Elimination of paediatric HIV in KwaZulu-Natal, South Africa: large-scale assessment of interventions for the prevention of mother-to-child transmission

objective: to report the rates of mother-to-child transmission (mtct) of the human immunodeficiency virus (hiv), and the coverage of interventions designed to prevent such transmission, in kwazulu-natal. methods: mothers with infants aged < 16 weeks and fathers or legal guardians with infants aged 4-8 weeks who, between may 2008 and april 2009, attended immunization clinics in six districts of kwazulu-natal were included. the mothers' uptake of interventions for the prevention of mtct was explored. blood samples from infants aged 4-8 weeks were tested for anti-hiv antibodies and, if antibody-positive, for hiv desoxyribonucleic acid (dna). findings: of the 19 494 mothers investigated, 89·9% reported having had an hiv test in their recent pregnancy. of the 19 138 mothers who reported ever having had an hiv test, 34.4% reported that they had been found hiv-positive and, of these, 13.7% had started lifelong antiretroviral treatment and 67.2% had received zidovudine and nevirapine. overall, 40.4% of the 7981 infants tested were found positive for anti-hiv antibodies, indicating hiv exposure. just 7.1% of the infants checked for hiv dna (equating to 2.8% of the infants tested for anti-hiv antibodies) were found positive. conclusion: the low levels of mtct observed among the infants indicate the rapid, successful implementation of interventions for the prevention of such transmission. sampling at immunization clinics appears to offer a robust method of estimating the impact of interventions designed to reduce such transmission. large-scale elimination of paediatric hiv infections appears feasible, although this goal has not yet been fully achieved in kwazulu-natal.