title: Mother-to-child HIV transmission in resource poor settings: how to improve coverage?
abstract: 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.
authors.affiliation: International Centre for Reproductive Health, Ghent University, Belgium. marleen.temmerman@rug.ac.be
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.forename: Ann
authors.initials: A
authors.lastname: Quaghebeur
authors.forename: Fabian
authors.initials: F
authors.lastname: Mwanyumba
authors.forename: Kishor
authors.initials: K
authors.lastname: Mandaliya
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine