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Integration of Preventing Mother-To-Child Transmission of HIV and Syphilis Testing and Treatment in Antenatal Care Services in the Northern Cape and Gauteng Provinces, South Africa

Dinh, Thu-Ha MD, MS*†; Kamb, Mary L. MD, MPH; Msimang, Veerle MPH; Likibi, Muptal MD§; Molebatsi, Thabo MPH; Goldman, Thurma MD*; Lewis, David A. MD

doi: 10.1097/OLQ.0000000000000042
Original Study

Background South Africa recommends universal syphilis and HIV testing in pregnancy, with prompt antiretroviral therapy or penicillin treatment for women testing positive.

Methods We used a multistage, purposeful sampling strategy to retrospectively identify clinical records from a sample (7.3%) of 32,518 women delivering from January 2005 to June 2006 at 6 public clinics in the Northern Cape and Gauteng. Descriptive analyses and logistic regression were used to assess coverage and factors related to testing and treatment of HIV and syphilis.

Results Of 2379 women sampled, 93% accessed antenatal care (ANC) services during pregnancy and 71% before the third pregnancy trimester. Testing during pregnancy or delivery was 74% for HIV and 84% for syphilis; testing at the first ANC visit was 41% and 71%; and infection prevalence at delivery was 14% and 5%, respectively. Of 243 women with reactive HIV tests, 104 (43%) had treatment documented (single-dose nevirapine) before delivery. Of 98 women with reactive syphilis tests, 73% had documented receipt of 1 penicillin injection and 36% had all 3 recommended injections. Multivariable analysis found women tested for syphilis were almost 4 times more likely to have had no HIV test compared with those without syphilis testing (adjusted odds ratios, 3.9; 95% confidence interval, 1.7–5.5).

Conclusions Integration and provision of a package of HIV and syphilis testing at the first ANC visit and decentralizing treatments of both infections to primary care settings could increase the coverage of testing and treatment services, thus enhancing the effectiveness of current programs eliminating mother-to-child transmission of HIV and syphilis.

A study of women giving birth at public facilities in South Africa suggests a lack of functional integration and medication for HIV and syphilis treatment at the facility level.

From the *Centers for Disease Control and Prevention, Division of Global HIV/AIDS (CDC/DGHA), Atlanta, GA; †Centers for Disease Control and Prevention, Division of Sexually Transmitted Disease Prevention (CDC/DSTDP), Atlanta, GA; ‡National Institute for Communicable Diseases of the National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa; §Gauteng Department of Health, Johannesburg, South Africa; ¶Northern Cape Department of Health, Kimberly, South Africa; and∥Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Acknowledgments: The authors are grateful for the help of Nathan Shaffer; Okey Nwanyanwu; Lesley Brooks; Thomas Peterman; Jeffrey Klausner; Latasha Treger; Lerato Lesole; Mikey Guness; the study teams at the NICD, Centers for Disease Control and Prevention (CDC)/DSTDP, and CDC/DGHA/Prevention of Mother to Child Transmission; and participatinghealth care providers and patients in the Northern Cape and Gauteng provincial departments of health.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the US CDC.

Conflict of interest: None declared.

Correspondence: Thu-Ha Dinh, MD, MS, US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. Email:

Received for publication May 15, 2013, and accepted August 28, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association