A foil pouch helps give HIV-positive mothers a way to protect their children

Last year, about 700,000 children—almost all of them in Africa—became infected with HIV. In most cases, the virus came to them from their mothers, transmitted during pregnancy, labor, or breastfeeding. Imagine how helpless a mother would feel, knowing that there’s one chance in four that she will infect her child with a devastating disease—and there’s nothing she can do to stop it.

PATH has found a way to make it easier for mothers to get the antiretroviral drugs that can stop mother-to-child transmission of HIV. The simple foil pouch we’ve developed can play an essential role in programs that bring necessary medication to mothers who need it.

A lifesaving program and a stumbling block

In June of 2000, the international pharmaceutical company Boehringer Ingelheim decided to give pregnant women with HIV a chance to protect their newborns. They started a large-scale donation program to send nevirapine—a drug they developed that helps prevent mother-to-child transmission—to selected countries in the developing world.

Just one dose of nevirapine for both the mother and newborn can reduce the risk of mother-to-child transmission of HIV by more than half. A birth dose of nevirapine can be a key part of a package of interventions that prevent mother-to-child transmission. But the path from a lifesaving medicine to healthier children hasn’t been a straight one. In the first years of the program, very few countries were requesting donations. Boehringer went to governments and groups like PATH to find out why.

One of the barriers was simple logistics. A woman giving birth at home, as many African women do, needs to give a single teaspoon of nevirapine syrup to her newborn to help protect the baby from infection. These mothers may walk miles for their last chance to see a health worker in the weeks before they deliver their babies, and their last chance to get the medication they need. How do they get it home and keep it clean and undamaged in the time before they go into labor?

Have nevirapine, will travel

Some health workers in Kenya, with inspiring ingenuity and determination, used materials they had at hand to send a single dose of nevirapine syrup home with as many mothers as possible. And they came up with solutions that were workable, if not ideal.

At one clinic, health workers filled oral dispensers with the right amount of nevirapine and then wrapped them in tape, then in aluminum foil, and then in plastic bags to protect the medication. Finally, they put this package into an old box from another medication. Effective—but the packaging process is time consuming, the packaging itself offers inconsistent protection for the medication, and the system depends on the willingness of overburdened health workers to go the extra mile.

Making it easier to protect infants from HIV

Using our experience with other problems in delivering medications beyond the reach of health clinics (for example, the Uniject™ device), PATH explored ways to make it easy for health care workers to send home single doses of nevirapine syrup. What we came up with was a simple foil pouch with a self-sealing strip and clearly illustrated instructions. Health care workers fill an oral dispenser with nevirapine, place it in the pouch, remove the adhesive strip, and seal it. The medication stays safe and clean until it’s used, even if the woman takes it home as long as two months before her delivery.

The pouch protects the medication and makes it less likely that the syringe will accidentally be squeezed—and the medication lost. It has instructions that remind the pregnant woman and her helpers when and how to give the nevirapine syrup. This label also includes a place where health workers can record the expiration date—so that unused medication is less likely to be handed off and used by another woman after it has expired.

Partnerships with impact

Boehringer supplies the medication, and PATH (with funding assistance from the US Agency for International Development and others) has developed a better way to help deliver it safely to the women who need it. Other collaborators, including the Elizabeth Glaser Pediatric AIDS Foundation and Family Health International, are using the pouch in the field—gathering evidence that may lead to much broader use. Together, we are transforming a good idea into an elegant solution. And no solution is as elegant as one that gives children a fair chance to be strong, healthy, and full of hope.

Increasing access

In October 2007, Boehringer Ingelheim announced that they would be donating the nevirapine infant-dose pouch as a component of their Viramune® Donation Program, making it available at no cost. Women will now be able to access one more tool to give their children chance in the fight against HIV.

Photos: PATH.