Lesotho's minimum PMTCT package: lessons learned for combating vertical HIV transmission using co-packaged medicines

Area of Science:

• Public Health
• Infectious Diseases
• Maternal and Child Health

Background:

• Mother-to-child transmission of HIV (PMTCT) is preventable with antiretroviral medications.
• Limited access to healthcare in countries like Lesotho results in high transmission rates.
• A Minimum PMTCT Package was introduced in Lesotho to improve access to essential medications.

Purpose of the Study:

• To evaluate the availability, feasibility, and acceptability of the Minimum PMTCT Package.
• To assess the impact of the package on antenatal care (ANC) and facility delivery rates.
• To identify potential negative consequences of the package.

Main Methods:

• Qualitative and quantitative study data from 2009 and a 2010 facility assessment were used.
• A difference-in-differences analysis of 2009 Demographic and Health Survey data was conducted.
• The study examined HIV-tested women who gave birth before and after package implementation.

Main Results:

• The Minimum PMTCT Package was found to be feasible and acceptable to providers and clients.
• Challenges included stock-outs of test kits and medicines, with 46% of women receiving the package after their first ANC visit.
• The proportion of HIV-positive women delivering in facilities decreased post-implementation, while it increased for HIV-negative women.

Conclusions:

• The take-away co-package model has potential to enhance access to PMTCT commodities in resource-limited settings.
• Resolving supply chain issues and improving client education are crucial for success.
• Careful monitoring of ANC visits, facility deliveries, adherence, safety, and effectiveness is necessary.