Half of infants exposed to HIV may not receive single-dose nevirapine

**Stringer EM. JAMA. 2010;304:293-302.**

Only 51% percent of infants treated at HIV prevention centers in four African countries received the recommended nevirapine-based antenatal care, according to findings published in the Journal of the American Medical Association and presented at the 18th International AIDS Conference in Vienna, Austria.

Study researchers evaluated mother-to-child-transmission prevention services at 43 randomly selected facilities in Cameroon, the Ivory Coast, South Africa and Zambia between June 10, 2007, and Oct. 30, 2008.

Umbilical cord blood sample analysis was used to determine the rate of nevirapine coverage, which was defined as the proportion of infants who received nevirapine in utero and antenatally. Maternal nevirapine intake was confirmed by cord blood chromatography, and infant nevirapine ingestion was confirmed by direct observation.

There were 27,893 cord blood specimens tested. Twelve percent of the specimens (n=3,324) were HIV seropositive.

Full results for 3,196 HIV-seropositive mother-infant pairs were included in the final analysis.

Nevirapine coverage ranged by site from 0% to 82%, according to the results. The overall coverage estimate was 51% (95% CI, 49%-53%) after adjustments were made for country.

Multivariate analysis results indicated that, compared with women older than 30 years, failed coverage of nevirapine-based services carried an adjusted OR of 1.44 (95% CI, 1.18-1.76) among mothers younger than 20 years and 1.28 (95% CI, 1.07-1.54) among mothers aged 20 to 25 years.

Further results indicated that, compared with women who had six or more antenatal visits, failed nevirapine-based services carried the following adjusted ORs in women who had:

one or fewer antenatal care visits (2.91; 95% CI, 2.40-3.54)
two or three antenatal care visits (1.93; 95% CI, 1.60-2.33)
four or five antenatal care visits (1.56; 95% CI, 1.34-1.80)

Infants who were delivered vaginally were less likely to get nevirapine than those infants who were surgically delivered.

For more information:

Stringer E. Presented at: International AIDS Conference. July 18-23, 2010. Vienna, Austria.