Pregnant Women’s Access to PMTCT and ART Services in South Africa and Implications for Universal Antiretroviral Treatment

Objectives: We describe pregnant womens ’ access to PMTCT and HAART services and associated birth outcomes in South Africa. Methods: Women recuperating in postnatal wards of a referral hospital participated in an evaluation during February–May 2010 during which their maternity records were examined to describe their access to VCT, CD4 Counts, dual ART or HAART during pregnancy. Results: Of the 1609 women who participated in this evaluation, 39 % (95%CI36.7–41.5%) tested HIV-positive during their pregnancy. Of the HIV-positive women 2.9 % did not have a CD4 count done and an additional 31.3 % did not receive their CD4 results. The majority (96.8%) of the HIV-positive women commenced dual ART at their first antenatal visit independent of their CD4 result. During February–May 2010, 48.0 % of the women who had a CD4 result were eligible for HAART (CD4,200 cells/mm3) and 29.1 % of these initiated HAART during pregnancy. Under the current South African PMTCT guidelines 71.1 % (95%CI66.4–75.4%) of HIV positive pregnant women could be eligible for HAART (CD4,350 cells/mm3). There were significantly more preterm births among HIV-positive women (p = 0.01) and women who received HAART were no more at risk of preterm deliveries (AOR 0.73;95%CI0.39–1.36;p = 0.2) as compared to women who received dual ART. Nine (2.4%; 95%CI1.1–4.5%) HIV exposed infants were confirmed HIV infected at birth. The in-utero transmission rate was highest among women who required HAART but did not initiate treatment (8.5%) compared to 2.7 % and 0.4 % among women wh