Jacob Nisha, Kalk Emma, Heekes Alexa, Phelanyane Florence, Anderson Kim, Davies Mary-Ann, Rice Brian, Boulle Andrew
School of Public Health, University of Cape Town, Cape Town, South Africa.
Western Cape Government Health and Wellness, Cape Town, South Africa.
PLoS One. 2025 Sep 11;20(9):e0328612. doi: 10.1371/journal.pone.0328612. eCollection 2025.
Despite universal HIV test-and-treat policy in South Africa, vertical transmission continues to occur. We evaluated the temporal effectiveness of vertical transmission prevention (VTP) over three maternal antiretroviral therapy (ART) policy periods (three-drug ART accessible to those with CD4 counts <200 cells/µl (January 2010 - March 2010); < 350 cells/µl (April 2010 - April 2013); and lifelong ART regardless of CD4 count (May 2013 - December 2020)) in Western Cape, South Africa using public sector routine individuated data.
We conducted a retrospective cohort study with child HIV infection as the primary outcome. The cohort of 842 641 pregnancies from 2010-2020, inclusive of child HIV exposure, maternal ART, and child outcomes, was enumerated using administrative, laboratory and pharmacy data. Multivariable logistic regression was used to explore associations with vertical transmission.
The proportion of pregnant women living with HIV (WLWH) initiating ART prior to pregnancy increased from 20.9% in 2010 to 71.1% in 2020. Of all pregnancies 17.1% (143 987/842 641) were HIV exposed and 16.3% (137 572/842 641) had a record of a child HIV outcome, of whom 3966 (2.9%) were HIV positive by 24 months. Among children with known maternal HIV exposure (143 987), 32.0% had unknown HIV status and 2.1% were diagnosed with HIV by study closure. In 2020, HIV status was ascertained in 87.2% (16 908/19 382) of children exposed to HIV. Children born in policy period 3 were less likely to have HIV than children born in policy period 2 (aOR 0.66; 95% CI 0.60-0.72), mediated through expanded ART access. Between 2017 and 2020, 16.5% of child HIV diagnoses were from pregnancies without maternal HIV exposure records. Young maternal age, no antenatal ART, previous tuberculosis and no records of antenatal visits were associated with vertical transmission in all periods.
Using routine data, we report an increase in WLWH initiating ART prior to pregnancy, and a decline in vertical transmission of HIV over three policy periods. Although HIV diagnosis amongst children exposed to HIV has reduced over time, the proportion of infections in children without established exposure emphasises the need to optimise VTP opportunities.
尽管南非实行了普遍的艾滋病毒检测与治疗政策，但垂直传播仍在继续发生。我们利用公共部门的常规个体数据，评估了在南非西开普省三个孕产妇抗逆转录病毒疗法（ART）政策时期（CD4细胞计数<200个/微升的人群可获得三联药物ART（2010年1月至2010年3月）；<350个/微升（2010年4月至2013年4月）；以及无论CD4细胞计数如何均接受终身ART（2013年5月至2020年12月））中预防垂直传播（VTP）的时间有效性。
我们进行了一项以儿童艾滋病毒感染为主要结局的回顾性队列研究。利用行政、实验室和药房数据，统计了2010年至2020年期间包括儿童艾滋病毒暴露、孕产妇ART和儿童结局在内的842641例妊娠队列。采用多变量逻辑回归来探讨与垂直传播的关联。
怀孕前开始接受ART的感染艾滋病毒孕妇（WLWH）比例从2010年的20.9%增至2020年的71.1%。在所有妊娠中，17.1%（143987/842641）的孕妇有艾滋病毒暴露情况，16.3%（137572/842641）有儿童艾滋病毒结局记录，其中3966例（2.9%）在24个月时艾滋病毒呈阳性。在已知有孕产妇艾滋病毒暴露的儿童（143987例）中，32.0%的儿童艾滋病毒状况未知，2.1%的儿童在研究结束时被诊断为艾滋病毒感染。2020年，在暴露于艾滋病毒的儿童中，87.2%（16908/19382）的艾滋病毒状况得以确定。政策时期3出生的儿童感染艾滋病毒的可能性低于政策时期2出生的儿童（调整后比值比0.66；95%置信区间0.60 - 0.72），这是通过扩大ART的可及性实现的。2017年至2020年期间，16.5%的儿童艾滋病毒诊断来自无孕产妇艾滋病毒暴露记录的妊娠。年轻的孕产妇年龄、未进行产前ART、既往有结核病以及无产前检查记录在所有时期均与垂直传播相关。
利用常规数据，我们报告了怀孕前开始接受ART的WLWH人数增加，以及在三个政策时期艾滋病毒垂直传播有所下降。尽管随着时间推移，暴露于艾滋病毒的儿童中艾滋病毒诊断率有所降低，但在未确定有暴露情况的儿童中感染比例仍凸显了优化VTP机会的必要性。
