[pronut-hiv] Outcome of Different Nevirapine Administration Strategies in Preventing PMTCT

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eJIAS: eJournal of the International AIDS Society
Outcome of Different Nevirapine Administration Strategies in Preventing
Mother-to-Child Transmission (PMTCT) Programs in Tanzania and Uganda
Posted 04/12/2006

Heiko Karcher, MD; Andrea Kunz, MD, MPH; Gabriele Poggensee, PhD;
Paulina Mbezi, MD; Kizito Mugenyi, MD; Gundel Harms, MD, MPH, PhD  

Abstract
Objective: Prevention-of-mother-to-child transmission (PMTCT)
interventions based on single-dose nevirapine (NVP) are widely
implemented in Africa, but strategies differ regarding how and when to
administer the drug to women and infants. The aim of this study was to
analyze the outcome of different strategies with regard to NVP intake in
pregnant women and their infants in Tanzania and Uganda.
Methods: In an observational study carried out between March 2002 and
December 2004, we compared a directly observed NVP administration
strategy in Tanzania (supervised NVP intake for women and infants at a
health unit) and a semi-observed administration strategy
(self-administered NVP for women at home and supervised intake for
infants at a health unit) in Uganda.

Results: The proportions of HIV-positive women accepting receipt of NVP
from the health units were similar in the 2 countries (42.4% in Tanzania
vs 45.6% in Uganda; P = .06). NVP intake in infants was significantly
higher in Tanzania than in Uganda (43.7% vs 24.1%; P < .001). In a
multivariate analysis, maternal age above 25 years, secondary education,
Catholic faith, and having undergone PMTCT counseling at a hospital were
independently associated with infant NVP intake.

Conclusion: In our settings, the directly observed administration
strategy resulted in a higher NVP intake in infants. The semi-observed
strategy, which implies that, after home delivery, the infant has to be
presented to a health unit for NVP administration, was less successful.