Impact and Effectiveness of South Africa’s PMTCT Programs on Perinatal HIV Transmission, : Using data to improve program implementation, and policy Yogan Pillay, PhD. (NDOH/DDG, South Africa) Thu-Ha Dinh, MD., MS., US CDC/GAP Ameena Goga, MD., MS.; Debra Jackson, PhD., RN., 2012 International AIDS Conference, Washington DC, July 22 th -27 st, 2012

: –HIV-infected pregnant women  CD4 > 200  AZT from 28 wks + sd NVP in labour  CD4< 200 or WHO clinical stage 4  ART for life –HIV-exposed infants: sd NVP + AZT ( days) 2010-present: –HIV-infected pregnant women  CD4 > 350  AZT from 14 wks + sd NVP + TDF/FTC in labour  CD4< 350  ART for life –HIV-exposed infants  Mother on ART or non-breastfed infants: 6 wks NVP  Breastfed infant: NVP through out breastfeeding Background: PMTCT guidelines

HIV prevalence in pregnant women by province (sentinel surveillance, 2010) 30.2% (95 CI, 29.4% -30.9%)

District Health Information System (DHIS) –PMTCT programme indicators –Data source were abstracted from clinic registers using paper-based forms  District –Districts cleaned data  enter the reported data to the electronic DHIS database National laboratory database –Electronic database from all labs in the country –Early Infant Diagnosis – coverage ~ 43% in 2010 and 54% in 2011 Background: National routine program databases

Preliminary Findings Adjusted for non-response rates Weighted for population live-birth in 2010 Survey analysis using SAS 9.2

Weighted HIV exposure prevalence and transmission rate measured at 4-8wks postpartum by year 1. Infant HIV-exposure prevalence – 2010: 31.4% (95% CI 30.1% %) – 2011: 32.2% (95% CI 30.7% %) 2. National perinatal transmission rate – 2010: 3.5% (95% CI 2.9% - 4.1%) – 2011: 2.7% (95% CI 2.1% - 3.2%)

PMTCT cascade by year HIV infected mothers

Using survey data to support policy Using the 2010 survey findings  2012 NSP targets  2% MTCT rate at 6 weeks and 5% at 18 months  repeat testing strategy and infant testing strategy have been reviewing to  Reduce unknown HIV acquisition during pregnancy  Increase coverage of EID at 6 weeks Reviewing findings in 2010 and 2011 to – Revise the 2010 PMTCT guidelines – Set a new target for 2012: Early MTCT rate at (2.1%) and significantly higher than 2010 (95%CI; 1.5% - 2.7)

Using survey data to improve program (2010) PROVINCEHIV-ExposedEarly MTCT % (95%CI) Eastern Cape 30.0 ( ) 4.7 ( )* Free State 31.1 ( )5.9 ( ) Gauteng 30.2 ( )2.5 ( ) KwaZulu Natal 43.9 ( )2.9 ( ) Limpopo 22.6 ( )3.6 ( ) Mpumalanga 36.2 ( )5.7 ( ) Northern Cape 15.6 ( )1.4 ( )* Northwest 30.9 ( )4.4 ( ) Western Cape 20.8 ( )3.9 ( ) * Unstable estimates due to small sample size

Using survey data to improve program

Using survey data to improve quality of the routine program (cascade) HIV infected mothers

Acknowledgements Nurse Data collectors Routine health workers Medical Research Council Carl Lombard (Statistician) Selamawit Woldesenbet Wesley Solomon Vundli Ramokolo Tanya Doherty Charles Hongoro Fred Koopman National Department of Health Nonhlanhla Dlamini Thabang Mosala Other members Provincial Departments of Health University of the Western Cape Wondwossen Lerebo UNICEF (SA) Siobhan CrowleyCDC Katherine Robinson/Lorena Espinoza Katherine Robinson/Lorena Espinoza Jeff Klausner/Thurma Goldman Jeff Klausner/Thurma Goldman Mary Mogashoa/Lerato Lesole Mary Mogashoa/Lerato Lesole CDC South Africa and Atlanta teams CDC South Africa and Atlanta teams Infant Diagnosis Gayle Sherman Adrian Puren Technical Advisors Mickey Chopra (UNICEF) Nathan Shaffer (WHO) Caregiver-infant pairs