A newborn receives neverapine syrup in a syringe. It reduces chances of HIV transmission by 50%

By Irene Nabusoba

MAJORITY of women in poor countries, especially in Africa, do not deliver at health facilities. Neither do they return for post-natal checkups or skilled assessment of the infant. This increases the chances of HIV infection.

But, this is about to change with the advent of repackaged neverapine, a drug that prevents mother-child transmission of the virus.

The Elizabeth Glazer Pediatric AIDS Foundation (EGPAF), a US organisation, has finished piloting the home-based approach, where the drug will be repackaged in syringes for mothers to give their infants in case they deliver outside a health facility.

The pediatric formulation of neverapine syrup when given immediately after birth reduces chances of transmission by 50%.

EGPAF, which is a global leader in the fight against pediatric AIDS through research, advocacy, prevention, and treatment programmes demonstrated the approach for eight months in Ssembabule and Mpigi districts.

Dr Edward Bitarakwate, EGPAF’s technical director says the the required dose of neverapine syrup is drawn using a syringe from its bottle, put in foil paper, sealed and given to the mother to take home.

“The syrup comes with the kit consisting of foil paper which is white inside and opaque on top to protect the medicine from sun rays.

The bottle is amber for the same purpose. Scribbled on the storage foil paper are instructions in English but they will be translated into local languages.

“The kit also has a syringe with a cap which we close after drawing the syrup from the bottle to avoid wastage and contamination. It should be given within three days,” Birakwate says.

The approach was introduced two years ago in Kenya. “We feel that just like it has worked in Kenya, it can be an easier way for HIV positive mothers to save their babies,” Birakwate notes.

“We are now discussing training dispensing technicalities with the Ministry Of Health,” Birakwate says.

Every time the neverapine is removed from its packaging, its shelf life reduces by about two months.

“This is a big challenge because we need to give it to a mom in a way that it won’t expire. It is pointless to give it to the mother in early pregnancy as it may expire before the baby comes.

“We target mothers at eight months (32 weeks) assuming that they will deliver between 36-42 weeks. If she exceeds, then she is advised to return it and take another dose,” he says.

Some argue that the approach may discourage hospital deliveries but Birakwate argues that the appeal for mothers to deliver from health units remains but government must address the challenges that keep mothers away.

“We are giving them home neverapine because we have failed to address the factors that deter mothers from delivering from hospitals,” he says.

The home-based neverapine approach is funded by USAID and PATH, who are donating the drug together with the home safety kits.

William Salmond, EGPAF’s country director says the Government needs to train midwives who will be charged with repackaging and sensitisatising mothers on storage and administration of the drug.

“We would have considered dispensers or pharmacists but this drug should be given on demand.
It will be intergrated in the ante-natal interventions like phasinder, deworming, iron and folic acid supplements.

After these pregnancy interventions and checks, the midwife explains the approach to the mothers, advices them to keep the drug at room temperature and administer it as soon as the baby is born,” Salmond says.

“If the mothers have not told their husbands and caregivers that they are HIV-positive, they may hide the drug in wierd places like on chimneys consequently destroying it.

It is, therefore, important that mothers open up. In case the delivery is difficult, a husband or caretaker can administer the drug. “Male involvement and support is very important here,” Salmond says.

Godfrey Esiru, the national coordinator of Prevention of Mother-To-Child Transmission (pmtct) programmes says male participation stands at a miserable 5%.

“Mother-child transmission is the second major mode of transmission accounting for 15% of infections and 95% of infections in children below two years. An estimated 110,000 children are living with HIV/AIDS.

In developed countries, mother-child HIV transmission has reduced to 1%.

In Uganda, 58% babies are delivered by TBAs, senior mothers like in-laws or neighbours who lack the skills to prevent mother-child transmission.

It is estimated that there are 1.4m pregnancies every year with 91,000 (6.5%) infected pregnant women. Esiru says without intervention, three out of ten women (30%) infect their children.

“PMTCT intervention reduces HIV risk by 50% with use of neverapine and by beyond 78% with combined regiments thus saving over 12,000 children from getting infected with HIV and dying of AIDS. But there are still challenges like voluntary counselling and testing,” Esiru says.

Pregnant women are required to undergo an HIV test to safeguard the unborn child from infection, but in Uganda, only 30% of Ugandans know their HIV status.

A study done by the Uganda AIDS Commission in seven districts indicates that 64% of people who tested did not disclose their status to their partners.

Large numbers of women get pregnant when they do not know their HIV status. Nevertheless, PMTCT programmes like this seek them out.

The next challenge is combating transmission through breastfeeding.