Date of Award

9-23-2010

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Brian Forsyth

Abstract

ABSTRACT AN EVALUATION OF PMTCT AND FOLLOW-UP INFANT HIV TESTING IN KWAZULU- NATAL, SOUTH AFRICA. Juliana Chen. Edendale Hospital, Pietermaritzburg, KwaZulu-Natal, South Africa. (Sponsored by Brian Forsyth, Department of Pediatrics, Yale University School of Medicine). Background: The primary cause of pediatric HIV infection is mother-to-child transmission, which can be reduced significantly by interventions that include highly active antiretroviral therapy (HAART) and antiretroviral (ARV) prophylaxis. Prevention of mother-to-child transmission (PMTCT) programs serve as critical entry points for the provision of HIV testing and treatment, though often remain poorly implemented and underutilized. Such programs are especially critical in resource-limited settings that have a heavy burden of HIV infection. Methods: Data were collected via retrospective medical record review of pregnant women who accessed antenatal services at a public sector PMTCT program from December 2006 to June 2007. A supplementary review of pregnant women with no prior history of HIV testing was conducted to evaluate HIV testing at delivery. Finally, an analysis of infant PCR testing was conducted to assess rates of follow-up testing among HIV-exposed infants. Results: High rates of testing reveal that half of women presenting for antenatal care were HIV positive. Rates of repeat testing during pregnancy and testing at delivery were low. There were high rates of ARV prophylaxis among mothers and infants, though less than two-thirds of eligible mothers initiated HAART. At most, only half of HIV-exposed infants returned for HIV testing by twelve weeks of age. Of those tested, over 16% were found to be HIV positive. Discussion: Despite significant enrollment in PMTCT and high acceptance of HIV testing in pregnancy, gaps in service delivery and/or failures in documentation result in multiple missed opportunities. An inability to link mother-infant pairs, poor follow-up of HIV-exposed infants, and a lack of coordination of services further limit overall PMTCT program effectiveness. More effective regimens will have limited success without fundamental improvements in service delivery. Improved training and protocols for care, as well as the development of uniform data collection tools, are critical to overall PMTCT program effectiveness.

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