A simple foil pouch provides HIV-positive mothers a way to protect their children

Screenshot from video on the nevirapine pouch.

Using a foil pouch to save lives—this antiretroviral medication can help an HIV-positive mother protect her baby against infection. Photo: PATH.

Pregnant women living with HIV in Africa once felt helpless, knowing there was one chance in four that they would infect their baby with HIV during pregnancy, labor, or while breastfeeding. Many felt that there was nothing they could do to stop it.

To help, PATH developed a simple foil pouch that made it easier for these mothers to transport, store, and use a key prevention option: an antiretroviral medication capable of stopping mother-to-child transmission of HIV.

A lifesaving program and a stumbling block

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

Just one dose of nevirapine for both a mother and her newborn can reduce the risk of mother-to-child transmission of HIV by more than half. A “birth dose” of the drug—along with other interventions—became an important tool for preventing mother-to-child transmission.

Still, the path from a lifesaving medicine to healthier children wasn’t a straight one. In the first years of the program, Boehringer realized that very few countries were requesting the donations it had offered. The company went to governments and international health groups like PATH to find out why.

One of the biggest barriers turned out to be simple logistics. A woman giving birth at home, as many African women did, needed to give a single teaspoon of nevirapine syrup to her newborn to help protect the baby from HIV infection—but that wasn’t as easy as it sounded. Mothers often walked miles in the weeks before they gave birth for their last chance to see a health worker. Even if they could get the nevirapine syrup during that visit, how would they carry it home, and keep it clean and undamaged, during the time before they went into labor?

Have nevirapine, will travel

Photo: tape, aluminum foil, plastic bags, and reused medication box for nevirapine packaging.

One Kenyan health worker used tape, aluminum foil, plastic bags, and an old medication box to package the drug nevirapine. Photo: PATH.

Foil pouch with illustrated instructions and oral nevirapine dispenser.

This pouch helps HIV-positive mothers bring protective medication to their newborn children. Photo: PATH.

Some health workers in Kenya, with inspiring ingenuity and determination, were already using materials they had at hand to send a single dose of nevirapine syrup home with as many mothers as possible. 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, aluminum foil, and plastic bags to protect the medication. Finally, they put this package into an old box from another medication. Effective—but the process was time consuming, the packaging offered inconsistent protection for the medication, and the system depended on the willingness of overburdened health workers to go the extra mile.

Making it easier to protect infants from HIV

Using our experience finding ways to deliver medications beyond the reach of health clinics (for example, the Uniject® injection system), we 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 filled an oral dispenser with nevirapine, placed it in the pouch, removed the adhesive strip, and sealed it. The medication stayed safe and clean until was used, even if the woman took it home as early as two months before her delivery.

The pouch protected the medication and made it less likely that the syringe would accidentally be squeezed—and the medication lost. It included instructions that reminded the pregnant woman and her helpers when and how to give the nevirapine syrup. The label also included a place where health workers could record the medicine's expiration date—so that unused, expired medication was less likely to be used by another woman.

Partnerships with impact

In the end, this project yielded a simple but crucial tool for women living with HIV—one that gave children a fair chance to grow up strong and healthy. Boehringer supplied the medication, and PATH (with funding assistance from the US Agency for International Development and others) developed a better, safer way to deliver it. Other collaborators included the Elizabeth Glaser Pediatric AIDS Foundation and Family Health International.