Mother-baby HIV kit targets transmission

It's no great medical breakthrough, just a simple colour-coded box packed with HIV drugs and pictures, but UNICEF hopes it will help prevent transmission of the virus to babies.

The mother-baby pack, dubbed "innovation for an HIV-free generation", will be distributed to 30,000 pregnant women in Kenya, Cameroon, Lesotho and Zambia starting this month.

It contains all the medicines and instructions needed to protect an HIV-infected mother and her newborn, even if she never visits a health clinic again until after the baby is born, and even if she can't read properly.

"We don't need any scientific breakthroughs or new technology to tackle this problem," said Jimmy Kolker, head of HIV and Aids at the United Nations Children's Fund (UNICEF). "What we need is a way to empower women to take charge of their own care."

No transmission from mother to child

In developed countries, there is now virtually no transmission of HIV from mothers to babies, which shows, as Kolker says, that we have the medicines and healthcare knowledge to halt it worldwide.

It is the logistics of getting the right drugs to the right people at the right time that is proving the biggest barrier in poorer countries to eliminating mother-to-child HIV transmission - a goal the United Nations has said it wants to reach by 2015.

"In the developed world, there are now very few babies born HIV positive, but in Africa there are still over 1,000 born every day," Kolker said. Eliminating mother-to-child transmission by 2015 was an "ambitious goal", but one that could be reached with some new ideas, he said.

More than 50% of HIV-positive women in sub-Saharan Africa in 2008 did not get the drugs they needed to prevent transmission of the virus to their children, according to data from the Joint United Nations Program on HIV/Aids (UNAIDS).

WHO estimates

The World Health Organisation says an estimated 430,000 children were newly infected with HIV in 2008, the vast majority of them through mother-to-child transmission.

"We're still missing a lot of mothers because they don't come back to the clinics, or because the clinics are short of drug supplies, or because the mothers don't take the drugs when they're supposed to," said Kolker.

At around $70 (about R470) per box, the mother-baby pack costs less than half of what it would take to give even a year of drug treatment to an HIV positive baby, UNICEF says.

"It's cost-effective from every point of view," said Kolker. "It's something that can be done at a village level and followed up by a community health worker or mothers group. It doesn't need a nurse or doctor to follow through."

The pack will also simplify the procurement, ordering and distribution of drugs and healthcare since it is a one-stop-shop, with a complete course of medicines and instructions to halt mother-to-child HIV transmission.

The HIV bag

The pack is divided into three sections of blue for drugs to be taken during pregnancy, yellow for medicines needed during labour and delivery and pink for drugs needed for mother and baby after delivery.

The colour-coding and a series of simple pictures are designed to help women with low levels of literacy understand when and in what doses to take the medicines.

UNICEF's $8.0 million (about R 54.4 million) pilot project in the first four countries is planned in three phases, with around 30,000 packs to be distributed in each phase to reach almost 100,000 women by the middle of 2011.

If it proves successful, Kolker said UNICEF plans to scale the project up in these countries and widen it to include more.

"We don't want to do this without being really sure that it works," he said. "But one of the things that is most promising about this project is that there are already a number of countries who want to be next in line."

(Reuters Health, Kate Kelland, November 2010)

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