Effects of the Pratt pouch model of dispensing nevirapine prophylaxis on HIV exposed infant completion of 6 weeks of prophylaxis in Uganda.
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2021-01
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Abstract
Introduction
The innovative Pratt pouch could optimize dispensing nevirapine prophylaxis to HIV-exposed infants in pre-measured single dose pouches to increase completion of the full 6 week infant nevirapine regimen.Materials and methods
Nineteen health facilities with highest HIV positivity rates among pregnant women across 9 districts in southwest and central Uganda were assigned to control and intervention groups. HIV-positive women enrolled at intervention facilities received pouches filled with premeasured single doses of nevirapine using Uganda national guidelines, which were integrated into the existing drug distribution system. During antenatal care (ANC) women received 14 pouches to cover time until the 6 day postpartum visit, with an additional 8 pouches if women were delayed in returning to the facility, and 28 pouches after delivery. Women enrolled at control facilities received standard nevirapine syrup following delivery for postnatal infant prophylaxis. In a select number of intervention facilities, during ANC, women received all 42 pouches needed to complete the 6 weeks regimen. Medical record data from enrolled women were extracted; interviews with HIV-positive women during postnatal care visits were conducted. Data were collected January to August 2018 (control sites) and October 2019 to February 2020 (intervention sites). Unadjusted and adjusted logistic regression models were used to identify factors associated with facility delivery, postnatal care follow-up visit, and completion of the full 6 weeks infant nevirapine regimen.Results
Significantly more women in the intervention (n = 320) versus control (n = 340) group had facility delivery (292/316, 92.4% versus 169/340, 49.7%, p<0.0001), postnatal visits within 2 weeks postpartum (295/297, 99.3% versus 133/340, 39.1%, p<0.0001) and reported their infants completing the full 6 weeks infant prophylaxis regimen (299/313, 95.5% versus 210/242, 86.8%, p = 0.0002). Dispensing 42 versus 14 pouches during ANC did not have negative effects on these outcomes. Among out-of-facility deliveries, a higher proportion of infants received nevirapine within 72 hours of birth in the intervention versus control group, 95.8% versus 77.9%. In multivariate models, the intervention group was the only significant factor associated with facility delivery or completion of the full 6 weeks infant prophylaxis.Conclusions
Use of the Pratt pouch resulted in an increase in HIV-exposed infants completing the full 6weeks prophylaxis regimen and associated benefits including increasing facility delivery and women's adherence to postnatal care services.Type
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Bitarakwate, Edward, Kim Ashburn, Patrick Kazooba, Ronald Khamasi, Eliab Natumanya, Nicole Herrera, Boaz Owomugisha, Robert A Malkin, et al. (2021). Effects of the Pratt pouch model of dispensing nevirapine prophylaxis on HIV exposed infant completion of 6 weeks of prophylaxis in Uganda. PloS one, 16(3). p. e0247507. 10.1371/journal.pone.0247507 Retrieved from https://hdl.handle.net/10161/31349.
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Robert A. Malkin
Professor Malkin is interested in medical instrumentation in the developing world.
Dr. Malkin is also the founder of The International Research Institute, Engineering World Health and the Global Public Service Academies. These unique study abroad programs allow undergraduates (EWH) and high school students (GPSA) to study and work in developing world healthcare settings.
Dr. Malkin also conducts research and development focused on medical equipment in the developing world.
Professor Malkin's work on medical instrumentation in the developing world has been supported by Engineering World Health, The National Institutes of Health, The American Heart Association, The Whitaker Foundation, the National Science Foundation and other organizations.
The DHT-Lab runs educational programs such as the EWH Summer Institute and formal classes and provides research and product development opportunities for undergraduates interested in developing world healthcare technology.
Engineering World Health Summer Institute is a unique study abroad program that allows undergraduates to study and work in developing world hospitals. Dr. Malkin and his associates have helped hospitals in Sudan, Nigeria, Nicaragua, El Salvador, Haiti, Liberia, Sierra Leone and many other places. If you came to this site looking for high school programs, consider visiting the International Research Institute or Global Public Service Academies a non-Duke program run by Dr. Malkin.
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.