Exploring Factors Driving Vertical HIV Transmission: A Case-Based Intervention in Cape Town, South Africa
1
1 School of Public Heatlh, University of Cape Town, Cape Town, South Africa
2
2 Department of Health and Wellness, Western Cape Government, Cape Town, South Africa
3
3 Department of Global Health, Stellenbosch University, Cape Town, South Africa
4
4 School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A587
ABSTRACT
INTRODUCTION:
Vertical transmission (VT) of HIV from pregnant or breastfeeding women to their infants is a preventable adverse outcome. The World Health Organization (WHO) emphasises early antenatal care, timely HIV diagnosis and rapid initiation of antiretroviral therapy (ART). We evaluated a quality improvement intervention designed to strengthen VT understanding, management and prevention in a Cape Town sub-district.
METHODS:
The intervention included: (1) digitising paper-based VT records (1 January 2016 – 31 December 2024) using a new electronic capture form integrated into the Western Cape Provincial Health Data Centre; (2) generating automated reports from captured data; and (3) conducting quarterly VT case reviews using a morbidity and mortality style approach to identify system gaps and propose preventative strategies. Data were described quantitatively, and qualitative reflections from key stakeholders informed the evaluation.
RESULTS:
Ninety woman–infant pairs with VT (15.1% of infants diagnosed with HIV) were recorded, with 90% documented in 2021–2022 during an intensive rollout. Most transmissions were detected through routine birth testing (72.2%). Antenatal attendance was recorded for 57.8% of women, 52.2% knew their HIV status pre-pregnancy and 63.3% initiated ART before or during pregnancy. Data completeness varied: demographic details were well-captured, but clinical variables e.g. ART regimen, were often missing. Quarterly case reviews enabled multidisciplinary learning, iterative improvements to the electronic form and strengthened referral pathways. Although clinicians viewed data entry as onerous, the engagement was valued. Key contributors to VT included late or absent antenatal care, treatment interruption and social factors. Concerns about blame and dependence on a single local champion highlighted sustainability risk.
CONCLUSIONS:
This case-based intervention enhanced understanding of VT and identified opportunities to strengthen prevention through earlier identification of at-risk pregnancies, improved referral pathways and better retention in care. Long-term success will require attention to governance, administrative burden and sustainable support for healthcare workers.
Vertical transmission (VT) of HIV from pregnant or breastfeeding women to their infants is a preventable adverse outcome. The World Health Organization (WHO) emphasises early antenatal care, timely HIV diagnosis and rapid initiation of antiretroviral therapy (ART). We evaluated a quality improvement intervention designed to strengthen VT understanding, management and prevention in a Cape Town sub-district.
METHODS:
The intervention included: (1) digitising paper-based VT records (1 January 2016 – 31 December 2024) using a new electronic capture form integrated into the Western Cape Provincial Health Data Centre; (2) generating automated reports from captured data; and (3) conducting quarterly VT case reviews using a morbidity and mortality style approach to identify system gaps and propose preventative strategies. Data were described quantitatively, and qualitative reflections from key stakeholders informed the evaluation.
RESULTS:
Ninety woman–infant pairs with VT (15.1% of infants diagnosed with HIV) were recorded, with 90% documented in 2021–2022 during an intensive rollout. Most transmissions were detected through routine birth testing (72.2%). Antenatal attendance was recorded for 57.8% of women, 52.2% knew their HIV status pre-pregnancy and 63.3% initiated ART before or during pregnancy. Data completeness varied: demographic details were well-captured, but clinical variables e.g. ART regimen, were often missing. Quarterly case reviews enabled multidisciplinary learning, iterative improvements to the electronic form and strengthened referral pathways. Although clinicians viewed data entry as onerous, the engagement was valued. Key contributors to VT included late or absent antenatal care, treatment interruption and social factors. Concerns about blame and dependence on a single local champion highlighted sustainability risk.
CONCLUSIONS:
This case-based intervention enhanced understanding of VT and identified opportunities to strengthen prevention through earlier identification of at-risk pregnancies, improved referral pathways and better retention in care. Long-term success will require attention to governance, administrative burden and sustainable support for healthcare workers.
| eISSN: | 2654-1459 |
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