What Works for Women and Girls

A study that analyzed medical records for three years, from 2005 to 2007, in Uganda,found that HIV-positive patients who were on antiretroviral therapy had lower malariaprevalence. Prevalence of malaria for HIV-positive patients on antiretroviral therapyduring the three-year period was 12% (12,929) as compared to 44% prevalence amongHIV-positive patients not on antiretroviral therapy (47,109). The average number oftimes a patient on antiretroviral therapy presented with malaria significantly reduced by23 times compared to the number of times HIV-positive patients not on antiretroviraltherapy (Taslima and Mulongo, 2008). (Gray V) (treatment, malaria, Uganda)2. Monthly doses of Intermittent Preventive Treatment (IPT) of malaria with sulfadoxine-pyrimethamine(SP) is effective in preventing malaria among pregnant HIV-positive women(but should not be combined with co-trimoxazole).A study in Malawi from 2002 to 2005 compared monthly doses of Sulfadoxine-Pyrimethamine (SP) Intermittent Preventive Treatment (IPTp) from initiation to deliverywith a 2-dose treatment of SP, at initiation and 28 weeks, to prevent placental malariain 195 HIV-positive and in 303 HIV-negative pregnant women. The study found thatmonthly dosage proved more effective for HIV-positive women with only 7.8% havingplacental malaria at delivery compared to 21.5% of women who underwent the 2-doseregimen. Reduction in relative risk was similar for HIV-positive and HIV-negativewomen: for HIV-negative women, 2.3% receiving monthly SP and 6.3% receiving2-dose SP had placental malaria, though the difference was not significant. Adversedrug reactions were reported in less than 1% of women. During the study combinationantiretroviral therapy was not routinely available in Malawi (Filler et al., 2006). (GrayIII) (treatment, malaria, Malawi)Promising Strategies:3. PCR has a higher sensitivity to detect malaria co-infection in HIV-positive and HIV-negativepregnant women.A hospital-based study in Kenya followed 157 women ages 15-40 with vaginal deliveriesand found placental malaria in 17.2% of infants and congenital malaria in 0% of infantsby microscopy, while PCR detected 33.1% and 10.8%, respectively (Perrault et al., 2009).(Gray IV) (PCR, malaria, pregnancy, Kenya)282 CHAPTER 10 PREVENTING, DETECTING AND TREATING CRITICAL CO-INFECTIONS