Prevention of mother-to-child transmission of HIV programme: low vertical transmission in KwaZulu-Natal, South Africa

Objective. To describe the operational effectiveness of the PMTCT programme at McCord hospital during the period from 1 March 2004 to 31 August 2005 Design. Observational cohort study Setting. McCord hospital, Durban, South Africa Subjects. Antenatal patients attending the PMTCT clinic Measurements and results. During the 18 months all 2624 women (100%) attending the antenatal clinic received HIV counselling resulting in 91% (2388) being tested for HIV. The prevalence of HIV in this cohort was 12.9% (95% confidence interval (CI) 11.6 to 14.2). Of the 302 (89%) HIV positive mothers who completed their pregnancy at the hospital, there were 3 intra-uterine deaths, 1 miscarriage, 1 maternal death (with baby in utero) and 297 live births with one early neonatal death. Only 11% (36 out of 338) were lost to follow-up. Of all women attending the antenatal clinic, a quarter (668) of partners was tested for HIV. Delivery in 70% (209) of live births was by caesarean section. Nevirapine was administered to 98% (290) of live babies and 76% (224) received AZT as well. The six week PCR baby test uptake was 81% (239 out of 296 live babies). Out of those tested 2.9% (95% CI 1.3-6.2) tested HIV positive. Conclusion. Despite the challenges faced by PMTCT providers in a resource constrained setting this state-aided hospital provides a comprehensive and integrated service and has achieved outcomes which compare favourably with those in the developed world