title: Nevirapine for the prevention of mother-to-child transmission of HIV: a nation-wide coverage survey in Côte d'Ivoire.
abstract: BACKGROUND
  Single-dose nevirapine (NVP) is the simplest antiretroviral regimen for the prevention of mother-to-child HIV transmission (PMTCT) in resource-limited settings. We evaluated NVP coverage among HIV-infected delivering women in Côte d'Ivoire.
  
  
  METHODS
  A cross-sectional survey of mother-infant pairs was conducted between November 2007 and September 2008 in 10 randomly selected facilities providing delivery services in the country. All sites used at least NVP for PMTCT. Anonymous HIV test and blood collection for NVP concentration measurement were performed in labor wards. NVP coverage was defined as the proportion of maternal and infant NVP intake confirmed by cord blood chromatography and direct observation.
  
  
  RESULTS
  A total of 9953 deliveries were enrolled. Median maternal age was 25 years, and the median number of antenatal care (ANC) visits was 3. Of the 9747 women (97.9%) who made at least 1 ANC visit, 5880 (60.3%) received an HIV test proposal, 5135 (87.3%) accepted it, and 251 (4.9%) were diagnosed HIV infected; 176 of them (70.1%) received antiretroviral prophylaxis according to the medical record. Using anonymous cord blood surveillance, HIV prevalence was 5.9% (570 of 9646), maternal NVP coverage was 24.3% (138 of 570), and maternal and infant NVP coverage was 17.9% (102 of 570). In multivariate analysis, maternal NVP coverage was associated with 2-3 ANC visits [adjusted odds ratio (aOR): 2.61; 95% confidence interval (CI): 1.27 to 5.39] or ≥ 4 ANC visits (aOR: 3.84; 95% CI: 1.86 to 7.90) (ref. ≤ 1), and giving birth in clinic of first ANC visit (aOR: 2.21; 95% CI: 1.43 to 3.40).
  
  
  CONCLUSIONS
  Maternal and infant NVP coverage was low irrespective of the method. Anonymous cord blood surveillance is more reliable for documenting PMTCT coverage.
authors.affiliation: Programme PACCI-Pôle Mère-enfant, Abidjan, Côte d'Ivoire.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Coffie
authors.forename: Serge K
authors.initials: SK
authors.lastname: Kanhon
authors.forename: Hapsatou
authors.initials: H
authors.lastname: Touré
authors.forename: Virginie
authors.initials: V
authors.lastname: Ettiegne-Traoré
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stringer
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Stringer
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
mesh_terms: D000328:Adult; D007560:Cote d'Ivoire; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D015999:Multivariate Analysis; D019829:Nevirapine / Q000627:therapeutic use*; D011247:Pregnancy; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*
chemical_list: D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine