Training HIV-Positive Pregnant Women To Administer Nevirapine To Infants
The Elizabeth Glaser Pediatric AIDS Foundation has completed the pilot phase of a home-based program in Uganda that teaches HIV-positive pregnant women how to administer the antiretroviral nevirapine to their infants immediately after birth to prevent mother-to-child transmission of the virus, New Vision reports. According to New Vision, the pediatric form of nevirapine can reduce an infant's risk of HIV by 50% when given after birth.
Under the program, nevirapine is repackaged to allow pregnant women who do not give birth at a heath facility to administer the formula at home. The package consists of a sealed syringe of the medication wrapped in foil paper that prevents sun exposure and includes instructions in local languages. It will be integrated into existing prenatal programs, New Vision reports.
According to Edward Bitarakwate, the foundation's technical director, a "big challenge" for the program will be to ensure the medication is not given to women early in their pregnancies because it could expire before the women give birth. The foundation is "discussing training [and] dispensing technicalities with the Ministry of Health," Bitarakwate said. "It is pointless to give [nevirapine] to the mother in early pregnancy as it may expire before the baby comes," Bitarakwate added.
In addition, pregnant women must receive training on how to properly store and dispense the drug. According to William Salmond, the foundation's director in Uganda, HIV-positive pregnant women who have not disclosed their HIV status to their husbands or caregivers "may hide the drug in weird places ... consequently destroying it." Salmond said that the government must train midwives to administer the drug if the pregnant woman is unable to, adding that male involvement and support is "very important."
According to Bitarakwate, the program targets women who are 32 weeks' pregnant, under the assumption that they will deliver at home between 36 weeks' and 42 weeks'. Women who do not deliver within the specified time frame are advised to return to the clinic for a new dose of the formula to ensure the infant is not given expired medicine.
Some critics have said the home-based approach will discourage women from delivering in hospitals, but Bitarakwate said that the government must address the challenges that prevent women from delivering in hospitals. He said the program is necessary because the health system has "failed to address the factors that deter mothers from delivering from hospitals."
According to Godfrey Esiru, the national coordinator of prevention of MTCT programs, MTCT is the second most common mode of HIV transmission in Uganda, accounting for 15% of all new HIV cases and 95% of cases among children younger than age two. He added that although nevirapine reduces the risk of MTCT and has prevented more than 12,000 HIV cases among children, challenges such as voluntary counseling and testing remain (Nabusoba, New Vision, 11/3).
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