The effectiveness of PMTCT programmes through the measurement of NVP coverage in populations of women delivering in designated areas in the Western Cape Region of South Africa

Includes bibliographical references.[Objective] The objective was to assess the uptake and coverage of SD-NVP to prevent mother-to-child transmission of HIV in women of unknown HIV status presenting in labour a sample of delivery sites in the Western Cape. This monitoring activity also accurately measures the prevalence of HIV among pregnant women and ascertains the proportion of HIV exposed infants delivered to these mothers, who received NVP prophylaxis to prevent MTCT. [ Design ] Anonymous, unlinked specimens of cord blood from discarded placentas were tested for HIV antibodies to determine population-level information on HIV infection and NVP coverage among all women delivering in the facilities. Uptake was measured by counting the number of women who were recorded to have accepted NVP when offered while coverage was measured by using the cord blood NVP assay. [ Results ] A total of 2198 (96.5%) cord blood specimens were collected from women at delivery. From these, 1876 (85.4%) women received pre-test counselling. Of those who were counselled, 1851 (84.2%) were tested for HIV and 365 (19.3%) tested positive. Amongst those who were infected, 229 (62.7%) received SD-NVP and but only 57.8% adhered to SD-NVP according to the cord blood. Of the infants born to HIV-infected mothers, 311 (85.2%) were recorded as 9 having received SD-NVP. There was no significant difference in SD-NVP uptake between the two facilities. The overall NVP coverage (mother and infant doses) was 55.3%. [ Conclusions ] The NVP coverage of 55.3% is poor. In order for PMTCT services to be successful, each mother-infant pair should go through a rigorous cascade of events that include HIV testing, receipt of results, diagnosis and drug adherence. The attrition cascade in this study was described using a new cord blood surveillance methodology. Coverage fails for a number of reasons and interventions are likely to differ from one facility to another. Appropriate interventions should be introduced to reduce the transmission to infants