Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
Integrated Regional Information Networks - December 4, 2006
NAIROBI, 4 December (PLUSNEWS) - HIV-positive pregnant women in Kenya may soon receive the AIDS drug Zidovudine, also known as AZT, alongside single-dose Nevirapine, a combination shown to significantly reduce the transmission of the virus to new-born babies.
"We began to introduce AZT in combination with Nevirapine at several pilot sites around the country last year and, depending on the results, we plan to roll out the new treatment across the country," said Dr Robert Ayisi of the National AIDS and other Sexually Transmitted Infections Control Programme (NASCOP).
Kenya currently uses a single dose of Nevirapine as a frontline drug in blocking mother-to-child transmission of the virus, but it has an efficacy rate of between 50 and 60 percent. "The administration of AZT, along with a caesarean birth, lowers the risk of HIV/AIDS infection to less than 10 percent," said Ayisi, the coordinator of the governmentÆs prevention initiative.
"We have never been able to get the PMTCT [prevention of mother-to-child transmission] ratios as low as we would like," said Dr Dorothy Mbori-Ngacha, head of the PMTCT section of the US Centers for Disease Control in Kenya. "With Nevirapine alone, even if we reached every woman who needed PMTCT, we would still only prevent half their children from contracting HIV." The CDC is providing technical guidance to the government's new programme, which is financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Mbori-Ngacha said Kenya had significantly increased the number of women accessing PMTCT, from 250,000 in 2005 to 500,000 in 2006. As the numbers grew, more women were presenting themselves for antenatal care earlier, greatly reducing the chances of their babies becoming infected. "We start AZT at 28 weeks, and the mother takes it twice a day until delivery, then she takes a single dose of Nevirapine, as does the baby."
Pregnant women receiving the new therapy were placed in three groups: "The first category is those who present early and are put on AZT for the duration of the pregnancy; the second category is those who present themselves early but are already exhibiting AIDS symptomatology - we put these women on HAART [highly active antiretroviral therapy] and they continue the treatment afterwards," she said. "The third group is women who come too late into their pregnancy for AZT, and we simply give them the single-dose Nevirapine."
Mbori-Ngacha said there was a need for closer monitoring and follow-up under the new therapy, as it was more complicated than single-dose Nevirapine.
"Adherence to any drug is difficult, but because the AZT is given for a short period, we are not very worried about resistance," she noted. "During studies at the University of Nairobi we found that women were very determined to prevent transmission to their children - we had adherence rates of more than 90 percent and most of those who did not adhere cited side-effects, such as nausea or dizziness."
NASCOP's Ayisi said adherence counsellors were employed at all the sites where AZT was being used. Kenya has increased its PMTCT sites significantly, from 600 to 1,060 over the past year, and has doubled the number of trained service providers from 5,000 in 2005 to 10,660.
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