Nevirapine for all pregnant women may be more acceptable in Zambia

A majority of Zambian women support the use of mass nevirapine therapy - universal provision of the drug without HIV testing - for the prevention of mother to baby transmission of HIV, if resources are unavailable for individual HIV testing and treatment according to a study published in the latest issue of The Lancet.

The use of nevirapine during pregnancy has been shown to dramatically reduce the risks of mother-to-baby transmission of HIV, and the drug's manufacturer, Boehringer Ingleheim, has undertaken to donate the drug to developing countries for such use.

The authors of The Lancet study set out to establish if pregnant women attending antenatal clinics in Lusaka, Zambia, a high prevalence HIV area, would support mass administration of the drug. A sample of 317 women completed a structured questionnaire. They first received a scripted educational session on HIV, its prevalence amongst pregnant women in Zambia, the risk of mother-to-baby transmission and the efficiency of nevirapine to prevent vertical transmission.

The women were then asked to answer questions on two treatment scenarios involving nevirapine. Scenario One offered both testing for HIV and nevirapine treatment for pregnant women who tested positive. The vast majority, 74 per cent, said that they would only take the treatment if they tested positive, but a substantial minority, 23 per cent, said that they would decline an HIV test and take nevirapine anyway.

In Scenario Two, the women were asked what action they would take if there weren't enough resources available to test and to treat everybody. A clear majority, 60 per cent, said that nevirapine should be offered to all women without HIV testing. Testing is estimated to cost much more than the supply and administration of nevirapine.

The women were also asked their age, if they had had a child die and their perceived risk of HIV. It was established that women who thought themselves to be at moderate to high risk of HIV were more likely to choose mass therapy for themselves. Age and having a child die did not seem to influence response.

The willingness of so many women, 23 per cent of the sample, to opt to take treatment without an HIV test even if a test was available, is thought by the report authors to be an indicator of the stigma attached to HIV.

At $5 per patient per year, resources for the care of pregnant women in Lusaka are limited and no funds are allocated for the special care of the estimated 9,000 HIV-positive women who deliver children within the city each year. The report authors conclude, "the survey suggests that most women in Lusaka would support a mass therapy approach if it would allow a greater proportion of women to receive nevirapine. Women's preferences should be considered as programme policies are developed in Africa and elsewhere."