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PMTCT: Uplifting Numbers from a Small District Hospital in Northern KwaZulu-Natal

Author(s): C. Burdet1
Affiliation(s): 1Outpatient Department, Manguzi Hospital, KwaNgwanase, South Africa
Keywords: PMTCT, Manguzi, KwaZulu-Natal, HIV, AIDS
Background:

PMTCT, Prevention of Mother to Child Transmission, is a combination of ante- and intrapartal antiretroviral drugs and general measures of precaution taken during and following childbirth so as to minimize the risk of vertical transmission of the HIV virus from an HIV infected mother to her child. Manguzi Hospital is a district hospital with 280 beds in Umkhanyakude health district of Norther KwaZulu-Natal, South Africa, serving a very rural population of an estimated 110 000 inhabitants. The HIV seroprevalence of mothers delivering in Manguzi Hospital’s maternity currently averages around 25%, and so properly conducted PMTCT is of crucial importance in this epdemiological context to minimize the number of children born with HIV at the very onset of life.

Methods:

This article aims to describe the PMTCT programme as conducted in Manguzi Hospital. At 6 weeks of age, children exposed to the risk of contracting HIV are tested by blood PCR for HIV antigen positivity. The proportion of children who test positive at this stage is a reflection of the success of the antenatal and intrapartal portions of the PMTCT programme. Without any PMTCT measures, rate of transmission is estimated at up to 30%. Subsequent transmission can still occur via breastfeeding, with infection to a further 5-20% of children. The ultimate rate of mother-to-child transmission (as measured by VCT at 18 months in Manguzi) is therefore higher still than the 6-week PCR positivity rates.

Results/Conclusions:

The rate of mother-to-child transmission of HIV in Manguzi as measured by the 6-week PCR lies at 5.3%. The AZT coverage to mothers approaches 99%, and that to babies 75%. The percentage of qualifying HIV pregnant women initiated on HAART is 73%. The rate of mother-to-child transmission as compared to surrounding dictrict hospitals is low (8% average, ranging from 5.3% to 16.4% in surrounding Umkhanyakude district hospitals). As compared to the national performance of 12% transmission, this number appears to be low, but still lies slightly above the target of <5% transmission expected of a well functioning PMTCT programme as set out by South Africa’s National Strategic Plan for HIV and AIDS and STIs 2007-2011. With the South African health care system already straining under the burden of disease brought forth by the high HIV prevalence and the exodus of health care professionals, circumventing the mother-to-child transmission of HIV is a priority. Manguzi Hospital shows an example at a district level of a well conducted PMTCT programme.

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