ABSTRACT
OBJECTIVE: To measure HIV prevalence at health-district level in the Western Cape (WC) and to compare these findings with those of the National HIV Antenatal Surveys (NHASs). This investigation aimed to estimate the degree of heterogeneity of HIV prevalence within the province in order to inform the design of appropriate and targeted HIV interventions. METHOD: Annual cross-sectional, unlinked district HIV antenatal surveys were implemented in all 25 health districts of the WC for the years 2001 - 2004, concurrently with the NHAS. A stratified proportional sample was drawn for each district, involving all 344 antenatal clinics in the province, and the anonymous screening method as described by the World Health Organization (WHO) was applied. RESULTS: The NHAS revealed a significant increase in HIV prevalence in the WC from 8.6% (95% confidence interval (CI): 5.6 - 11.6) in 2001 to 15.4% (95% CI: 12.5 - 18.2) in 2004. The district-level HIV surveys showed wide variation in HIV prevalence across the health districts, which increased progressively during this period (a range of 0.6 - 22% for the year 2001 increased to 1 - 33% in 2004). Spatial analysis of HIV prevalence by health district for this period also revealed progressive spatial growth of the sub-epidemics, with the highest prevalence observed in districts located in the Cape metropole region. CONCLUSIONS: These concurrent surveys highlight the fact that examining a provincial estimate of HIV prevalence alone has the potential to mask epicentres within the province. This underscores the importance of expanding the surveillance systems to detect heterogeneity sub-provincially, in order to link with local-level planning and resource allocation.
Subject(s)
Catchment Area, Health/statistics & numerical data , HIV Infections/epidemiology , HIV Seroprevalence/trends , Population Surveillance/methods , Pregnancy Complications, Infectious/epidemiology , Anonymous Testing , Cluster Analysis , Confidence Intervals , Cross-Sectional Studies , Female , HIV Infections/diagnosis , HIV Infections/prevention & control , Health Planning/organization & administration , Health Surveys , Humans , Pilot Projects , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/prevention & control , Prenatal Diagnosis , Residence Characteristics , Risk Factors , South Africa/epidemiology , Urban Health/statistics & numerical dataABSTRACT
BACKGROUND: In the absence of interventions and breast-feeding, the in utero transmission rate of human immunodeficiency virus (HIV) is estimated to be 10%-15%, and the role that amniotic fluid (AF) plays in this is unclear. OBJECTIVES: Levels of cytomegalovirus (CMV) in AF and levels of HIV-1 in AF, maternal blood, and fetal cord blood were assessed.Study design. We enrolled 23 HIV-1-positive women with healthy, singleton pregnancies who underwent elective cesarean section (CS) at full term. The Roche Amplicor HIV-1 Monitor test (version 1.5) was used for determination of maternal plasma VLs. The NASBA Nuclisens assay was used for determination of VLs in other samples. To determine the feasibility of detecting viral infections in AF, CMV polymerase chain reaction DNA extraction was performed on the AF samples by use of the QIAamp DNA kit. RESULTS: HIV-1 RNA was not detected in either AF or fetal cord blood. CMV was detected in 4 AF samples. Maternal CD4(+) T cell counts were 158-654 cells/mL (mean, 405 cells/mL). The maternal plasma VLs ranged from below detectable limits to 169,990 copies/mL (mean, 33,700 copies/mL). CONCLUSIONS: In the absence of medical complications and before labor, AF collected during elective CS from women who had received either zidovudine or nevirapine during late-stage pregnancy was free of HIV.
