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
Tropical Medicine and International Health
MRC/UVRI Uganda Research Unit on AIDS, Medical Research Council, Uganda Virus Research Institute, PO 49, Entebbe, Uganda; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; London School of Hygiene and Tropical Medicine, United Kingdom
OBJECTIVES: 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. © 2010 Blackwell Publishing Ltd.
nevirapine; anti human immunodeficiency virus agent; nevirapine; child health; disease control; disease transmission; drug; educational attainment; human immunodeficiency virus; pregnancy; rural area; academic achievement; adult; antiviral therapy; article; female; health service; health survey; human; Human immunodeficiency virus infection; infection prevention; live birth; newborn; patient compliance; prophylaxis; single drug dose; survival rate; Uganda; virus transmission; cohort analysis; evaluation study; HIV Infections; medication compliance; pregnancy; prevention and control; procedures; register; rural population; transmission; utilization; vertical transmission; young adult; Uganda; Adult; Anti-HIV Agents; Cohort Studies; Female; HIV Infections; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Maternal Health Services; Medication Adherence; Nevirapine; Population Surveillance; Pregnancy; Registries; Rural Population; Uganda; Young Adult