Pregnant women's access to PMTCT and ART services in South Africa and implications for universal antiretroviral treatment

PLoS One. 2011;6(12):e27907. doi: 10.1371/journal.pone.0027907. Epub 2011 Dec 5.


Objectives: We describe pregnant womens' access to PMTCT and HAART services and associated birth outcomes in South Africa.

Methods: Women recuperating in postnatal wards of a referral hospital participated in an evaluation during February-May 2010 during which their maternity records were examined to describe their access to VCT, CD4 Counts, dual ART or HAART during pregnancy.

Results: Of the 1609 women who participated in this evaluation, 39% (95%CI36.7-41.5%) tested HIV-positive during their pregnancy. Of the HIV-positive women 2.9% did not have a CD4 count done and an additional 31.3% did not receive their CD4 results. The majority (96.8%) of the HIV-positive women commenced dual ART at their first antenatal visit independent of their CD4 result. During February-May 2010, 48.0% of the women who had a CD4 result were eligible for HAART (CD4<200 cells/mm(3)) and 29.1% of these initiated HAART during pregnancy. Under the current South African PMTCT guidelines 71.1% (95%CI66.4-75.4%) of HIV positive pregnant women could be eligible for HAART (CD4<350 cells/mm(3)). There were significantly more preterm births among HIV-positive women (p = 0.01) and women who received HAART were no more at risk of preterm deliveries (AOR 0.73;95%CI0.39-1.36;p = 0.2) as compared to women who received dual ART. Nine (2.4%; 95%CI1.1-4.5%) HIV exposed infants were confirmed HIV infected at birth. The in-utero transmission rate was highest among women who required HAART but did not initiate treatment (8.5%) compared to 2.7% and 0.4% among women who received HAART and women who were not eligible for HAART and received PMTCT prophylaxis respectively.

Conclusion: In this urban South African community the antenatal HIV prevalence remains high (39%) and timeous access to CD4 results during pregnancy is limited. Under the current South African guidelines, and assuming that access to CD4 results has improved, more than 70% of HIV-positive pregnant women in this community would be requiring HAART.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Retroviral Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active
  • CD4-Positive T-Lymphocytes / cytology
  • Child
  • Cross-Sectional Studies
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • Health Services Accessibility
  • Humans
  • Infectious Disease Transmission, Vertical / prevention & control
  • Middle Aged
  • Pregnancy
  • Pregnancy Complications, Infectious
  • Pregnancy Outcome
  • Prevalence
  • South Africa
  • Women's Health


  • Anti-Retroviral Agents