Prevention of mother-to-child transmission of HIV in Africa: successes and challenges in scaling-up a nevirapine-based program in Lusaka, Zambia.
BACKGROUND
Nearly half of perinatal HIV infection is preventable with nevirapine (NVP), which has transformed the ability to confront this transmission route in resource-limited settings.


METHODS
A NVP-based perinatal HIV prevention program initiated in Lusaka, Zambia in November 2001.


RESULTS
The first 12 months cost US$221 000 and enabled 178 district health employees to be trained in voluntary counseling and testing: 17 263 pregnant women were counseled for HIV, 12 438 (72%) were tested, and 2924 (24%) were found to be infected with HIV. NVP has been taken by 1654 (57%) mothers and 1157 (40%) babies. It is estimated that at least 190 infants have been spared HIV infection (11 per 1000 counseled women or 65 per 1000 identified HIV-infected women).


CONCLUSIONS
Prevention of mother-to-child HIV transmission is feasible and cost effective in resource-limited settings. In Lusaka, thousands of women have received voluntary counseling and testing and NVP therapy under the present scheme. Patient attrition and non-adherence represented a major source of program inefficiency, which requires to be systematically addressed.
Stringer
Elizabeth M
EM
School of Medicine, University of Alabama at Birmingham, USA.
Sinkala
Moses
M
Stringer
Jeffrey S
JS
Mzyece
Elizabeth
E
Makuka
Ida
I
Goldenberg
Robert L
RL
Kwape
Pascal
P
Chilufya
Martha
M
Vermund
Sten H
SH
D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003376:Counseling; D003906:Developing Countries; D016527:Drug Costs; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D019829:Nevirapine / Q000191:economics / Q000627:therapeutic use*; D010349:Patient Compliance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D014504:Urban Health; D015024:Zambia
D000998:Antiviral Agents; D019829:Nevirapine