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Getting to under 1% vertical HIV transmission: lessons from a breastfeeding cohort in South Africa

Brodie Daniels1,2, Elizabeth Spooner3,2, Anna Coutsoudis2

  • 1HIV and other Infectious Diseases Research Unit, South African Medical Research Council Durban, Overport, South Africa Brodie.Daniels@mrc.ac.za.

BMJ Global Health
|September 21, 2022
PubMed

Insights

We studied HIV transmission in breastfeeding infants in South Africa. Despite prevention programs, a small percentage of infants acquired HIV, highlighting the need for ongoing strategies to eliminate mother-to-child transmission.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Pediatrics

Background:

  • South Africa implemented Option B+ for preventing mother-to-child HIV transmission (PMTCT) in 2015.
  • The study focuses on the critical period of breastfeeding transmission in an area with a high HIV prevalence.

Purpose of the Study:

  • To assess HIV transmission rates in breastfeeding infants within a PMTCT program.
  • To identify factors contributing to vertical HIV transmission post-Option B+ implementation.
  • To inform strategies for the elimination of mother-to-child HIV transmission.

Main Methods:

  • A cohort of 1219 infants born to HIV-positive mothers was enrolled in a non-inferiority trial.
  • Infants and breastfeeding mothers were followed for 12 months post-birth in eThekwini, KwaZulu-Natal.
  • The study assessed cotrimoxazole prophylaxis guidelines for HIV-exposed, uninfected infants.

Main Results:

  • A total of 8 infants (less than 1%) seroconverted during the study period.
  • Estimated transmissions included four at birth and four through breastfeeding.
  • The overall transmission rate remained very low, below 1%.

Conclusions:

  • Continued vigilance and assessment of transmission routes are crucial in the post-Option B+ era.
  • Understanding the reasons for vertical transmission is vital for refining PMTCT strategies.
  • Sustained efforts are necessary to achieve the elimination of mother-to-child HIV transmission.

Keywords:
HIVPaediatrics

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