{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:23:26Z","timestamp":1793715806307,"version":"4.6.1"},"reference-count":14,"publisher":"BMJ","issue":"12","funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["K01 MH112443"],"award-info":[{"award-number":["K01 MH112443"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203525\/Z\/16\/Z"],"award-info":[{"award-number":["203525\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP 1017641"],"award-info":[{"award-number":["OPP 1017641"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,11,20]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The coverage of prevention of mother-to-child transmission (PMTCT) services in South Africa is variable. Identifying gaps in the implementation of these services is necessary to isolate steps needed to further reduce paediatric infections and eliminate transmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Two primary care clinics in Paarl, South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1225 pregnant women; inclusion criteria were 18 years or older, clinic attendance and remaining in area for at least 1\u2009year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were collected through the Drakenstein Child Health Study, a population-based birth cohort in a periurban area of the Western Cape, South Africa. A combination of clinic records, hospital records, national database searches and maternal self-report were collected during the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 1225 mothers enrolled in the cohort between 2012 and 2015, 260 (21%) were confirmed HIV infected antenatally and 1 mother tested positive in the postnatal period. Of those with documentation (n=250\/260, 96%), the majority (99%) received antiretroviral prophylaxis or therapy (ART) before labour; however, there was a high rate of defaulting from ART noted during pregnancy (20%). All HIV-exposed infants with data received antiretroviral prophylaxis, 35% were exclusively breast fed until 6 weeks and 16% for 6 months. There were two cases of infant HIV infection (0.8%) who were initiated on ART but had complicated histories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite the low transmission rate in this cohort, reaching elimination will require further work, and this study illustrates several areas to improve implementation of PMTCT services and reduce paediatric infections including retesting at-risk HIV-negative mothers through the duration of breast feeding, infant HIV testing at any admission in addition to routine testing and improved counselling to prevent defaulting from treatment. Better data surveillance systems are essential for determining the implementation of PMTCT guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-033259","type":"journal-article","created":{"date-parts":[[2019,12,16]],"date-time":"2019-12-16T05:35:55Z","timestamp":1576474555000},"page":"e033259","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Implementation of prevention of mother-to-child transmission (PMTCT) in South Africa: outcomes from a population-based birth cohort study in Paarl, Western Cape"],"prefix":"10.1136","volume":"9","author":[{"given":"Jennifer","family":"Pellowski","sequence":"first","affiliation":[{"name":"Department of Behavioral and Social Sciences and International Health Institute, Brown University School of Public Health, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Wedderburn","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob A M","family":"Stadler","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Rondebosch, South Africa"},{"name":"Unit on Child and Adolescent Health, South African Medical Research Council, Tygerberg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5082-7864","authenticated-orcid":false,"given":"Whitney","family":"Barnett","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Rondebosch, South Africa"},{"name":"Unit on Child and Adolescent Health, South African Medical Research Council, Tygerberg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa"},{"name":"Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council, Tygerberg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Landon","family":"Myer","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics and Centre for Infectious Diseases Epidemiology and Research, University of Cape Town Faculty of Health Sciences, Observatory, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather J","family":"Zar","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Rondebosch, South Africa"},{"name":"Unit on Child and Adolescent Health, South African Medical Research Council, Tygerberg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,15]]},"reference":[{"key":"2025121513460599000_9.12.e033259.1","unstructured":"World Health Organization . Elimination of mother-to-child transmission (EMTCT) of HIV and syphilis: global guidance on criteria and processes for validation; 2017."},{"key":"2025121513460599000_9.12.e033259.2","unstructured":"Republic of South Africa Department of Health . The 2013 national antenatal sentinel HIV prevalence survey South Africa, 2015."},{"key":"2025121513460599000_9.12.e033259.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0132425","article-title":"Missed opportunities along the prevention of mother-to-child transmission services cascade in South Africa: uptake, determinants, and attributable risk (the SAPMTCTE)","volume":"10","author":"Woldesenbet","year":"2015","journal-title":"PLoS One"},{"key":"2025121513460599000_9.12.e033259.4","unstructured":"Goga A , Jackson D , Lombard C , et al . Highest risk of mother to child transmission of HIV or death in the first 6 months postpartum: results from 18 month follow-up of an HIV-exposed national cohort, South Africa. Durban, South Africa: International AIDS Society Conference, 2016."},{"key":"2025121513460599000_9.12.e033259.5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jneumeth.2015.03.016","article-title":"Investigating the psychosocial determinants of child health in Africa: the Drakenstein child health study","volume":"252","author":"Stein","year":"2015","journal-title":"J Neurosci Methods"},{"key":"2025121513460599000_9.12.e033259.6","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-206242"},{"key":"2025121513460599000_9.12.e033259.7","unstructured":"Health RoSADo . The South Africa antiretroviral treatment guidelines 2015: PMTCT guidelines, 2013."},{"key":"2025121513460599000_9.12.e033259.8","unstructured":"Provincial Government of the Western Cape . The Western Cape consolidated guidelines for HIV treatment: prevention of mother-to-child transmission of HIV (PMTCT), children, adolescents and adults. Department of Health HASTHD, 2015."},{"key":"2025121513460599000_9.12.e033259.9","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.ypmed.2017.07.004","article-title":"Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study","volume":"102","author":"Thomas","year":"2017","journal-title":"Prev Med"},{"key":"2025121513460599000_9.12.e033259.10","doi-asserted-by":"crossref","unstructured":"Barnett W , Brittain K , Sorsdahl K , et al . Maternal participant experience in a South African birth cohort study enrolling healthy pregnant women and their infants. 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