South Africa: Lower coverage of maternal HIV testing among adolescents leading to higher mother-to-child transmission

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Adolescents have lower coverage of HIV testing and subsequent prevention of mother-to-child transmission (PMTCT) services and significantly higher early vertical transmission rates compared with adults, according to findings from three South African national surveys, presented by Trisha Ramraj at the 7th South African AIDS Conference last month in Durban.

The surveys also found that there was a significant reduction in early mother-to-child transmission in pregnant women who were 20 years and older, but not in pregnant women who were younger than 20 years old. Infants born to adolescent mothers were three times more likely to be infected with HIV compared to adult women across all surveys (OR: 2.99, 95% CI: 1.12-7.98), when adjusted for PMTCT intervention, maternal education, CD4 cell count and survey year.

Data from 4704 women younger than 20 years old and 25,253 women who were 20 years and older were analysed. The only significant difference in PMTCT coverage across all three surveys between women younger than twenty years and those who were 20 years old and over was being tested for HIV prior to the current pregnancy. Only 14.7%, 20.9% and 59% of adolescent pregnant women, compared to 40.9%, 64.9% and 76.3% in adult women, had been tested for HIV before the current pregnancy in 2010, 2011 and 2012 respectively. There was no significant difference in the average number of antenatal care visits, knowledge about the PMTCT programme or provision of antiretroviral treatment (ART) during pregnancy when comparing adolescent and adult women.


vertical transmission

Transmission of an infection from mother-to-baby, during pregnancy, childbirth, or breastfeeding.


mother-to-child transmission (MTCT)

Transmission of HIV from a mother to her unborn child in the womb or during birth, or to infants via breast milk. Also known as vertical transmission.


Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).

cross-sectional study

A ‘snapshot’ study in which information is collected on people at one point in time. See also ‘longitudinal’.

retrospective study

A type of longitudinal study in which information is collected on what has previously happened to people - for example, by reviewing their medical notes or by interviewing them about past events. 

Three cross-sectional facility-based surveys were conducted in 2010, 2011 and 2012 at 580 randomly selected health facilities. Infants between 4 and 8 weeks old were sampled consecutively and systematically. The primary caregiver was interviewed and infant dry blood spot (DBS) samples were taken. Data were weighted for sample realisation and population live births and analysed separately for each survey and then pooled across all three years for overall vertical transmission for adolescents and adults to be calculated.

“Adolescent-focused services are urgently needed to improve adolescent HIV testing uptake and PMTCT coverage,” said Ramraj.

Another study looked at the reproductive health status of adolescents assessed by Ward Based Outreach Teams (WBOTs) in a retrospective cross-sectional study of nine communities in Tshwane, South Africa, which between October 2011 and September 2013 reviewed the self-reported information on pregnancy, HIV, genital disorder and use of contraception among 7123 10- to 19-year-old adolescents.

This study also showed poor reproductive health outcomes for adolescents. Between 3.4% and 6.1% of the adolescents tested HIV-positive. This HIV prevalence rose to between 4.9% and 7.7% among the pregnant women. Genital disorders were also found in 3.2% of the respondents.

The prevalence of current pregnancy was found to be 3.6% currently, which rose to 13.8% when all previous pregnancies were included. Only 17.5% of the adolescents were using contraceptive methods and only 17.4% were using dual contraception (male condoms and female hormonal contraceptive). Forty-six per cent of respondents reported not having used a condom during their last penetrative sexual act.

The outreach teams consist of 12 to 20 community health workers that service a defined number of households in a specific geographic area. Their activities include health education, community-based screening referrals, disease monitoring, adherence support and home-based care and have been active in the area since 2011.  

“The reproductive health status of the adolescents assessed is a concern. Adolescents are more susceptible to health issues such as unintended pregnancy and HIV infection and are more vulnerable to the consequences thereof than adults such as financial dependency and the loss of educational and employment opportunities. However, adolescent health is still often neglected,” said Dr Hans-Friedemann Kinkel, who presented the study.


Kinkel H-F et al. The reproductive health status of adolescents assessed by Ward Based Outreach Teams (WBOTs): a cross-sectional study of nine communities in Tshwane District, South Africa. 7th South African AIDS Conference, June 2015, Durban, South Africa.

Ramraj T et al. Mother-to-child transmission of HIV amongst adolescents: findings from three national surveys, South Africa, 2010, 2011-12 and 2012-13. 7th South African AIDS Conference, June 2015, Durban, South Africa.