Reduction in Perinatal HIV Infections in KwaZulu-Natal, South Africa, in the Era of More Effective Prevention of Mother to Child Transmission Interventions (2004–2012)

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To describe a trend in perinatal HIV transmission associated with the implementation of rapidly changing prevention of mother to child transmission (PMTCT) interventions from 2004 to 2012.


Retrospective analysis of infant HIV polymerase chain reaction results of infants from 2004 to 2012 archived from a Laboratory Information System.


KwaZulu-Natal, South Africa.

Main Outcome Measure:

HIV infection in infants aged 4–8 weeks.


The proportion of 4- to 8-week-old infants who tested HIV polymerase chain reaction positive decreased significantly (P < 0.0001) from 27.5% in 2004 to 2.9% in 2012. The reduction rates in perinatal HIV infections in 4- to 8-week-old HIV-exposed infants decreased significantly (P < 0.0001) by 48.7% following single-dose nevirapine (sdNVP) (2005 to April 2008), 68.4% with zidovudine from 28 weeks and sdNVP together with triple antiretroviral therapy for women with CD4+ cell count < 200 cells/mm3 (May 2008–April 2010), and 89.5% with zidovudine from 14 weeks, sdNVP, and triple antiretroviral therapy for women with CD4+ cell count < 350 cells/mm3 (May 2010–December 2012).


We show an almost 10-fold reduction in mother to child transmission from 2004 to 2012 in infants aged 4–8 weeks during a rapid implementation of more complex and robust PMTCT interventions. The significant reductions in mother to child transmission in the South African PMTCT program are encouraging for a middle-income country with the second highest antenatal HIV prevalence in the world.

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