title: Universal nevirapine upon presentation in labor to prevent mother-to-child HIV transmission in high prevalence settings.
abstract: OBJECTIVE
  To assess the uptake of and adherence to nevirapine to prevent mother-to-child HIV transmission among women of unknown HIV serostatus presenting in labor. We also assessed preliminary efficacy of the approach.
  
  
  METHODS
  Women of unknown HIV serostatus presenting in labor were offered single-dose nevirapine in a prospective cohort study. Two additional contemporaneous comparison populations were also studied.
  
  
  METHODS
  We measured uptake by counting the number of women that accepted enrollment when offered. We measured adherence with cord blood nevirapine assay. We measured preliminary efficacy with HIV DNA polymerase chain reaction of infant blood spots at 4-6 weeks of life.
  
  
  RESULTS
  Of 1591 women approached in labor, 634 (40%) took up the intervention and received nevirapine, of whom 185 (29%) were HIV infected. Of 179 cord blood specimens from HIV-exposed infants that could be evaluated, 178 (99.4%) had nevirapine detected. This was higher than the 73 of 98 (74%) adherence rate observed in a comparison cohort in which women self-administered nevirapine before presenting to the labor ward (P < 0.001). Of 145 available infant specimens, 17 (11.7%) showed evidence of infection at 4-6 weeks, compared with 12 of 60 (20%) infants born immediately prior to study commencement whose HIV-infected mothers did not receive nevirapine (P < 0.05).
  
  
  CONCLUSIONS
  Nevirapine without HIV testing upon presentation in labor was accepted by two-fifths of women. Because therapy is directly observed, adherence is nearly perfect. Labor ward dosing to enhance nevirapine coverage should be considered as an adjunct to antenatal nevirapine administration for prevention of mother-to-child transmission of HIV.
authors.affiliation: Schools of Medicine and Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. stringer@uab.edu
authors.forename: Jeffrey S A
authors.initials: JS
authors.lastname: Stringer
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Rosemary
authors.initials: R
authors.lastname: Kumwenda
authors.forename: Edward P
authors.initials: EP
authors.lastname: Acosta
authors.forename: Grace M
authors.initials: GM
authors.lastname: Aldrovandi
authors.forename: Julia P
authors.initials: JP
authors.lastname: Stout
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003906:Developing Countries; D023801:Directly Observed Therapy; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D019829:Nevirapine / Q000627:therapeutic use*; D011247:Pregnancy; D011446:Prospective Studies; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine