What Works for Women and Girls

Training a key obstetrician on antiretroviral treatment at a medical center in Tanzaniaresulted in 25 women needing HAART gaining timely access to treatment (Ginsburg etal., 2007). (Gray V) (providers, training programs, HAART, Tanzania)In a study at Coronation Women and Children Hospital, South Africa, data were gatheredfrom HIV-positive women attending antenatal care from June 2004 to July 2005 toevaluate linking antenatal with antiretroviral treatment (ARV) services. After a patientrecord review, interventions were implemented to strengthen service linkages and integrateARV treatment within antenatal care. Laboratory investigations were streamlined,including CD4 cell count testing at the first antenatal visit. MTCT risk for women initiatingARV treatment was compared with that of women-infant pairs receiving singledosenevirapine (sd-NVP). In total, 164 pregnant women initiated ARV treatment and863 received sd-NVP. After changes to service delivery, time-to-treatment initiation wasreduced from a median of 56 days to 37 days. The risk of MTCT for women receivingARV treatment was lower than for those given sd-NVP (van der Merwe et al., 2006).(Gray V) (PMTCT, treatment, antenatal care, South Africa)6. PMTCT-Plus (family-focused) HIV care can increase the numbers of women and theirmale partners who access testing and treatment.A study from Côte d’Ivoire evaluating an MTCT-plus program from 2003 to 2005 founda significant increase in antiretroviral treatment initiation and high rates of retention incare for women and their partners. Of the 605 women enrolled during the study period,fewer than 2% of women and 9% of their partners were receiving antiretroviral treatmentprior to enrollment in the program, in comparison to 41.5% of women and 65%of their partners after enrollment at the close of the study period. Retention rates werealso high: only 2.5% of women and 5.5% of partners initiating ART were lost to followup,while 2% of women and 0% of partners not eligible for ART were lost to follow-up(Tonwe-Gold et al., 2009). (Gray III) (PMTCT-Plus, treatment, Côte d’Ivoire)A study in rural Uganda providing PMTCT-Plus resulted in vertical HIV transmissionrate dropping from over 27% to 8%; a HAART adherence rate of more than 95% for80% of clients and an overall 36-month mortality rate of 8%. The program reached16,000 pregnant women, 1,454 children and 683 men with VCT and HIV services.Services consisted of patient monitoring using WHO clinical staging, generic antiretroviraldrugs and rapid HIV testing. Social services included nutrition interventions,loans and home based water chlorination. All services were incorporated into reproductivehealth services (Lukoda and Gibson, 2008). (Abstract) (PMTCT-plus, HAART,PMTCT, HIV testing, Uganda)244 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION