What Works for Women and Girls

transmission by 28 weeks among those infants who were negative at 1 week was: 6.4%in the control group, 3% in the second group receiving zidovudine, lamivudine, lopinarand ritonavir (MHAART) and 1.8% in the third group, in which infants received dailynevirapine (INVP). The estimated risk of HIV transmission or death at 28 weeks (breastfeedingstopped at 24 weeks) was 7.6% in the control group, 4.7% in the MHAARTgroup and 2.9% in the INVP group. These results were statistically significant althoughthe study was not powered to compare the two treatment groups. There was a trendfavoring INVP prophylaxis (Chasela, et al., 2009) (Abstract) (breastfeeding, treatment,PMTCT, Malawi)2. Early postpartum visits can result in increased condom use, contraceptive use, HIV testingand treatment.A quasi-experimental pre-post test study conducted from 2006 through 2007 ofmaternal health care interventions in Swaziland that provided care for all pregnantwomen, including HIV-positive women at several intervals (within the first six hoursafter delivery; an exam once per day postpartum while the woman was in the healthfacility; providing assessment, care and counseling, along with a specific appointmentfor the first postnatal visit upon being discharged from the facility and providing a postnatalvisit at one week postpartum and a second visit at four to six weeks postpartum)increased contraceptive use and counseling on condom use. Over 60% of maternaldeaths occur within 48 hours after childbirth (Lewis, 2004 cited in Mazia et al., 2009),yet in Swaziland, mothers are usually discharged within 12 hours of delivery. Theconventional recommendation for the first postnatal visit is at four to six weeks, bywhich time most of the postpartum deaths have already taken place. The study collecteddata on 114 HIV-positive women at the start of the study and from 136 HIV-positivewomen to evaluate the impact a year later. The intervention increased early postnatalvisits by twenty-fold. Providers increased counseling of HIV-positive women on theneed to regularly monitor CD4 counts for the mother from 41% to 74%. Following theintervention, 93% of mothers were assured of privacy. While at baseline, the providerasked the woman her preferred family planning only 32% of the time, by the end of theintervention, 82% did so. While at baseline, only 28% of clients received their preferredfamily planning method, at the end of the intervention, 70% did so. While at baseline,providers only counseled on condom use 16% of the time, by the end of the intervention,25% did so. The percent of women on HAART increased from 4% to 15% and themother tested for her CD4 count since giving birth increased from 4% to 26%. Therewas also a statistically significant increase in the proportion of postpartum women (88to 98%) and their partners (from 28% to 56%) getting tested for HIV. Since the postnatalvisit within one week of delivery did not exist anywhere in the country at the preinterventionphase, conclusions following the introduction of the new timing of postnatalcare could be assessed. Actual condom use was not measured (Mazia et al., 2009).(Gray III) (PMTCT, family planning, counseling, HIV testing, Swaziland)258 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION