title: Dual and triple therapy to prevent mother-to-child transmission of HIV in a resource-limited setting - lessons from a South African programme.
abstract: OBJECTIVE
  To determine outcomes of pregnant women and their infants at McCord Hospital in Durban, South Africa, where dual and triple therapy to reduce HIV vertical transmission have been used since 2004 despite national guidelines recommending simpler regimens.
  
  
  METHODS
  We retrospectively examined records of all pregnant women attending McCord Hospital for their first antenatal visit between 1 March 2004 and 28 February 2007. Uptake of HIV testing and HIV prevalence were determined, and clinical, immunological and virological outcomes of HIV-positive women and their infants, followed through to 6 months after delivery, were described.
  
  
  RESULTS
  The antenatal clinic was attended by 5 303 women; 4 891 (92%) had an HIV test, and 703 (14%) were HIV positive. The HIV-positive women were subsequently followed up: 653 (93%) received antiretroviral therapy or prophylaxis, including 424 (60%) who received triple therapy. Of the 699 live babies delivered, 661 (94%) received prophylaxis. At 6 weeks 571 babies (82%) were brought back for HIV testing; 16 (2.8%) were HIV positive. After 6 months, only 150 women (21%) were receiving follow-up care at the adult HIV clinic.
  
  
  CONCLUSIONS
  Where a tailored approach to prevention of mother-to-child transmission (PMTCT) is used, which attempts to maximise available technology and resources, good short-term transmission outcomes can be achieved. However, longer-term follow-up of mothers' and babies' health presents a challenge. Successful strategies to link women to ongoing care are crucial to sustain the gains of PMTCT programmes.
authors.affiliation: Department of Public Health Medicine, University of KwaZulu-Natal, Durban. rosemary.geddes@hgu.mrc.ac.uk
authors.forename: Rosemary
authors.initials: R
authors.lastname: Geddes
authors.forename: Janet
authors.initials: J
authors.lastname: Giddy
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Butler
authors.forename: Erika
authors.initials: E
authors.lastname: Van Wyk
authors.forename: Tamaryn
authors.initials: T
authors.lastname: Crankshaw
authors.forename: Tonya M
authors.initials: TM
authors.lastname: Esterhuizen
authors.forename: Stephen
authors.initials: S
authors.lastname: Knight
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D013019:South Africa