Operational evaluation of a service for prevention of mother-to-child transmission of HIV in rural Uganda: barriers to uptake of single-dose nevirapine and the role of birth reporting

Abstract

Summaryobjectives To determine factors associated with pregnant women being HIV positive, barriers to the uptake of single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (PMTCT) and feasibility and effectiveness of reporting HIV-exposed infants born in facilities with no PMTCT services so as to receive NVP.methods From 2002 to 2007, a sdNVP PMTCT service was implemented in 53 rural villages of southwest Uganda. Twenty-five of them were HIV-surveillance study villages. The proportions of mothers testing positive and mother and newborns receiving and ingesting sdNVP and associated factors were determined.results Women with incomplete primary or no education, aged 25-34 years or not living with their partners were at increased risk of being HIV infected. Seventy-seven percentage of pregnant women with HIV (PWH) received therapy. Of the 63 PWH who received therapy and had surviving live births, only 39 (62%) reported births and received newborn prophylaxis within 72 h. Women were more likely to collect and ingest NVP if they were from study villages, preferred home administration of newborn NVP or presented at a more advanced stage of pregnancy. Newborns were more likely to be reported and receive NVP if mothers were aged 25-34 years, on antiretroviral therapy (ART) or came from study villages.conclusions The uptake of PMTCT services was unacceptably low. Asking PWH with less advanced pregnancies to return to collect NVP leads to missed opportunities especially if PWH are less educated. Birth reporting enabled the programme to provide NVP to some infants who otherwise would have missed. Antenatal, delivery and PMTCT services should be integrated.

Adherence to antiretroviral prophylaxis during early infancy in Latin America

“…Our results differ substantially from those of other studies in which lower adherence rates were reported from Africa 2,3 (62-73.1% adherence to a single dose of nevirapine at birth) and the U.S. (71% adherence to zidovudine in the week prior to interview) 4 using similar self-report methods. It is unclear why higher adherence was observed in our population, although a higher susceptibility to social desirability bias is a possibility.…”

Missed opportunities to prevent mother-to-child-transmission

“…The results from the two testing strategies were clearly different (p <0·001 from meta-regression). Predictors of successful HIV testing were reported in six publications [10, 17-21] and included cART provision at the antenatal clinic [21] and being accompanied by a male partner [20] (webppendix Table S2). …”

“…In three of the 34 studies the antiretroviral regimen was not specified. Information on predictors of sdNVP uptake was available in six studies [10, 13, 17, 19, 20, 23]. Uptake was better when the male partner was involved [20] and when women delivered at the health care facility [19] (webappendix Table S2).…”

Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

“…[2] Maintaining ARV adherence has been challenging for patients, and predicting who will be non-adherent and intervening in an effective way has been challenging for prevention of mother-to-child HIV transmission (PMTCT) programs. [3-8] Almost one half of postpartum patients included in a recent meta-analysis did not maintain an adherence level thought to be needed for virologic suppression (>80%). [9]…”