Background: Combination antiretroviral therapy (cART) is the current strategy to prevent mother-to-child transmission
(PMTCT) of HIV. Women initiated on cART should continue taking treatment life-long or stop after cessation of
breastfeeding depending on their CD4 cell count or on their World Health Organization (WHO) staging. Keeping
people living with HIV on treatment is essential for the success of any antiretroviral therapy (ART) programme.
There has been a rapid scale-up of cART in the PMTCT programme in South Africa. cART is supposed to be taken
life-long or until cessation of breastfeeding, but premature or unmanaged discontinuation of cART postpartum is
not unusual in South Africa and is confirmed by studies from around the world. Discontinuation of cART can lead
to mother-to-child transmission (MTCT), drug resistance and poor maternal outcomes. The extent of this problem
in the South African context however is unclear. This study aims to determine the prevalence of and identify risk
factors associated with discontinuation of cART postpartum amongst women who were initiated on antiretroviral
treatment during their index pregnancy.
Methods: An observational analytic cross-sectional study design will be conducted in six health facilities in a high
prevalence district in KwaZulu-Natal, South Africa over a period of 3 months in 2014. An interviewer-administered
questionnaire will be used to collect data from mothers who initiated cART during their index pregnancy. The
prevalence of discontinuation of cART postpartum will be measured, and the association between those who
discontinue cART postpartum and independent variables will be estimated using multivariable-adjusted prevalence
odds ratios for discontinuation.