Objectives: We describe pregnant womens’ access to PMTCT and HAART services and associated birth outcomes in South
Methods: Women recuperating in postnatal wards of a referral hospital participated in an evaluation during February–May
2010 during which their maternity records were examined to describe their access to VCT, CD4 Counts, dual ART or HAART
Results: Of the 1609 women who participated in this evaluation, 39% (95%CI36.7–41.5%) tested HIV-positive during their
pregnancy. Of the HIV-positive women 2.9% did not have a CD4 count done and an additional 31.3% did not receive their
CD4 results. The majority (96.8%) of the HIV-positive women commenced dual ART at their first antenatal visit independent
of their CD4 result. During February–May 2010, 48.0% of the women who had a CD4 result were eligible for HAART
(CD4,200 cells/mm3) and 29.1% of these initiated HAART during pregnancy. Under the current South African PMTCT
guidelines 71.1% (95%CI66.4–75.4%) of HIV positive pregnant women could be eligible for HAART (CD4,350 cells/mm3).
There were significantly more preterm births among HIV-positive women (p = 0.01) and women who received HAART were
no more at risk of preterm deliveries (AOR 0.73;95%CI0.39–1.36;p = 0.2) as compared to women who received dual ART. Nine
(2.4%; 95%CI1.1–4.5%) HIV exposed infants were confirmed HIV infected at birth. The in-utero transmission rate was highest
among women who required HAART but did not initiate treatment (8.5%) compared to 2.7% and 0.4% among women who
received HAART and women who were not eligible for HAART and received PMTCT prophylaxis respectively.
Conclusion: In this urban South African community the antenatal HIV prevalence remains high (39%) and timeous access to
CD4 results during pregnancy is limited. Under the current South African guidelines, and assuming that access to CD4
results has improved, more than 70% of HIV-positive pregnant women in this community would be requiring HAART.