Healthcare services provided to pregnant women with HIV and their outcomes at primary healthcare clinics in the Free State province, South Africa

Background: HIV prevalence among pregnant women in South Africa was very high at 25.3% of infections reported in 2022. KwaZulu-Natal province had the highest HIV prevalence of 34.2%, followed by the Eastern Cape with 32.0% infections, and the Free State with a prevalence of 28.8%. Objectives: To determine the HIV prevalence and healthcare services provided to pregnant women with HIV at primary healthcare clinics in the Free State province. Method: This was a retrospective evaluation of all antenatal records from 2020 to 2023 at primary healthcare facilities in the Free State province, South Africa. All pregnant women who started antenatal care and delivered at the clinic were included in the study. Maternal demographic and clinical data, including HIV status, the clinical management of HIV, and perinatal outcomes were recorded. Maternal records of unbooked mothers and those who did not deliver at the clinic were excluded. Results: The antenatal records of 668 pregnant women during the period 2020–2023 were reviewed. The prevalence of HIV was 27.9%, of which 22.4% tested for the first time at booking. Among pregnant women living with HIV, 4.2% had a CD4-count of < 200 cells/mm3, 48.7% had no viral load recorded and 85% were on antiretroviral therapy. Only 69.6% of the HIV-negative women were retested. All infants (n = 187) born to mothers living with HIV had a negative HIV birth polymerase chain reaction test. Approximately 41% of the HIV-exposed infants had a low-birth weight. In addition, two low-birthweight infants were stillbirths. Conclusion: HIV prevalence among pregnant women remains high, with gaps in viral load monitoring and HIV retesting and early antenatal booking. Low-birth-weight rates were higher among HIV-exposed infants, indicating ongoing vulnerability despite available services.