Scientific Letter

Reasons for failure of prevention of mother-to-child HIV transmission in a rural South African district hospital

Clifford Kendall, Lore Claessens, Jienchi Dorward, Gloria Mfeka, Kelly Gate
Southern African Journal of HIV Medicine | Vol 16, No 1 | a365 | DOI: https://doi.org/10.4102/sajhivmed.v16i1.365 | © 2015 Clifford Kendall, Lore Claessens, Jienchi Dorward, Gloria Mfeka, Kelly Gate | This work is licensed under CC Attribution 4.0
Submitted: 24 February 2015 | Published: 28 April 2015

About the author(s)

Clifford Kendall, Bethesda Hospital, Umkhanyakude District, KwaZulu-Natal, South Africa
Lore Claessens, 20,000 Plus Partnership, University of KwaZulu-Natal, South Africa
Jienchi Dorward, Bethesda Hospital, Umkhanyakude District, KwaZulu-Natal, South Africa
Gloria Mfeka, Bethesda Hospital, Umkhanyakude District, KwaZulu-Natal; Departmentof Family Medicine, University of KwaZulu-Natal, South Africa
Kelly Gate, Bethesda Hospital, Umkhanyakude District, KwaZulu-Natal; Departmentof Family Medicine, University of KwaZulu-Natal, South Africa


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Abstract

Further reduction of mother-to-child transmission (MTCT) of HIV requires improved understanding of the reasons for MTCT. We reviewed maternal and infant case notes for HIV- positive infants diagnosed by polymerase chain reaction at Bethesda Hospital. Nineteen cases were analysed. Median gestation at first antenatal consultation (ANC) was 22.5 (interquartile range [IQR] 19.25–24). Eleven (57.9%) mothers were HIV positive at first ANC, whilst eight tested negative and later positive (2 antepartum, 6 postpartum). Median maternal CD4 was 408 cells/μL (IQR 318–531). Six (31.6%) received no antenatal antiretroviral therapy (ART) because they were diagnosed as HIV positive postpartum; 9 (47.3%) received antenatal ART and 3 (15.8%) were never initiated on ART. At 6 weeks postpartum, 5 infants (26.3%) were not on prophylactic nevirapine (NVP) because their mothers had not yet been diagnosed. Maternal seroconversion in pregnancy and breastfeeding, and possibly false-negative HIV tests, were important reasons for prevention of mother-to-child transmission (PMTCT) failure.

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