Acceptability of Short -Course AZT Prevention Regimen by HIV Infected Pregnant Women; Should VCT in the Antenatal Setting Be Modified

Background: Acceptability VCT by pregnant women is critical in the contest of trials accessing interventions to reduce mother to- child transmission (MTCT) of HIV. We studied the logistics and uptake of short –course oral AZT regimen by HIV-infected women after VCT in areas of Uganda.

Objectives:NA

Methods:from June 2004, a pilot project on the feasibility of short-course AZT was launched in an antenatal clinic in mulago hospital. All pregnant women hear a 15- minute talk by clinic nurses a bout MTCT of HIV and are offered voluntary pre-and post-test counseling by lay community volunteers. Consenting HIV-positive women are offered AZT (300mg twice daily) from 36 weeks gestation until labor, one tablet at onset of labor, and then every 3h delivery. HIV positive women are counseled and supported on their choice of infant.

Results:over a 6-month period, 1062 antenatal women were offered VCT, 247 (22%) underwent pre-test counseling and 206 (18%) agreed to be tested. Among those tested 78 (38%) were HIV-positive, of these 17(83%) returned to collect results, including 65 HIV positive women. As of September 2004, 40(62%) women consented for AZT, 17 women have completed the regimen, 5 are currently receiving drug, 7 are eligible to start AZT and 11 women dropped out of the study (preterm births, incorrect dates, failure to notify nurses during labor, and non-compliances). Of the 17 women who received AZT, 12 opted for formula feeding and 5 women chose breast feeding.

Conclusions:HIV prevalence in this setting is estimated at 30% of 332 projected HIV infected women seen, only 40(12%) women actually received AZT. The major barrier appears to be entrance into counseling. When counseled, most HIV-pregnant women choose to receive AZT prophylaxis. New approaches to antenatal HIV counseling and testing are urgently required to improve future acceptance of VCT and the successful implementation of antiretroviral pro-phylaxis.

Implications for Programs, Policy, and Research:NA