Mothers able to treat both themselves and new born with nevirapine, says Ugandan study

Most HIV-positive mothers in a rural area of Uganda were able to provide single-dose nevirapine at home to both themselves and their newborn babies, achieving a low rate of mother-to-baby transmission of HIV, according to a study published in the May 1^st edition of the Journal of Acquired Immune Deficiency Syndromes. The proof of concept study, which recruited women in the rural Rakai area of Uganda, demonstrated that self-medication of nevirapine resulted in a rate of mother-to-baby transmission of 8%, similar to that seen in clinical trial where single-dose nevirapine was provided to mother and child in a healthcare setting.

Approximately 85% of the Ugandan population lives in rural areas, which are estimated to have an HIV prevalence rate of 5%. Mother-to-baby transmission of HIV occur more frequently among rural mothers, who usually give birth at home. In addition, the provision of services to prevent vertical transmission of HIV are limited in Ugandan rural healthcare facilities.

The Ugandan health authorities recommend that HIV-positive women giving birth at home should be provided with a dose of nevirapine to take at the onset of labour and to attend a healthcare facility within 72 hours of birth so their infant can be provided with a dose of nevirapine syrup. However, data suggest that few women attend a healthcare facility within 72 hours for their baby to be provided with nevirapine syrup.

Investigators conducted a proof of concept study to see if they could improve access to nevirapine syrup amongst newly born babies.

Between October 2001 and February 2003, midwives involved in the Rakai Health Services Programme located 900 pregnant women who accepted voluntary testing and counselling. A total of 105 women were identified as HIV-positive.

A total of 93 women were therefore provided with nevirapine for themselves and their baby with instructions on how and when to take it and administer it to their infant. The remaining twelve women could not be provided with nevirapine because their test results were not available on time.

Of the 93 HIV-positive women, 81 were followed-up after giving birth, with 75% visited within three days.

These 81 women delivered 84 babies, but there were five infant deaths. A total of 69 women (85%) said that they took their dose of nevirapine and 68 women (84%) said that they provided their newborn babies with the drug.

Over 50% of women said that they took their dose of nevirapine within two hours of the onset of labour, and 87% said that the drug was taken before their membranes ruptured.

The mothers reported that 96% of babies were given their dose of nevirapine on the day of delivery and all but one infant was dosed with the drug within 72 hours.

Blood samples were collected from 25 mothers and their babies, and nevirapine was detected in the samples of 22 women (88%) and 24 babies (96%).

HIV PCR tests were conducted on 69 of the 74 surviving infants who were followed-up four to six weeks after they were born. All but one of the infants were being breastfed at the time. Five babies tested HIV-positive, resulting in a mother-to-baby transmission of HIV of 8%. It was not possible to tell from the investigators study if these infants were infected with HIV during delivery or as a consequence of breastfeeding.

“This programme of maternal self-medication with nevirapine tablets at the onset of labour and maternal provision of nevirapine syrup to newborns resulted in a low rate of mother-to-child transmission comparable to those observed in clinical trials”, write the investigators. They note that the rate of mother-to-baby transmission in the study area had been 19% before the initiation of their programme, “suggesting that this strategy may reduce…transmission by approximately 60% compared with historic levels.”

However, the investigators note that the acceptance of voluntary testing and counselling was much higher than that usually seen in rural Africa. Nevertheless they believe “the Rakai experience represents a ‘proof of concept’ and suggests mechanisms by which prevention of mother-to-child transmission may be provided in other settings. Mothers can be empowered to self-medicate themselves and their newborns and to reduce perinatal HIV infection.”