Prevention of mother-to-child transmission of HIV in Africa: successes and challenges in scaling-up a nevirapine-based program in Lusaka, Zambia

Abstract

Background: Nearly half of perinatal HIV infection is preventable with nevirapine (NVP), which has transformed the ability to confront this transmission route in resource-limited settings.

Methods: A NVP-based perinatal HIV prevention program initiated in Lusaka, Zambia in November 2001.

Results: The first 12 months cost US$221 000 and enabled 178 district health employees to be trained in voluntary counseling and testing: 17 263 pregnant women were counseled for HIV, 12 438 (72%) were tested, and 2924 (24%) were found to be infected with HIV. NVP has been taken by 1654 (57%) mothers and 1157 (40%) babies. It is estimated that at least 190 infants have been spared HIV infection (11 per 1000 counseled women or 65 per 1000 identified HIV-infected women).

Conclusions: Prevention of mother-to-child HIV transmission is feasible and cost effective in resource-limited settings. In Lusaka, thousands of women have received voluntary counseling and testing and NVP therapy under the present scheme. Patient attrition and non-adherence represented a major source of program inefficiency, which requires to be systematically addressed.

Fig. 1. Stamp placed in maternal antenatal record for documenting HIV pre-test counseling, acceptance or refusal of testing, HIV status, and receipt of maternal and infant nevirapine

PCR, patient counseled and refused testing (will be approached again at a subsequent visit); PCA, patient counseled and accepted testing; R, reactive (HIV-infected); NR, non-reactive (HIV uninfected); I, indeterminate; RMd, reactive, mother given the drug; RBd, reactive, baby given the drug.