Impact of breastfeeding, maternal antiretroviral treatment and health service factors on 18-month vertical transmission of HIV and HIV-free survival: results from a nationally representative HIV-exposed infant cohort, South Africa

BackgroundWe analysed the impact of breastfeeding, antiretroviral drugs and health service factors on cumulative (6 weeks to 18 months) vertical transmission of HIV (MTCT) and ‘MTCT-or-death’, in South Africa, and compared estimates with global impact criteria to validate MTCT elimination: (1) 6 wee...

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Published in:Journal of epidemiology and community health (1979) 2020-12, Vol.74 (12), p.1069-1077
Main Authors: Goga, Ameena Ebrahim, Lombard, Carl, Jackson, Debra, Ramokolo, Vundli, Ngandu, Nobubelo Kwanele, Sherman, Gayle, Puren, Adrian, Chirinda, Witness, Bhardwaj, Sanjana, Makhari, Nobuntu, Ramraj, Trisha, Magasana, Vuyolwethu, Singh, Yagespari, Pillay, Yogan, Dinh, Thu-Ha
Format: Article
Language:English
Subjects:
Anti-HIV Agents - therapeutic use
Antibodies
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Babies
Births
Breast Feeding
Breastfeeding & lactation
Caregivers
CD4 antigen
child health
Consent
Data analysis
Death
Disease transmission
epidemiology
Evidence-based public health policy and practice
Female
Health Services
HIV
HIV Infections - drug therapy
Households
Human immunodeficiency virus
Humans
Infant
Infants
Infections
Infectious Disease Transmission, Vertical - prevention & control
Medical research
Medical tests
Mortality
Mothers
Nevirapine
Pregnancy
Pregnancy Complications, Infectious - drug therapy
Public health
Risk factors
South Africa
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Summary:BackgroundWe analysed the impact of breastfeeding, antiretroviral drugs and health service factors on cumulative (6 weeks to 18 months) vertical transmission of HIV (MTCT) and ‘MTCT-or-death’, in South Africa, and compared estimates with global impact criteria to validate MTCT elimination: (1) 6 weeks to 18 months) was 1.7% (95% CI 1.2% to 2.4%). Cumulative ‘MTCT-or-death’ was 6.3% (95% CI 5.5% to 7.3%); 81% and 62% of cumulative MTCT and ‘MTCT-or-death’, respectively, occurred by 6 months. Postnatal MTCT increased with unknown maternal CD4-cell-count (adjusted HR (aHR 2.66 (1.5–5.6)), undocumented maternal HIV status (aHR 2.21 (1.0–4.7)) and exclusive (aHR 2.3 (1.0–5.2)) or mixed (aHR 3.7 (1.2–11.4)) breastfeeding. Cumulative ‘MTCT-or death’ increased in households with ‘no refrigerator’ (aHR 1.7 (1.1–2.9)) and decreased if infants used nevirapine at 6 weeks (aHR 0.4 (0.2–0.9)).ConclusionsWhile the
ISSN:0143-005X
1470-2738
1470-2738
DOI:10.1136/jech-2019-213453