title: Operational evaluation of a service for prevention of mother-to-child transmission of HIV in rural Uganda: barriers to uptake of single-dose nevirapine and the role of birth reporting.
abstract: OBJECTIVE
  To determine factors associated with pregnant women being HIV positive, barriers to the uptake of single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (PMTCT) and feasibility and effectiveness of reporting HIV-exposed infants born in facilities with no PMTCT services so as to receive NVP.
  
  
  METHODS
  From 2002 to 2007, a sdNVP PMTCT service was implemented in 53 rural villages of south-west Uganda. Twenty-five of them were HIV-surveillance study villages. The proportions of mothers testing positive and mother and newborns receiving and ingesting sdNVP and associated factors were determined.
  
  
  RESULTS
  Women with incomplete primary or no education, aged 25-34 years or not living with their partners were at increased risk of being HIV infected. Seventy-seven percentage of pregnant women with HIV (PWH) received therapy. Of the 63 PWH who received therapy and had surviving live births, only 39 (62%) reported births and received newborn prophylaxis within 72 h. Women were more likely to collect and ingest NVP if they were from study villages, preferred home administration of newborn NVP or presented at a more advanced stage of pregnancy. Newborns were more likely to be reported and receive NVP if mothers were aged 25-34 years, on antiretroviral therapy (ART) or came from study villages.
  
  
  CONCLUSIONS
  The uptake of PMTCT services was unacceptably low. Asking PWH with less advanced pregnancies to return to collect NVP leads to missed opportunities especially if PWH are less educated. Birth reporting enabled the programme to provide NVP to some infants who otherwise would have missed. Antenatal, delivery and PMTCT services should be integrated.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute, Entebbe, Uganda. hebagye@yahoo.com
authors.forename: Henry
authors.initials: H
authors.lastname: Barigye
authors.forename: Jonathan
authors.initials: J
authors.lastname: Levin
authors.forename: Dermot
authors.initials: D
authors.lastname: Maher
authors.forename: Gladys
authors.initials: G
authors.lastname: Tindiwegi
authors.forename: Elly
authors.initials: E
authors.lastname: Atuhumuza
authors.forename: Stephen
authors.initials: S
authors.lastname: Nakibinge
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D055118:Medication Adherence; D019829:Nevirapine / Q000008:administration & dosage*; D011159:Population Surveillance / Q000379:methods; D011247:Pregnancy; D012042:Registries; D012424:Rural Population; D014454:Uganda; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine