Single-dose Nevirapine, and other ARV options for PMTCT
The simplest drug regimen used to prevent HIV transmission is a single dose of Nevirapine given to the mother at the onset of labour, and a single dose given to the baby after delivery. It is estimated that this regimen reduces the rate of HIV transmission by half. As it is given only once to the mother and baby, it is relatively cheap and easy to administer. Consequently, it has been the mainstay of many PMTCT programmes in Ethiopia and other resource limited countries. You may be expected to use this simple intervention at your level for PMTCT.
Because of concerns about drug resistance, and that a single-dose regimen may not be as effective as combination drug therapies, there is now general agreement that single-dose Nevirapine should be used only when no alternative PMTCT drug regimen is available. Whenever possible, women should receive a combination of drugs to prevent HIV resistance problems, and to decrease mother-to-child transmission rates even further.
Nevirapine, however, is still the only single-dose drug available for PMTCT. Other treatments require women to take drugs during and after pregnancy, as well as during labour and delivery. This means they are much more expensive and more difficult to implement, unlike Nevirapine, which can be used with little or no medical supervision at all. For the moment, single-dose Nevirapine remains the only practical choice for PMTCT in areas with minimal medical resources.
In addition to single-dose Nevirapine, two other options are available, but these are beyond the scope of this study session (some of these drugs were introduced in Study Session 24):
- Combining AZT with single-dose Nevirapine and Lamivudine.
- Three full-dose combination of ARVs.
At this point it should be emphasised that short-term ARV prophylaxis for PMTCT does not treat maternal HIV immunosuppression, and therefore does not provide long-term benefits for the health of the mother. For this reason, women should be regularly assessed for ART eligibility. And if a pregnant mother is eligible to start ARV drugs, she should be referred to the nearest health facility to start the treatment.
Explain the difference between using ARV drugs for ART or PMTCT.
When ARVs are used for treatment purposes, usually patients take three or more combined drugs, and they are taken for life. In PMTCT, ARVs are taken as prophylaxis for a short duration, with the aim of preventing the transmission of the HIV from the mother to the child. In addition, in PMTCT a single drug, or a combination of drugs, can be taken.