Journal of acquired immune deficiency syndromes (1999) 2017 01 18() doi 10.1097/QAI.0000000000001289
In 2010, South Africa reported an early mother to child transmission (MTCT) rate of 3.5% at 4-8 weeks postpartum. Provincial early MTCT rates ranged from 1.4% (95% confidence interval [CI]: 0.1-3.4%) to 5.9% (95% CI: 3.8-8.0%). We sought to determine reasons for these geographic differences in MTCT rates.
This study employed multilevel modelling using 2010 South African PMTCT evaluation (SAPMTCTE) data from 530 facilities. Interview data and infant blood samples were collected from 3085 mother-infant pairs at 4-8 weeks postpartum. Facility-level data on human resources, referral systems, linkages to care and record keeping were collected through facility staff interviews. Provincial level data were gathered from publically available data (e.g. health professionals per 10,000 population) or aggregated at province-level from the SAPMTCTE (PMTCT maternal-infant ARV coverage). Variance partition coefficients and Odds ratios (for provincial facility- and individual-level factors influencing MTCT) from multilevel modelling are reported.
The provincial (5.0%) and facility (1.4%) level variance partition coefficients showed no substantive geographic variation in early MTCT. In multivariable analysis accounting for the multi-level nature of the data, the following were associated with early MTCT: individual-level – low maternal-infant ARV uptake (adjusted odds ratio [AOR] =2.5, 95%CI: 1.7-3.5), mixed breastfeeding (AOR=1.9, 95%CI: 1.3-2.9) and maternal age <20 years (AOR 1.8, 95%CI: 1.1-3.0); facility-level - insufficient (≤2) health-care-personnel for HIV-testing services (AOR=1.8 95%CI: 1.1-3.0); provincial level PMTCT antiretroviral -ARV- (maternal-infant) coverage lower than 80% (AOR=1.4, 95%CI:1.1-1.9), and number of health professionals per 10,000 population (AOR=0.99, 95%CI: 0.98-0.99). CONCLUSION
There was no substantial province-/facility-level MTCT difference. This could be due to good overall performance in reducing early MTCT. Disparities in human resource allocation (including allocation of insufficient health care personnel for testing and care at facility level) and PMTCT coverage influenced overall PMTCT programme performance. These are long-standing systemic problems that impact quality of care.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.