Cape Town, South Africa, Clinic Launches Nevirapine Distribution Program
A Cape Town, South Africa, clinic last month became the first among a national network of 18 public clinics to offer nevirapine free of charge to pregnant women, the New York Times reports. The Guguletu clinic has already provided the drug to more than 80 HIV-positive pregnant women in an effort to prevent vertical HIV transmission and reduce the flood of sickly, HIV-positive babies, who have put an "overwelm[ing]" strain on South African hospitals. The program provides women who test positive for HIV with one nevirapine pill, which they are instructed to keep in a "safe place" and take during labor; their newborns are also given a single dose of nevirapine -- a regimen that is estimated to reduce vertical HIV transmission by 50%. The program also provides women a six-month supply of free baby formula, as HIV can be transmitted through breastfeeding. South African officials hope that by April, all 18 clinics in the network will provide HIV testing, counseling and drugs to pregnant women, and that the program will reach between 36,000 and 60,000 women in its first year. According to the Times, however, the program will reach "probably no more than 20% of the estimated 250,000 women infected with [HIV] who become pregnant each year in South Africa." In addition, the program does not offer women any other treatment. About 600,000 babies are born with HIV worldwide every year; 90% of these are born in Africa.
Obstacles to Success
In deciding to launch the nevirapine program, South Africa "ends its bitter, public feud with the medical establishment," and joins eight other African countries -- including Botswana, Zimbabwe, Uganda and Ivory Coast -- in offering nevirapine through similar programs. However, health officials in those African nation that operate nevirapine distribution programs have encountered several roadblocks. Some pregnant women "resist" taking HIV tests, and nurses and counselors are "overwhelmed" by the "new burden" of testing and counseling. Women also have resisted accepting the free infant formula, as African women who do not breastfeed "are often shunned" in society. Moreover, health officials have not been able to "guarantee reliable supplies" of the formula or clean water. Peggy Henderson, a specialist in "mother-to-child programs" for UNICEF, said, "Giving out the drugs is the easy part. The whole intervention is much more difficult than we predicted" (Swarns, New York Times, 2/18).