title: Maternal self-medication and provision of nevirapine to newborns by women in Rakai, Uganda.
abstract: To assess the effectiveness of maternal self-administration of nevirapine for prevention of mother-to-child transmission (MTCT) of HIV, we conducted a program to provide maternal and newborn doses of nevirapine to pregnant women in rural Uganda. Women provided blood for HIV testing and were offered voluntary counseling and testing (VCT) during annual community HIV surveys. HIV-positive women who accepted VCT were offered nevirapine tablets and syrup. Blood samples were collected postpartum from women and their babies. Infants were tested for HIV by polymerase chain reaction (PCR), and a subsample of maternal and infant blood was assayed for nevirapine. Among the 981 women tested for HIV, 900 (91.7%) accepted VCT, of whom 105 (11.7%) were HIV-positive. Ninety-three women accepted nevirapine, of whom 81 (87.1%) were followed postpartum; 75 (92.6%) reported receipt of the drug, and 69 reported taking the tablets (85.2%). There were 81 liveborn babies (3 sets of twins), and 67 (84.8%) received the syrup. In a subsample of 25 mothers reporting receipt of the drug, nevirapine was detected in 22 (88.0%) and 24 (96.0%) babies tested. PCR of 67 infant blood samples identified 5 HIV-positive (MTCT rate = 7.5%, 95% confidence interval [CI]: 0.3%-16.6%). Mothers can administer nevirapine to themselves and their newborns and can achieve low rates of perinatal HIV infection.
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kagaayi
authors.forename: Michele L
authors.initials: ML
authors.lastname: Dreyfuss
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Michael Z
authors.initials: MZ
authors.lastname: Chen
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: Meddie
authors.initials: M
authors.lastname: Kiddugavu
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019829:Nevirapine / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology*; D012424:Rural Population; D012646:Self Administration; D014454:Uganda
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine