Survey reveals pregnant Zambians support universal nevirapine treatment

A majority of pregnant women in Lusaka, Zambia, support the mass treatment of pregnant women with nevirapine, rather than targeted treatment, if it means more positive women will be treated, according to a survey published in the Lancet of 10 November.

Singledose nevirapine has proven efficacy and cost effectiveness in preventing perinatal transmission of HIV, and manufacturer Boehringer Ingelheim is committed to donating the drug throughout the developing world. The debate is now focusing on how to distribute the drug in poor countries: Lusaka District allocates $5 per patient per year for obstetrical care, report Dr Jeffrey Stringer and colleagues at Lusaka and Alabama, USA.

The researchers say a shortage of resources could mean choosing between the mass distribution of nevirapine to all pregnant women regardless of their HIV status, or HIV testing for only some women and the treatment of those who test positive. Researchers questioned 310 women attending antenatal clinics. The overwhelming majority (74 per cent) only wanted to be treated if they were positive, but given a choice between mass treatment for all pregnant women or testing and treatment of half the women, most (60 per cent) chose universal treatment.

This survey suggests that most women in Lusaka would support a mass therapy approach if it would allow a greater proportion of women to receive nevirapine. Women’s preferences should be considered as programme policies are developed in Africa and elsewhere, – they write.

Sinkala M, Stout JP, Vermund SH et al. Zambian women’s attitudes toward mass nevirapine therapy to prevent perinatal transmission of HIV. Lancet 2001 Nov 10;358(9293):16112