Pregnant women in Zambia-a country with high HIV-1 prevalence-would support a mass distribution campaign for the HIV drug nevirapine, according to a survey detailed in a research letter in this week’s issue of THE LANCET.
Nevirapine is a cost-effective treatment in the prevention of mother-to-child HIV-1 transmission. The major challenge is to establish how best to administer the drug in settings of extreme resource constraints and underdeveloped clinical infrastructure. Two potential strategies for perinatal nevirapine administration have suggested that mass therapy (universal drug provision, without HIV-1 diagnosis) would be preferable to the more standard targeted therapy (HIV-1 testing with treatment of infected individuals only). However, mass nevirapine administration remains a controversial issue, both locally in Zambia and across the international community.
Moses Sinkala and colleagues from the Zambian Ministry of Health and the University of Alabama, USA, surveyed 310 pregnant women attending antenatal clinics about their attitudes to nevirapine administration under two scenarios: first, given no resource constraints, targeting nevirapine only at women identified from testing as being HIV positive; second, mass nevirapine administration if a targeted approach only covered half the population. Three-quarters of women (74%) preferred a targeted strategy if resources were able to cover the whole population, but 60% supported mass drug administration if the targeted approach was limited to half the population.
Moses Sinkala comments: “If internal resources were to become available for a nevirapine-administration programme, or if an outside donor were to provide drugs, it is possible that we would fall short of the resources to test and treat all women. Thus, we could be faced with the choice between offering HIV testing and nevirapine to some, or mass nevirapine to all. This survey suggests that most women in Lusaka would support a mass therapy approach if it would allow a greater proportion of women to access nevirapine. Women’s preferences should be considered as programme policies are developed in Africa and elsewhere.”
Contact: Dr Moses Sinkala, Lusaka Urban District Health Management Board, Zambian Ministry of Health, Lusaka, Zambia; E) msinkala@hotmail.com
Journal
The Lancet