OBJECTIVES: To review coverage of the current nevirapine prevention model in Coast Provincial General Hospital (CPGH) in Mombasa, Kenya, and to reflect on alternative models to reduce mother-to-child transmission (MTCT) of HIV. METHODS: At the antenatal clinic, health information is provided, followed by pre-test HIV voluntary counselling and testing (VCT). Because many women deliver at home, HIV-infected women are provided with a tablet of 200 mg nevirapine for themselves, and with 0.6 ml (6 mg) nevirapine in a luer lock syringe for the baby. Data on coverage are provided from antenatal records and delivery registers. RESULTS: Out of 3564 first-visit pregnant women receiving health education, 2516 were counselled (71%) and 2483 were tested (97%); 348 were HIV positive (14%), and 106 women took nevirapine in labour, resulting in an overall coverage rate of 20%. In the same period, approximately 6000 women gave birth in CPGH, of whom 21% had attended a facility with VCT services. Assuming an overall HIV prevalence of 14%, 840 mother-infant pairs could have received a preventative intervention with a hospital policy of antepartum as well as intrapartum testing and treatment in place. CONCLUSION: The coverage of perinatal MTCT was low as a result of a variety of programme elements requiring urgent improvement at different levels. Alternative models, including intrapartum testing, should be considered as a safety net for women without access to VCT before delivery, and recommendations for nevirapine should be considered in the light of home deliveries.
OBJECTIVES: To review coverage of the current nevirapine prevention model in Coast Provincial General Hospital (CPGH) in Mombasa, Kenya, and to reflect on alternative models to reduce mother-to-child transmission (MTCT) of HIV. METHODS: At the antenatal clinic, health information is provided, followed by pre-test HIV voluntary counselling and testing (VCT). Because many women deliver at home, HIV-infectedwomen are provided with a tablet of 200 mg nevirapine for themselves, and with 0.6 ml (6 mg) nevirapine in a luer lock syringe for the baby. Data on coverage are provided from antenatal records and delivery registers. RESULTS: Out of 3564 first-visit pregnant women receiving health education, 2516 were counselled (71%) and 2483 were tested (97%); 348 were HIV positive (14%), and 106 women took nevirapine in labour, resulting in an overall coverage rate of 20%. In the same period, approximately 6000 women gave birth in CPGH, of whom 21% had attended a facility with VCT services. Assuming an overall HIV prevalence of 14%, 840 mother-infant pairs could have received a preventative intervention with a hospital policy of antepartum as well as intrapartum testing and treatment in place. CONCLUSION: The coverage of perinatal MTCT was low as a result of a variety of programme elements requiring urgent improvement at different levels. Alternative models, including intrapartum testing, should be considered as a safety net for women without access to VCT before delivery, and recommendations for nevirapine should be considered in the light of home deliveries.
Authors: Elizabeth M Stringer; Benjamin H Chi; Namwinga Chintu; Tracy L Creek; Didier K Ekouevi; David Coetzee; Pius Tih; Andrew Boulle; Francois Dabis; Nathan Shaffer; Catherine M Wilfert; Jeffrey S A Stringer Journal: Bull World Health Organ Date: 2008-01 Impact factor: 9.408
Authors: Carey Farquhar; James N Kiarie; Barbra A Richardson; Marjory N Kabura; Francis N John; Ruth W Nduati; Dorothy A Mbori-Ngacha; Grace C John-Stewart Journal: J Acquir Immune Defic Syndr Date: 2004-12-15 Impact factor: 3.731
Authors: Eugene J Kongnyuy; Enow R Mbu; Francois X Mbopi-Keou; Nelson Fomulu; Philip N Nana; Pierre M Tebeu; Rebecca N Tonye; Robert J I Leke Journal: BMC Pregnancy Childbirth Date: 2009-02-27 Impact factor: 3.007
Authors: David A Katz; James N Kiarie; Grace C John-Stewart; Barbra A Richardson; Francis N John; Carey Farquhar Journal: PLoS One Date: 2009-11-02 Impact factor: 3.240