Prevention of mother-to-child transmission.

235 March 2014, Vol. 104, No. 3 (Suppl 1) Eliminating mother-to-child transmission (MTCT) of HIV requires monitoring of the prevention of mother-to-child transmission (PMTCT) programme to identify programme gaps for intervention. Early infant diagnosis (EID) is critical for identifying HIVinfected infants to enable early initiation of antiretroviral therapy (ART), which has been shown to reduce morbidity and mortality. As South Africa (SA) works towards eliminating vertical transmission by 2015, EID is also essential for monitoring the success of the PMTCT programme by demonstrating a decline in MTCT. The target set for virtual elimination is <2% and <5% transmission at 6 weeks of age and 18 months of age, respectively. EID is performed by an HIV polymerase chain reaction (PCR) test recommended at ~6 weeks of age. An estimated 270 000 HIV-exposed infants are born annually in SA and are eligible for PCR testing. At inception of the PMTCT programme in 2002, diagnostic assays required for EID were unavailable in the public sector. Instead, HIV-exposed children were tested at 18 months of age with an HIV enzyme-linked immunosorbent assay to establish their HIV infection status. When the national rollout of ART in the public sector commenced in April 2004, a p24 antigen assay with a sensitivity of 50% was recommended for EID to identify infants for treatment. Although PCR testing was available in three National Health Laboratory Service (NHLS) laboratories in the public health sector, it was considered too expensive and complex and was therefore restricted to clinical trial participants and abandoned children requiring adoption or foster care placement. Towards the end of 2004, PCR testing became available in the public sector, but lack of paediatric phlebotomy skills in primary healthcare facilities prevented decentralisation of EID services. This bottleneck was addressed during 2005 by the introduction of dried blood spot sampling for the PCR assay and training of healthcare workers. Coupled with improved clinical capacity, public sector laboratory capacity was increased to 10 NHLS laboratories and the EID testing programme was launched. By 2006, approximately half of the public health facilities submitted HIV PCR tests and by 2012 virtually all 4 000 public sector facilities submitted PCR tests. All HIV tests for the public sector, accounting for ~85% of the SA population who do not have medical insurance, are done by the NHLS. The NHLS has a national network of >260 laboratories, each with its own laboratory information system (LIS). PCR tests received by local NHLS laboratories are referred to the nearest of ten centralised NHLS PCR laboratories. Laboratory requisition forms, completed by healthcare workers at each public health facility, accompany each sample submitted for testing. Data on the requisition form (including patient identifying details, name of the facility where blood sampling was done, date of blood sampling and tests requested) are captured onto the LIS. All data, including the test result, are fed centrally to the corporate data warehouse (CDW) and are available for analysis in real time. The CDW records the number of PCR tests performed, but as there is currently no unique identifier for each patient, the number of Laboratory information system data demonstrate successful implementation of the prevention of motherto-child transmission programme in South Africa