An exploratory study of Zambian pregnant women’s perceptions of the use of extended infant nevirapine to prevent HIV transmission during breastfeeding

Overview

Guidelines on prevention of mother-to-child transmission (PMTCT) and infant feeding from the World Health Organization (WHO) show promise towards eliminating confusion about infant feeding and move us closer to possible elimination of pediatric HIV infection. Zambia adopted Option A, which outlines the use of extended infant nevirapine through the duration of breastfeeding. Through the use of extended infant nevirapine, these revised guidelines preserve breastfeeding as the safest method of infant feeding in resource-constrained settings.

The WHO guidelines require women and caregivers to deliver infant nevirapine daily through the duration of breastfeeding (which, in sub-Saharan Africa where HIV is most prevalent, typically extends into the second year of life). While the extended use of nevirapine through the duration of breastfeeding is recommended, little is known about how mothers respond to this advice given issues of treatment fatigue, stigma, and disclosure issues. This study improved understanding of how beneficiaries view the changes and their ability to carry out these revised guidelines over an extended period outside the support and guidance of a large clinical trial.

The study aimed to improve our understanding of unforeseen challenges and possible solutions to implementing Option A of the WHO PMTCT guidelines. It provided insight into possible solutions to overcome such challenges from the perspective of HIV-positive pregnant and lactating women. The exploratory, qualitative study included focus groups and in-depth interviews with pregnant and lactating women in urban and rural sites, as well as interviews with health care workers in the selected sites.