|UNAIDS Technical Update Mother-to-Child Transmission of HIV - Update 1.2 (UNAIDS, 2001, 9 p.)|
Health policy makers need further guidance on the following policy issues:
1. When and where to introduce Nevirapine?
· Incidence of MTCT
· Knowledge of safety/adverse effects and need for further research
· Experience with large-scale implementation of ARV regimens already in place (short/long regimen of ZDV)
· Replacement of AZT short regimen by Nevirapine among breastfeeding women
· Affordability verses health budget
· Operational feasibility: capacity of health system to implement VCCT, deliveries attended, and capacity of systems to reach women/children after the delivery
· Nevirapine procurement
· Role of the private sector in offering treatment
2. Implication for counseling on infant feeding?
Instead of AZT and replacement feeding, potential criteria for exclusive breast-feeding and Nevirapine with or without a postnatal component:
· Under 5 mortality
· Affordability of replacement feeding
· Marginal cost-effectiveness of adding AZT or NVP during the exclusive breastfeeding period to the short regimen of NVP
· Present Breast-feeding patterns, notably exclusive breastfeeding
· Stigma associated with replacement feeding
· Is it already in place?
· Discrimination/stigma linked to HIV positive test results
· Access and quality and effective use of MCH services
· Other potential benefits to intervene: development of user-friendly services, primary prevention among women of reproductive age