Development of a Model for National Scale-up of the Pratt Pouch to Expand Infant Nevirapine Prophylaxis in Uganda, Prevent Mother-to-child Transmission of HIV, and Save Infant Lives
Annually, 120,000 HIV-exposed infants are born in Uganda with nearly 16,000 becoming HIV-infected through transmission from their HIV-positive mothers during pregnancy, delivery, or breastfeeding. Antiretroviral prophylaxis given from birth to six weeks of age can dramatically reduce the risk of transmission, yet 68% of HIV-exposed infants do not receive critical nevirapine (NVP) prophylaxis in Uganda. The Pratt Pouch, a foilized, polyethylene pouch (similar to a ketchup pouch) designed and proven to safely store NVP doses, offers an innovative way to expand NVP coverage. The Elizabeth Glaser Pediatric AIDS Foundation and its partners propose to introduce and scale up the Pratt Pouch in antenatal care, delivery, and postnatal care services in Uganda. Integrating this technology into existing services will simplify dosing and ensure all HIV-positive women have access to infant NVP. The easy-to-use pouches will empower women to immediately initiate NVP after delivery and encourage them to deliver in a health facility or bring their infants for postnatal care within 14 days. Our primary endpoint will be the proportion of HIV-exposed infants receiving the full NVP regimen from birth to six weeks of age, while impact will be measured by the proportion of HIV-exposed infants diagnosed with HIV at six to eight weeks of age. By achieving these outcomes, we will demonstrate an effective, evidence-informed model for national scale-up and reach 40,000 infants in three years.