Divergent spatial patterns in the prevalence of the human immunodeficiency virus (HIV) and syphilis in South African pregnant women.

An analysis of the ecological association between the human immunodeficiency virus (HIV) and syphilis was undertaken using joint mapping modelling based on data from South African national HIV and syphilis sentinel surveillance surveys carried out between 2007 and 2009. The syphilis prevalence, taken as proxy for sexual behaviour and increased HIV transmission, was first used with health district-level deprivation and population density as a covariate in a HIV prevalence spatial regression model and, secondly, together with HIV as a bivariate outcome. HIV is more highly prevalent in deprived and populated areas than elsewhere, while syphilis has a high prevalence in less deprived and less populated areas. Spatially, the HIV prevalence was lowest in the southwestern and highest in the northeastern parts of the country. This was in discordance to the syphilis prevalence, which revealed negative correlations with HIV prevalence. Considerable variations across the districts remained after adjusting for the contextual covariate factors. Divergent spatial patterns between HIV and syphilis were identified, regarding both observed and unobserved covariate effects. The differential disease-specific spatial prevalence patterns may point to inconsistent successes in interventions between the two diseases. Overall, the results emphasize the need to develop and test plausible aetiological hypotheses relating to ecological correlations and causes of the disease-specific interjectory between the districts.

Follow-up survey of women who have undergone a prevention of mother-to-child transmission program in a resource-poor setting in South Africa.

The aim of this study was to investigate the implementation of a prevention of mother-to-child transmission (PMTCT) program and to evaluate the uptake and adherence to single-dose nevirapine in a cohort sample that had undergone PMTCT in five public clinics in a resource-poor setting, Quakeni Local Service Area, O.R. Tambo District in the Eastern Cape, South Africa. Results indicated that 116 women (15.3% of the sample) were infected with HIV, 642 (84.7%) were uninfected, and 552 (42.1%) had an unknown HIV status. Almost all of the women had received information about HIV and HIV testing prenatally, but 552 (42%) had not been tested for HIV, and their HIV status was unknown. Only 66 (57%) of the HIV-infected pregnant women had been provided with nevirapine. It is recommended that the quality of HIV counseling be improved and the program of maternal self-medication with nevirapine tablets at onset of labor and maternal provision of nevirapine syrup to newborns be encouraged.

Barriers to prevention of HIV transmission from mother to child (PMTCT) in a resource poor setting in the Eastern Cape, South Africa.

The aim of this study was to investigate knowledge of PMTCT and to describe potential barriers that might affect acceptability of interventions for PMTCT in a resource poor setting in South Africa. The sample included 1534 pregnant women recruited at first antenatal care visit from 5 clinics implementing PMTCT (61%) and from 5 communities around the 5 clinic areas (39%). In addition, the mothers or mothers-in-law (70.9%) and husbands or partners (58.2%) of the pregnant women were interviewed at their homes. Results indicate that major potential barriers in implementing PMTCT programmes in a resource poor setting included physical access to the health facility, PMTCT knowledge, stigma and support, HIV testing, and delivery preference.