PMTCT, and National's - Health Systems Trust

Figure 6.2.1: Nevirapine dispensing to HIV positive women in the pilot sites, 2002
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%
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80
70
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50
40
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WC KZN NW LP FS GT MP EC NC Average
There are a number of problems with the dispensing of nevirapine to HIV positive pregnant
women:
1. Inadequate patient information regarding correct nevirapine administration
There were reports from some sites that women did not adequately understand the
regimen for nevirapine administration. This resulted in some women taking the tablet
antenatally at the time it was dispensed and requiring a second dose when in labour.
Some sites reported a high number of women who required nevirapine to be dispensed
in the labour ward which suggests that tablets are not correctly self-administered or
are lost, or that women forget to take the tablet when they go into labour.
2. Lack of clarity regarding the dispensing of repeat doses to women
The national PMTCT protocol for the pilot sites stipulates that in the case of false or
prolonged labour nevirapine can be taken again 24 hours after the first dose at a
subsequent onset of labour. A study conducted in South Africa showed that giving two
doses of nevirapine to mothers results in a much higher rate of nevirapine resistance
than one dose 4 . A circular dated 16 th of April 2002 was sent from the national
Department of Health to provinces informing them, amongst other things of the revised
nevirapine regimen. The circular states that women in prolonged or false labour should
not receive a repeat dose of nevirapine. This evaluation found that in many facilities,
midwives were not aware of the change to the protocol and this information did not
appear to have been transmitted from provincial management to the facility level.
3. Difficulties identifying HIV positive women in the labour ward due to non-disclosure
The dispensing of nevirapine to HIV positive women in labour relies on the presence
of a unique patient identifier or on the willingness of the woman to disclose her status
to health workers. HIV positive women may be reluctant to reveal their HIV status in
delivery rooms that lack privacy, or to staff that have not been involved in their antenatal
counselling and care. This can result in missed opportunities for nevirapine coverage
of HIV positive pregnant women.
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