Background In Mozambique, all HIV+ pregnant women attending prenatal consults (PNCs) receive single-dose nevirapine (NVP) at 36 weeks' gestation. The pill is to be taken when active labor commences. HIV+ women are also encouraged to have institutional deliveries for further measures of prevention of mother-to-child transmission (pMTCT). Because of an institutional birth rate of less than 40%, the lack of a uniform data recording system, and frequently incomplete or unclear patient registries, it has been difficult to determine longitudinal usage of pMTCT program elements and assess adherence by its users. We hoped to better define the population taking single-dose NVP during labor through the analysis of routinely collected data.
Study Design and Methods Significant data from all 2004-2005 “sero-positive patient registries” from prenatal clinics in the urban centers of Chimoio and Beira, MZ, were copied into the study database. The HIV+ entries from maternity wards were matched against the PNC database from their respective city, linking individual patient records. Prenatal records with prospective NVP delivery dates (36 weeks' gestation) falling after July 1, 2005, and not matching with a maternity record were discarded.
Results Of 1,244 HIV+ women attending PNCs in Beira and Chimoio, 306 women (25%) received NVP at 36 weeks' gestation. Thirty-six percent of women receiving NVP at a PNC had record of an institutional birth, but only 53% of this group reported taking the NVP at home before arriving at the maternity. The other 64% of women given NVP gave birth at home or elsewhere outside the urban center. Of 744 HIV+ institutional birth records, 617 women (84%) either reported taking NVP at home (19%) or received it upon arrival at the maternity (65%). Only 25 records were found indicating a home birth after which the mother returned to the maternity to get the necessary second dose of NVP for her newborn. Several inconsistencies and inadequacies in the routine data collection system were also observed.
Conclusion These results show that roughly 65% all of HIV+ women in these areas are still not getting NVP prophylaxis before giving birth, the percentage being even higher in the population giving birth at home. Specific improvements in individual health centers, and in the data collection system in general, may augment the longitudinal care of women in pMTCT programs.
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