Mother-to-child HIV transmission in resource poor settings: how to improve coverage?
OBJECTIVE
To review coverage of the current nevirapine prevention model in Coast Provincial General Hospital (CPGH) in Mombasa, Kenya, and to reflect on alternative models to reduce mother-to-child transmission (MTCT) of HIV.


METHODS
At the antenatal clinic, health information is provided, followed by pre-test HIV voluntary counselling and testing (VCT). Because many women deliver at home, HIV-infected women are provided with a tablet of 200 mg nevirapine for themselves, and with 0.6 ml (6 mg) nevirapine in a luer lock syringe for the baby. Data on coverage are provided from antenatal records and delivery registers.


RESULTS
Out of 3564 first-visit pregnant women receiving health education, 2516 were counselled (71%) and 2483 were tested (97%); 348 were HIV positive (14%), and 106 women took nevirapine in labour, resulting in an overall coverage rate of 20%. In the same period, approximately 6000 women gave birth in CPGH, of whom 21% had attended a facility with VCT services. Assuming an overall HIV prevalence of 14%, 840 mother-infant pairs could have received a preventative intervention with a hospital policy of antepartum as well as intrapartum testing and treatment in place.


CONCLUSIONS
The coverage of perinatal MTCT was low as a result of a variety of programme elements requiring urgent improvement at different levels. Alternative models, including intrapartum testing, should be considered as a safety net for women without access to VCT before delivery, and recommendations for nevirapine should be considered in the light of home deliveries.
Temmerman
Marleen
M
International Centre for Reproductive Health, Ghent University, Belgium. marleen.temmerman@rug.ac.be
Quaghebeur
Ann
A
Mwanyumba
Fabian
F
Mandaliya
Kishor
K
D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003376:Counseling; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D019829:Nevirapine / Q000008:administration & dosage* / Q000627:therapeutic use; D018743:Perinatal Care / Q000592:standards*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D011295:Prenatal Care / Q000592:standards; D011297:Prenatal Exposure Delayed Effects; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine