Most of the ART initiatives particularly those linked to clinical trials and in the externally funded projects have aimed to use the highly potent three-drug combination therapies i.e. regimens containing a Protease Inhibitor, as recommended by international guidelines. In Brazil, 55% of patients on ART are on triple combination therapy as are 43 of 109 patients treated in one centre in Ivory Coast. Generally speaking, however, as the choice and sustainability of ART regimens is largely determined by cost, there is widespread use, especially in private practice, of dual nucleoside regimens (2 NRTIs) because of simpler monitoring requirements, improved compliance and lower cost. There is also a significant amount of use of hydroxyurea containing regimens. The implications of these therapeutic practices seeking to adapt ART combination regimens to the resources of low-income countries are discussed in section 3.4.