the Gauteng Department of Health, and from 2004 onwards it was funded by President{\textquoteright}s Emergency Plan for AIDS Relief (PEPFAR), via the USAID. Funding Information: The Soweto PMTCT programme was initially funded by the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) with funding from the United States Agency for International Development (USAID), the Fonds De Solidarit? Th?rapeutique International (FSTI) and the Gauteng Department of Health, and from 2004 onwards it was funded by President's Emergency Plan for AIDS Relief (PEPFAR), via the USAID. This study was funded by the US PEPFAR through the USAID under Cooperative Agreement number 674-A-12-00015 to the Anova Health Institute, Carnegie Corporation of New York PhD Fellowship (Grant number: B 8749.RO1) and SACEMA (DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis), Stellenbosch University. Publisher Copyright: Copyright: {\textcopyright} 2020. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.",
year = "2020",
month = mar,
day = "23",
doi = "10.4102/sajhivmed.v21i1.1024",
language = "English",
volume = "21",
journal = "Southern African Journal of Hiv Medicine",
issn = "1608-9693",
publisher = "AOSIS (Pty) Ltd",
number = "1",
}