What Works for Women and Girls

dine and lamivudine during pregnancy, labor, and postpartum along with a single doseof nevirapine during labor is especially effective in reducing perinatal transmission. Forinfants of HIV-positive mothers who have not received antiretroviral prophylaxis, treatmentwith a single dose of nevirapine along with one week of zidovudine reduced therisk of HIV acquisition. No significant adverse events were identified for either mothersor their infants after antiretroviral use to prevent perinatal transmission (Volmink et al.,2007). (Gray I) (PMTCT, treatment)A study from the USA that analyzed data from 2,543 HIV-positive women attendingclinics at various sites correlating HAART use during pregnancy with maternal andpregnancy outcomes found that the benefits of antiretroviral treatment outweighed therisks. Maternal outcomes assessed included hematologic, gastrointestinal, neurologic,renal and dermatologic complications; gestational diabetes; lactic acidosis; and death.Logistic regression analyses controlling for multiple covariates revealed HAART to beindependently associated with few maternal complications (Tuomala et al., 2005). (GrayI) (treatment, HAART, PMTCT, United States)Secondary data analysis from a completed randomized trial assessing nevirapine versuszidovudine in reducing PMTCT in Uganda found that maternal viral load was the bestpredictor of both early and late perinatal transmission. Treatment with HAART lowersmaternal viral load. Of 610 infants who were evaluated for HIV acquisition, 99 wereinfected in the early transmission period (first positive HIV RNA PCR obtained before56 days of age) and 23 were infected in the late transmission period (after 56 days ofage). In the multivariate model, six to eight weeks postpartum maternal log10viralload, with a hazard ratio of 3.66, was the strongest predictor of HIV transmission.Pre-entry maternal log10 viral load was also significantly associated with early transmission,hazard ratio of 2.11. (Mmiro et al., 2009). (Gray III) (treatment, HAART, PMTCT,Uganda)A study from Nigeria successfully demonstrated the transition from nevirapine forPMTCT to HAART for both PPT and improved maternal health. With HAART, ratesfollowing HAART (3.6%) were lower than PPT rates using ZDV plus nevirapine (5.2%)or nevirapine only (7.1%) in 1,138 HIV-exposed babies. Almost half of the women deliveredat home or in peripheral health facilities (Sagay et al., 2008). (Gray III) (PMTCT,HAART, Nigeria)A 2004–2007 study in South Africa followed 302 women, who initiated HAART atan antenatal ARV clinic, and found a perinatal transmission rate of 5%. Women whoreceived more than seven weeks of HAART during pregnancy had a perinatal transmissionrate of 0.3%. The study analyzed 689 women who had not previously received treatmentfor HIV and began treatment with HAART while pregnant. These women werefollowed weekly for eight weeks until stable. HIV status was determined by HIV-1 DNAtesting. The study also routinely screened for syphilis. Women were excluded if theyconceived while initiating HAART. About 300 women were diagnosed with HIV duringWHAT WORKS FOR WOMEN AND GIRLS237