{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:06:09Z","timestamp":1790766369472,"version":"4.1.0"},"reference-count":41,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2014,10,13]]},"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>There is a paucity of data on the national population-level effectiveness of preventing mother-to-child transmission (PMTCT) programmes in high-HIV-prevalence, resource-limited settings. We assessed national PMTCT impact in South Africa (SA), 2010.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A facility-based survey was conducted using a stratified multistage, cluster sampling design. A nationally representative sample of 10\u2005178 infants aged 4\u20138\u2005weeks was recruited from 565 clinics. Data collection included caregiver interviews, record reviews and infant dried blood spots to identify HIV-exposed infants (HEI) and HIV-infected infants. During analysis, self-reported antiretroviral (ARV) use was categorised: 1a: triple ARV treatment; 1b: azidothymidine &gt;10\u2005weeks; 2a: azidothymidine \u226410\u2005weeks; 2b: incomplete ARV prophylaxis; 3a: no antenatal ARV and 3b: missing ARV information. Findings were adjusted for non-response, survey design and weighted for live-birth distributions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Nationally, 32% of live infants were HEI; early mother-to-child transmission (MTCT) was 3.5% (95% CI 2.9% to 4.1%). In total 29.4% HEI were born to mothers on triple ARV treatment (category 1a) 55.6% on prophylaxis (1b, 2a, 2b), 9.5% received no antenatal ARV (3a) and 5.5% had missing ARV information (3b). Controlling for other factors groups, 1b and 2a had similar MTCT to 1a (Ref; adjusted OR (AOR) for 1b, 0.98, 0.52 to 1.83; and 2a, 1.31, 0.69 to 2.48). MTCT was higher in group 2b (AOR 3.68, 1.69 to 7.97). Within group 3a, early MTCT was highest among breastfeeding mothers 11.50% (4.67% to 18.33%) for exclusive breast feeding, 11.90% (7.45% to 16.35%) for mixed breast feeding, and 3.45% (0.53% to 6.35%) for no breast feeding). Antiretroviral therapy or &gt;10\u2005weeks prophylaxis negated this difference (MTCT 3.94%, 1.98% to 5.90%; 2.07%, 0.55% to 3.60% and 2.11%, 1.28% to 2.95%, respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>SA, a high-HIV-prevalence middle income country achieved &lt;5% MTCT by 4\u20138\u2005weeks post partum. The long-term impact on PMTCT on HIV-free survival needs urgent assessment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2014-204535","type":"journal-article","created":{"date-parts":[[2014,11,5]],"date-time":"2014-11-05T01:45:25Z","timestamp":1415151925000},"page":"240-248","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":77,"title":["First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa"],"prefix":"10.1136","volume":"69","author":[{"given":"Ameena E","family":"Goga","sequence":"first","affiliation":[{"name":"Health Systems Research Unit, Medical Research Council, Cape Town, South Africa"},{"name":"Department of Paediatrics and Child Health, Kalafong Hospital, University of Pretoria, Hatfield, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thu-Ha","family":"Dinh","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra J","family":"Jackson","sequence":"additional","affiliation":[{"name":"School of Public Health, University of the Western Cape, Bellville, South Africa"},{"name":"UNICEF New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Lombard","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Medical Research Council, Cape Town, South Africa"},{"name":"School of Public Health and Family Medicine, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7562-7647","authenticated-orcid":false,"given":"Kevin P","family":"Delaney","sequence":"additional","affiliation":[{"name":"Division of HIV\/AID Prevention, Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD, and Tuberculosis Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Puren","sequence":"additional","affiliation":[{"name":"Division of National Health Laboratory Services, National institute of Communicable Diseases, Sandringham, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayle","family":"Sherman","sequence":"additional","affiliation":[{"name":"Division of National Health Laboratory Services, National institute of Communicable Diseases, Sandringham, Johannesburg, South Africa"},{"name":"Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Parktown, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selamawit","family":"Woldesenbet","sequence":"additional","affiliation":[{"name":"Health Systems Research Unit, Medical Research Council, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vundli","family":"Ramokolo","sequence":"additional","affiliation":[{"name":"Health Systems Research Unit, Medical Research Council, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siobhan","family":"Crowley","sequence":"additional","affiliation":[{"name":"Affiliated with UNICEF South Africa at the time of the study. Currently affiliated to Elma Philanthropies, New York USA, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Doherty","sequence":"additional","affiliation":[{"name":"Health Systems Research Unit, Medical Research Council, Cape Town, South Africa"},{"name":"School of Public Health, University of the Western Cape, Bellville, South Africa"},{"name":"School of Public Health, University of the Witwatersrand, Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mickey","family":"Chopra","sequence":"additional","affiliation":[{"name":"UNICEF New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Shaffer","sequence":"additional","affiliation":[{"name":"World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogan","family":"Pillay","sequence":"additional","affiliation":[{"name":"National Department of Health, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,11,4]]},"reference":[{"key":"2025100702342857000_69.3.240.1","unstructured":"United Nations. The Millennium Development Goal Report. 2012. http:\/\/www.undp.org\/content\/dam\/undp\/library\/MDG\/english\/The_MDG_Report_2012.pdf. (accessed 8 Jul 2013)."},{"key":"2025100702342857000_69.3.240.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)01075-2"},{"key":"2025100702342857000_69.3.240.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa033500"},{"key":"2025100702342857000_69.3.240.4","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.07.043117"},{"key":"2025100702342857000_69.3.240.5","doi-asserted-by":"publisher","DOI":"10.1097\/00126334-200311010-00003"},{"key":"2025100702342857000_69.3.240.6","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.06.033639"},{"key":"2025100702342857000_69.3.240.7","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32801424d2"},{"key":"2025100702342857000_69.3.240.8","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32814db7d4"},{"key":"2025100702342857000_69.3.240.9","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32832d84fd"},{"key":"2025100702342857000_69.3.240.10","first-page":"289","article-title":"PMTCT from research to reality\u2014results from a routine service","volume":"94","author":"Sherman","year":"2004","journal-title":"South African Med J"},{"key":"2025100702342857000_69.3.240.11","first-page":"489","article-title":"Effectiveness of the first district-wide programme for the prevention of mother-to-child transmission of HIV in South Africa","volume":"83","author":"Coetzee","year":"2005","journal-title":"BullWorld Health Organisation"},{"key":"2025100702342857000_69.3.240.12","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.11.092056"},{"key":"2025100702342857000_69.3.240.13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001424"},{"key":"2025100702342857000_69.3.240.14","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328350995c"},{"key":"2025100702342857000_69.3.240.15","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-404"},{"key":"2025100702342857000_69.3.240.16","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1080\/10158782.2006.11441271","article-title":"Immunisation coverage estimates by cluster sampling survey of children (aged 12\u201323 months) in Gauteng Province, 2003","volume":"21","author":"Fonn","year":"2006","journal-title":"South African J Epidemiol Infect"},{"key":"2025100702342857000_69.3.240.17","unstructured":"National Department of Health. National Antenatal Sentinel HIV and Syphilis Prevalence Survey, South Africa. 2008. Published 2009. http:\/\/www.info.gov.za\/view\/DownloadFileAction?id=109007. (accessed 8 Jul 2013)."},{"key":"2025100702342857000_69.3.240.18","doi-asserted-by":"crossref","unstructured":"Lehtonen R , Pahkinen E . Practical methods for design and analysis of complex surveys. 