Public health lessons from a pilot programme to reduce mother-to-child transmission of HIV-1 in Khayelitsha

Objective. Short-course antiretroviral therapy (ART) has been shown to be e ffective in reducing mother-to-child transmission (MTCT) of HIV-1. This art icle details the public health lessons learnt from a district-based pilot p rogramme where a short-course zidovudine (ZDV) regimen has been used in a t ypical South African peri-urban setting. Methods. The pilot programme was initiated at two midwife obstetric units i n January 1999. Lay counsellors conducted pre- and post-test counselling an d nurses took blood for HIV enzyme-linked immunosorbent assay (ELISA) testi ng. Short-course ZDV was administered antenatally (from 36 weeks' gestation ) and during labour. Mother-infant pairs were followed up at eight child he alth clinics where free formula feed was dispensed weekly. Infants received co-trimoxazole prophylaxis and were ELISA tested for HIV at 9 and 18 month s, After 17 months protocol changes aimed at eliminating weaknesses include d initiation of ZDV at 34 weeks, self-administration of the first dose of Z DV with the onset of labour, and rapid HIV testing for both mothers and inf ants. Results. Voluntary counselling and testing was shown to be highly acceptabl e, with individual counselling more effective than group counselling. Based on less than optimal availability of records, ZDV utilisation was encourag ing with up to 59% of subjects initiating treatment, 3 weeks' median durati on of ZDV use, and up to 88% receiving at least one intrapartum ZDV dose. S elf-administration of the intrapartum dose reached 41%. Conclusion. Short-course antenatal and intraparturn ART to prevent MTCT of HIV1 was shown to be feasible.