Feasibility of HIV prophylaxis with nevirapine in a northeastern rural area of the Democratic Republic of the Congo

Several developing countries, including the Democratic Republic of the Congo have adopted HIV NET 012, i.e. a single dose of nevirapine to mother (200 mg at labour onset) and baby (2 mg/kg within 72 h of birth), because of the accessible cost of nevirapine and its supposedly easy use in MTCTP programs [2]. The protocol can nonetheless prove complex to apply in rural regions of Africa and must be evaluated. This article aims to present the difficulties encountered in implementation of this protocol at the Oicha General Reference Hospital, in the northeastern region of the Democratic Republic of the Congo. The study took place time from December 2002 through December 2004. During the study period, 94 women were identified as HIV positive at the prenatal clinic of Oicha Hospital. Of the 94 HIV positive women: 59 (62.8%) received antiretroviral prophylaxis and 35 (37.2%) did not receive nevirapine despite their identification at the prenatal clinic. Among these 35 women, 26 (27.7%) of the expected women arrived fully dilated and thus went directly to the delivery room. Nine (9.5%) of the expected women who delivered at the Oicha maternity were not administered the product by the midwives. For administration of nevirapine to the mother: 33 pregnant women out of 59 (55.9%) received nevirapine within the time recommended - within two hours of the onset of contractions. Twenty four of 59 women (40.7%) did not receive the nevirapine within the time recommended, but within an average delay of 11.00 hours. For 2 of 59 women (3.4%), the hour of administration of the nevirapine was not specified. For administration of nevirapine to the child: 48 of 101 children (47.5%) received nevirapine within the recommended period, i.e. in the 24-72 hours after birth. 52 of 101 children (51.5%) received the nevirapine in an average of 2.9 hours of birth. This is the proportion of the children whose mothers arrived at the maternity ward ready for delivery. Only 1 child (1%) received the nevirapine later than the recommended period, 13.9 hours later. Applying as simple a protocol as the HIV prophylaxis program with nevirapine in African rural areas encounters difficulties.