What Works for Women and Girls

HIV acquisition was low birth weight, while infant feeding practice, gender, maternalARV regimen, CD4 count and age were not significant. (Tonwe-Gold et al., 2007). (GrayIII) (PMTCT-Plus, HAART, PMTCT, Côte d’Ivoire)A 2002 study in Nigeria found that among the 32 women who were given HAART,transmission of HIV to infants was 9.1%. Among the 22 women who had single dosenevirapine in labor there was a transmission rate of over 33%. The best outcome wasamong those that had HAART, an elective C-section and did not breastfeed; none of thebabies were HIV-positive at 18 months. “It is recommended that the single dose nevirapinebe abandoned in favour of combination treatment… The single dose nevirapine….may lead to the spread of a nevirapine-resistant strain” (Chama et al., 2007: 134 and136). (Gray III) (HAART, PMTCT, treatment, Nigeria)A study in Mozambique from 2002 to 2005 of 985 HIV-positive pregnant women foundthat HAART was more widely accepted than single-dose nevirapine in earlier studies,with 80% completing a treatment protocol of HAART until six months postpartumand beyond. Maternal mortality was 0.8%, with vertical transmission rates of 1.4% atsix months, equivalent to those developed countries (Marazzi et al., 2007). (Gray III)(HAART, treatment, Mozambique)A study in Jamaica with over 69,995 pregnant women presenting for antenatal carebetween 2005 and 2007 found that the use of HAART decreased perinatal transmissionfrom 6% to 1.6% in 3 urban areas and to 4.75% island-wide (Christie et al., 2008).(Gray V) (antenatal care, HAART, PMTCT, Jamaica)2. For women who are pregnant and not eligible for HAART for their own health, shortcourseARV therapy used for prophylaxis can reduce nevirapine resistance.A 2009 study from Thailand found that one month of zidovudine (ZDV 300 mg twicedaily) and didanosine (ddI400 mg once daily) following a single dose of nevirapine(NVP) during labor prevented almost all NNRTI resistance. Two hundred and twentyARV-näive HIV-positive pregnant women with CD4 counts greater than 250 cells/mm 3receiving postpartum ZDV treatment during the third trimester, single dose NVP duringlabor, and 1 month of ZDV/ddI were matched with women (with similar CD4 counts)receiving ZDV treatment during the third trimester and single dose NVP during labor(but no postpartum treatment). Resistance mutations were found in 1.8% of womenwho received the 1 month postpartum ZDV/ddI and in 20.7% of the women who didnot receive postpartum treatment (Lallemant et al., 2009). (Gray III) (PMTCT, treatment,Thailand)A study from Thailand that enrolled 169 HIV-positive pregnant women (28 to 38 weeksgestation) from 2006 to 2008 found that postpartum antiretroviral treatment for atleast 7 days after a single dose of intrapartum nevirapine (NVP) significantly reducedthe development of NVP resistance. Women included in the study had CD4 counts ofgreater than 250 cells/mm 3 , may or may not have received zidovudine (ZDV) during240 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION