Original articles

Dual and triple therapy to prevent mother-to-child transmission of HIV in a resource-limited setting - lessons from a South African programme

Rosemary Geddes, Janet Giddy, Lisa M Butler, Erika van Wyk, Tamaryn Crankshaw, Tonya M Esterhuizen, Stephen Knight


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.

Method. 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.

Conclusion. 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' affiliations

Rosemary Geddes, Medical Research Council

Janet Giddy, McCord Hospital, Durban, South Africa

Lisa M Butler, Department of Epidemiology and Biostatistics, and Global Health Sciences, University of California, San Francisco, San Francisco, USA

Erika van Wyk, McCord Hospital, Durban

Tamaryn Crankshaw, McCord Hospital, Durban

Tonya M Esterhuizen, University of KwaZulu-Natal, Durban

Stephen Knight, Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa

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prevention of mother-to-child transmission; HIV; PMTCT outcomes; vertical HIV transmission

Cite this article

South African Medical Journal 2011;101(9):651-654.

Article History

Date submitted: 2010-12-14
Date published: 2011-09-05

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