Highest risk of mother-to-child transmission of HIV or death in the first 6 months postpartum: - PowerPoint Presentation

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Highest risk of mother-to-child transmission of HIV or death in the first 6 months postpartum: Results from 18 month follow-up of an HIV-exposed national cohort, South Africa aids 2016

Goga

AE, Jackson DJ, Lombard C, Ramokolo V, Ngandu N, Sherman G, Puren A, Doherty T, Bhardwaj S, Noveve N, Ramraj T, Magasana V, Singh Y, Pillay, Dinh T for the SAPMTCTE study group.

Background 18-24 months HIV-free survival = Gold standard measuring PMTCT impact +

Few low-middle income, high

HIV prevalence countries produce these data, nationally2001: PEARL study: 79.7% (76.4-82.6) at 24 months2004-7: SWEN study: 92% HIV-free survival at 6 months. Ethiopia, India, Uganda2008-2009: Ngoma et.al. Zambia (maternal ART): 87.2% (79.1-93.5

) at 18 months

2012:

Buzdugan R et.al. Zimbabwe (Option A context): 90.9% (88.7-92.7%) at 9-18 months. Com-based survey 5 districtsSA: Option A (2010-April 2013) Option B (2013)

Primary questionWhat is the risk of MTCT and ‘MTCT or death’ at 3, 6, 9, 12, 15 and 18

months, amongst a nationally representative sample of HEU infants

methods Closed POC of HEU infants. Target: 1620 HEU at 18 months for national estimates

PHC / CHC

C/S surveillance at 580 EPI sites.

Target: 12

200

infants aged 4-8 weeks - national and provincial estimates

Multistage PPS sampling Consecutive or systematic sampling of participants to establish cohort

NICD

HIV Ab

TNA PCR

Rapid HIV tests

Methods: Data AnalysisWeighted for: South African live births, non consented eligible infants, consented infants who were lost to follow-up

Adjusted for survey design and competing risks

Conducted using SAS version 9.2

Study Profile:

2811 eligible HEU infants

6% no f-up consent1600-1700 f-up at each time point1797 (71%) f-up at 18 mo

4.3 (3.7-5.0) n =1797 = 71%

Cumulative HIV incidence till 18 months

age in weeksAge in monthsCumulative % MTCT (95% CI)%PN MTCT32.7 (2.6-12.6)

0.1%

6

3.5 (3.1-4.4)0.9% 93.7 (3.2-4.6)1.1% 123.9 (3.4-4.7)1.3%

154.1 (3.5-4.8)

1.5% 18

4.3 (3.7-5.0)

1.6%

2.6%

81% cumulative MTCT by 6 months

56% PN MTCT occurred by 6 months; 68% by 9 months

PN MTCT accounted

for

37%

of 18-month

MTCT

Amongst

infants alive at 6 weeks

with followed-up till 18 months 93.7% (92.2-94.8%) were alive and HIV-free 6.3%(5.2-7.8%)

Limitations and strengthsLimitations

Excluded infants without consent or who died <

6 weeksClosed cohortMTCT and HIV-free survival could be under-estimatedStrengthsCohort drawn from nationally representative sample94.1% of eligible population participated in f-upInfants could enter and exit cohort

Attained >1620 (estimated sample size)

71

% interviewed at 18 months 96% tracked for survivalAnalysis adjusted for no consent and loss to follow-up

SUMMARYAt population level <5% MTCT was achieved in a BF- national setting by 2014The first 6 months postpartum is a critical period for

HEU infants

Acknowledgments

Caregiver-infant pairsResearch nurses

NDoH NursesMRC Team: Ameena Goga Carl Lombard Nobuntu Noveve Vundli RamokoloTanya Doherty Yages Singh Nobubelo Ngandu Vuyolwethu Magasana Trisha Ramraj Duduzile Nsibande

Natasha

Titus

Jazelle Kiewitz Lucille HeynsSurvey supervisors

The SAPMTCTE was supported by:

The President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC

)

NDoH

NICD/NHLS

SANAC

Global Fund

EU

(through

NDoH

)

SAMRC

CDC

:

Thu-Ha Dinh

Mireille

Cheyip

Mary

Mogashoa

NDoH

:

Yogan Pillay

Provincial

DoHs

UWC/ UNICEF NY:

Debra

Jackson

UNICEF

(SA)

Sanjana

Bhardwai

NICD/NHLS

:

Adrian

Puren

Gayle Sherman

Beverley Singh

Ushmita

Patel

Ewalde

Cutler

UNIT : Health Systems Research Unit

Contact details

: Ameena Goga

E-MAIL :

Ameena.Goga@mrc.ac.za