Elimination of paediatric HIV in KwaZulu-Natal, South Africa: Large-scale assessment of interventions for the prevention of mother-to-child transmission

Objective 

To report the rates of mother-to-child transmission (MTCT) of the human immunodefciency virus (HIV), and the coverage of interventions designed to prevent such transmission, in KwaZulu-Natal. 

Methods 

Mothers with infants aged ≤ 16 weeks and fathers or legal guardians with infants aged 4-8 weeks who, between May 2008. and April 2009, attended immunization clinics in six districts of KwaZulu-Natal were included. The mothers' uptake of interventions for the prevention of MTCT was explored. Blood samples from infants aged 4-8 weeks were tested for anti-HIV antibodies and, if antibody-positive, for HIV deoxyribonucleic acid (DNA). 

Findings 

Of the 19 494 mothers investigated, 89·9% reported having had an HIV test in their recent pregnancy. Of the 19 138 mothers who reported ever having had an HIV test, 34.4% reported that they had been found HIV-positive and, of these, 13.7% had started lifelong antiretroviral treatment and 67.2% had received zidovudine and nevirapine. Overall, 40.4% of the 7981 infants tested were found positive for anti-HIV antibodies, indicating HIV exposure. Just 7.1% of the infants checked for HIV DNA (equating to 2.8% of the infants tested for anti-HIV antibodies) were found positive. 

Conclusion 

The low levels of MTCT observed among the infants indicate the rapid, successful implementation of interventions for the prevention of such transmission. Sampling at immunization clinics appears to offer a robust method of estimating the impact of interventions designed to reduce such transmission. Large-scale elimination of paediatric HIV infections appears feasible, although this goal has not yet been fully achieved in KwaZulu-Natal.