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

Stringer, Elizabeth Ma–c; Sinkala, Mosesa–d; Stringer, Jeffrey SAa–c; Mzyece, Elizabethc; Makuka, Idac; Goldenberg, Robert La,c; Kwape, Pascale; Chilufya, Marthae; Vermund, Sten Ha,c

Epidemiology & Social

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.

From the aSchools of Medicine and Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA, bUniversity of Zambia School of Medicine, cCentre for Infectious Disease Research in Zambia, dLusaka Urban District Health Management Board and eZambia Counseling Council, Zambian Ministry of Health, Lusaka, Zambia.

Requests for reprints to: E. Stringer, Centre for Infectious Disease Research in Zambia, Plot 5977, Mwembeshi Rd, Northmead, Lusaka, Zambia.

Received: 20 November 2002; revised: 9 January 2003; accepted: 22 January 2003.

© 2003 Lippincott Williams & Wilkins, Inc.