What Works for Women and Girls

What Works—Safe Motherhood and Prevention of Vertical Transmission: Treatment1. Antiretroviral treatment regimens for pregnant women living with HIV can improvethe health of the mother when used as treatment and can reduce the risk of motherto-childtransmission when used as prophylaxis.2. For women who are pregnant and not eligible for HAART for their own health, shortcourseARV therapy used for prophylaxis can reduce nevirapine resistance.3. Extending an HIV-positive woman’s life increases the long-term survival of her infant.4. National scale-up of HAART in pregnancy improves maternal and infant outcomes.Promising Strategies:5. Integrating ARV therapy into antenatal care, rather than referring women separatelyfor HIV treatment, may reduce time to treatment initiation for pregnant women livingwith HIV.6. PMTCT-Plus (family-focused) HIV care can increase the numbers of women and theirmale partners who access testing and treatment.EVIDENCE1. Antiretroviral treatment regimens for pregnant women living with HIV can improve thehealth of the mother when used as treatment and can reduce the risk of mother-to-childtransmission when used as prophylaxis. [See also 9E. Postpartum]A systematic review of the literature on the relationship between pregnancy and HIVdisease progression in the context of HAART with six research studies found that “...thegeneral consensus remains that the potential side effects of HAART use for HIV-positivewomen during pregnancy appear to be minimal, but further research is required”(MacCarthy et al., 2009: S67). However, studies suggest that pregnant HIV-positivewomen on HAART have the lowest risk of HIV disease progression, compared withpregnant HIV-positive women on other forms of treatment (MacCarthy et al., 2009).(Gray I) (HAART, pregnancy)A 2007 Cochrane review on antiretrovirals used to prevent perinatal transmission ofHIV found that antiretroviral treatment during the perinatal period (antenatal and peripartum)significantly reduced the risk of HIV transmission in comparison with placebo.For zidovudine, the length of treatment was significantly associated with risk of HIVtransmission. Longer treatments during the antenatal period appear to significantlylower infant risk of HIV acquisition. Moreover, for mothers, a short-course of zidovu-236 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION