Home deliveries: implications for adherence to nevirapine in a PMTCT programme in rural Malawi

Although nevirapine (NVP) is provided by prevention of mother-to-child-transmission (PMTCT) of HIV programmes to be taken at onset of labor independent of place of delivery, few studies have assessed adherence to NVP outside the hospital setting. This study aimed to follow women in a PMTCT programme up to delivery and to assess the adherence to the prophylaxis in rural Malawi. A total of 75 HIV-positive women were registered in the PMTCT at Malamulo SDA hospital between January and June 2005. Forty women (53%) delivered in the hospital and 35 (47%) did not. Of the 35 women who delivered at home, it was possible to trace 27 (77.2%). All women who delivered in the hospital took their NVP tablets and all their babies had NVP syrup except one baby who died soon after delivery. Of the 27 traced women who had not delivered in the hospital, 16 (59.3%) had access to NVP and had taken their tablets during labor. However, none of their babies was taken back to the health facility for NVP syrup. Traditional birth attendants might be crucial in efforts aiming to increase adherence to NVP among women and their babies.