title: Improved pregnancy outcomes with increasing antiretroviral coverage in South Africa.
abstract: BACKGROUND
  Universal multi drug antiretroviral treatment in pregnancy is a global priority in our bid to eliminate paediatric HIV infections although few studies have documented the impact of antiretroviral coverage on overall pregnancy outcomes.
  
  
  METHODS
  We conducted a maternity audit at a large regional hospital in South Africa during July-December 2011 and January-June 2014 with an aim to determine an association between pregnancy outcomes and the ARV treatment guidelines implemented during those specific periods. During 2011, women received either Zidovudine/sd Nevirapine or Stavudine/Lamivudine/Nevirapine if CD4+ count was < 350 cells/ml. During 2014, all HIV positive pregnant women were eligible for a fixed dose combination (FDC) of triple ARVs (Tenofovir/Emtracitabine/Efavirenz).
  
  
  RESULTS
  In 2011, 622 (35.9%) of 1732 HIV positive pregnant women received triple antiretrovirals (D4T/3TC/NVP) and in 2014, 2104 (94.8%) of 2219 HIV positive pregnant women received the fixed dose combination (TDF/FTC/EFV). We observed a reduction in the proportion of unregistered pregnancies, caesarean delivery rate, still birth rate, very low birth weight rate, and very premature delivery rate in 2014. In a bivariate analysis of all 9,847 deliveries, unregistered pregnancies (2.2%) and HIV infection (37.8%) remained significant risk factors for SB(OR 6.36 and 1.43 respectively), PTD(OR 4.23 and 1.26 respectively),LBW (OR 4.07 and 1.26 respectively) and SGA(OR 2.17 and 1.151 respectively). In a multivariable analysis of HIV positive women only, having received AZT/NVP or D4T/3TC/NVP or EFV/TDF/FTC as opposed to not receiving any ARV was significantly associated with reduced odds of a SB (OR 0.08, 0.21 and 0.18 respectively), PTD (OR 0.52, 0.68 and 0.56 respectively) and LBW(0.37, 0.61 and 0.52 respectively).
  
  
  CONCLUSIONS
  An improvement in birth outcomes is likely associated with the increased coverage of triple antiretroviral treatment for pregnant women. And untreated HIV infected women and women who do not seek antenatal care should be considered most at risk for poor birth outcomes.
authors: Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa. theronmoodley@gmail.com.
authors: Theron
authors: T
authors: Moodley
authors: Womens Health and HIV Research Unit, Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa. moodleyd1@ukzn.ac.za.
authors: Dhayendre
authors: D
authors: Moodley
authors: Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa. Sebitloanem@ukzn.ac.za.
authors: Motshedisi
authors: M
authors: Sebitloane
authors: Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa. drray@vodamail.co.za.
authors: Niren
authors: N
authors: Maharaj
authors: Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Ground Floor, George Campbell Building, Durban, South Africa. Sartorius@ukzn.ac.za.
authors: Benn
authors: B
authors: Sartorius
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000068257:Efavirenz, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019259:Lamivudine / Q000627:therapeutic use; D019829:Nevirapine / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology; D018119:Stavudine / Q000627:therapeutic use; D055815:Young Adult; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D044966:Anti-Retroviral Agents; D000068257:Efavirenz, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; C516355:stavudine, lamivudine, nevirapine drug combination; D019259:Lamivudine; D015215:Zidovudine; D019829:Nevirapine; D018119:Stavudine