Zambian Women Prefer Nevirapine Therapy Without HIV Testing to Prevent Perinatal Transmission When Resources Are Limited

Universally providing the antiretroviral nevirapine to pregnant women without testing for HIV -- a strategy known as mass therapy and used to prevent vertical HIV transmission in high-risk areas with very limited resources -- is "controversial," but most Zambian women said in a survey that they would prefer the method, according to a study published in the Nov. 10 issue of the Lancet. Mass therapy has been found to be more cost-effective and preferable in regions that lack trained clinical staff, health care infrastructure and resources to test and counsel patients than the more standard targeted therapy, in which patients receive the drug only after testing positive for HIV.

Mass vs. Targeted
To survey the preferences of the women who would be eligible to receive mass nevirapine therapy, Moses Sinkala of the Zambian Ministry of Health and colleagues gave a questionnaire to 310 Zambian women at two public antenatal clinics in Lusaka following an educational session on HIV and nevirapine. The women were asked which treatment approach -- mass vs. targeted -- they would choose if resources were available to test and provide nevirapine to all patients, and which they would choose if resources were limited. The survey showed that when presented with a setting of unlimited resources, 74% of women preferred targeted therapy, saying they would prefer to be tested for HIV and then given the drug only if found to be infected. Twenty-three percent said they did not wish to know their HIV status, but just wanted to be given the drug, and 2.3% said they did not wish to be tested or given nevirapine. In a setting without the resources to test and treat everyone, in which only 50% of patients could be both tested and treated, 60% of the women said they would prefer mass therapy, and 39% said they would prefer that testing and nevirapine be offered to half of the women and nothing to the other half. Women who described their personal HIV risk to be moderate or high were "significantly" more likely to choose mass therapy for themselves, but not more likely to advocate it as general policy under a limited resource setting. The researchers noted, "Given the recent commitment by the manufacturer (Boehringer Ingelheim) to donate nevirapine throughout the less-developed world, there will be continued pressure to consider mass administration. ... This survey suggests that most women in Lusaka would support a mass therapy approach if it would allow a greater proportion of women to receive nevirapine" (Sinkala et al., Lancet 11/10).