2nd edn. West Sussex, UK: John Wiley & Sons; 2004.","DOI":"10.1002\/0470091649"},{"key":"2025100702342857000_69.3.240.19","unstructured":"National Department of Health. The Road to Health Chart: Guidelines for Health Workers. http:\/\/www.doh.gov.za\/docs\/factsheets\/guidelines\/health\/healthchart.htm. (accessed 12 May 2013)."},{"key":"2025100702342857000_69.3.240.20","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-9-51"},{"key":"2025100702342857000_69.3.240.21","doi-asserted-by":"crossref","unstructured":"Heeringa SG , West B , Berglund PA . Applied survey data analysis. Boca Raton, FL: Chapman & Hall\/CRC; 2010.","DOI":"10.1201\/9781420080674"},{"key":"2025100702342857000_69.3.240.22","doi-asserted-by":"crossref","unstructured":"Vinnard C , Wileyto E , Bisson G , et al . First use of multiple imputation with the National Tuberculosis Surveillance System. Epidemiol Res Int 2013. doi:10.115\/2013\/875234","DOI":"10.1155\/2013\/875234"},{"key":"2025100702342857000_69.3.240.23","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328362e832"},{"key":"2025100702342857000_69.3.240.24","doi-asserted-by":"crossref","unstructured":"Schafer J . Analysis of incomplete multivariate data. New York: Chapman and Hall; 1997.","DOI":"10.1201\/9781439821862"},{"key":"2025100702342857000_69.3.240.25","unstructured":"Spath H . Cluster analysis algorithms. Chichester: Ellis Horwood; 1980."},{"key":"2025100702342857000_69.3.240.26","doi-asserted-by":"publisher","DOI":"10.1007\/BF01908064"},{"key":"2025100702342857000_69.3.240.27","doi-asserted-by":"crossref","unstructured":"Kleinbaum D , Klein M . Logistic regression: a self-learning text. New York: Springer Science and Business Media; 2010.","DOI":"10.1007\/978-1-4419-1742-3"},{"key":"2025100702342857000_69.3.240.28","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyr218"},{"key":"2025100702342857000_69.3.240.29","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwm179"},{"key":"2025100702342857000_69.3.240.30","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwm299"},{"key":"2025100702342857000_69.3.240.31","unstructured":"UNAIDS. Together we will end AIDS 19 July 2012. http:\/\/globalhealth.kff.org\/Daily-Reports\/2012\/July\/19\/GH-071912-UNAIDS-Report.aspx. (accessed 19 Jul 2012)."},{"key":"2025100702342857000_69.3.240.32","unstructured":"National Department of Health. National Antenatal Sentinel HIV and Syphilis Prevalence Survey in South Africa, 2009. Published 2010 http:\/\/www.health-e.org.za\/documents\/85d3dad6136e8ca9d02cceb7f4a36145.pdf. (accessed 27 Aug 2011)."},{"key":"2025100702342857000_69.3.240.33","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)71048-5"},{"key":"2025100702342857000_69.3.240.34","unstructured":"Shapiro D , Balasubramanian r , Fowler M , et al . Time to HIV DNA-PCR Positivity According to Maternal\/Infant Antiretroviral Prophylactic Regimen in Non-Breastfed HIV-Infected Infants in Populations with Predominantly Non-B HIV Subtype: A Collaborative Analysis of Data from Cohorts in Thailand, South Africa, Botswana, and the United Kingdom. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Rome, 2011."},{"key":"2025100702342857000_69.3.240.35","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00431-12"},{"key":"2025100702342857000_69.3.240.36","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0029823"},{"key":"2025100702342857000_69.3.240.37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0010411"},{"key":"2025100702342857000_69.3.240.38","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3181469050"},{"key":"2025100702342857000_69.3.240.39","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200010053431401"},{"key":"2025100702342857000_69.3.240.40","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001156"},{"key":"2025100702342857000_69.3.240.41","unstructured":"National Department of Health. Policy and Guidelines for the Implementation of the PMTCT programme. 2008. http:\/\/www.info.gov.za\/view\/DownloadFileAction?id=77877. (accessed 1 Oct 20)."}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2014-204535","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T09:34:44Z","timestamp":1759829684000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2014-204535"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,11,4]]},"references-count":41,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2015,2,10]]},"published-print":{"date-parts":[[2015,3]]}},"alternative-id":["10.1136\/jech-2014-204535"],"URL":"https:\/\/doi.org\/10.1136\/jech-2014-204535","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,11,4]]}}}