Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Kampala, Uganda.
Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America.
PLoS One. 2021 Mar 10;16(3):e0247507. doi: 10.1371/journal.pone.0247507. eCollection 2021.
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.
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.
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.
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.
创新的 Pratt 袋可以将奈韦拉平预防用药优化为针对 HIV 暴露婴儿的预测量单剂量袋，以增加完成完整的 6 周婴儿奈韦拉平疗程的比例。
乌干达西南部和中部 9 个地区的 19 家卫生机构，孕妇 HIV 阳性率最高，分为对照组和干预组。在干预设施中，HIV 阳性的孕妇按照乌干达国家指南领取预先测量的单剂量奈韦拉平药袋，该指南已经整合到现有的药物分发系统中。在产前保健期间（ANC），妇女收到 14 个药袋，以覆盖产后 6 天就诊前的时间，如果妇女返回医疗设施的时间延迟，则另外提供 8 个药袋，产后提供 28 个药袋。在对照组设施中，婴儿在产后接受标准的奈韦拉平糖浆进行新生儿预防。在一些干预设施中，在 ANC 期间，妇女领取完成 6 周疗程所需的所有 42 个药袋。从参加的妇女那里提取医疗记录数据；在产后护理期间对 HIV 阳性妇女进行访谈。数据于 2018 年 1 月至 8 月（对照组）和 2019 年 10 月至 2020 年 2 月（干预组）期间收集。使用未调整和调整后的逻辑回归模型确定与设施分娩、产后护理随访和完成完整的 6 周婴儿奈韦拉平方案相关的因素。
干预组（n=320）与对照组（n=340）相比，显著有更多的妇女在设施中分娩（292/316，92.4%与 169/340，49.7%，p<0.0001）、在产后 2 周内进行产后随访（295/297，99.3%与 133/340，39.1%，p<0.0001），并报告婴儿完成完整的 6 周婴儿预防方案（299/313，95.5%与 210/242，86.8%，p=0.0002）。在 ANC 期间发放 42 个而不是 14 个药袋对这些结果没有负面影响。在非设施分娩中，干预组婴儿在出生后 72 小时内接受奈韦拉平治疗的比例高于对照组，分别为 95.8%和 77.9%。在多变量模型中，干预组是与设施分娩或完成完整的 6 周婴儿预防方案相关的唯一显著因素。
使用 Pratt 袋可增加完成完整 6 周预防方案的 HIV 暴露婴儿数量，并带来相关益处，包括增加设施分娩和妇女对产后护理服务的依从性。
