Although the HIV epidemic is still touching all corners of the world, the sub-populations at risk differ from region to region. The subject of this article is infants at risk because their mothers are HIV positive. In North America, pediatric AIDS is simply not a major issue. Rates of transmission from an HIV-positive mother to her baby are approaching zero, as we have the means of effective antiretrovirals (ARV) treatment for both mother and baby.
Without any treatment, the risk of transmission from mother to child ranges from 15-45%. In sub-Saharan Africa, where in many countries up to 50% of HIV-positive pregnant women are not on ARV treatment, maternal to child transmission is one of the prevailing unaddressed paths of the epidemic. In addition, many of these infants will die as a result of HIV: for babies infected by mother-to-child transmission, 1/3 will not see their first birthday, and 1/2 will not survive to the age of two.
One of the biggest obstacles to complete ARV treatment in newborns in sub-Saharan Africa is access to health care facilities. A newborn is supposed to begin ARV treatment within 24 of birth, so unless a mother gives birth at a health clinic with sufficient ARVs, the baby will be at greater risk of infection. This especially applies to mothers who give birth at home and without a skilled birth attendant, which in many countries approaches 50 percent.
So far, this all sounds pretty bleak. However, a new innovation is bridging part of the gap of treatment for home births of HIV-positive mothers. This innovation is a ketchup-packet-shaped pouch, called the Pratt Pouch, which enables mothers to effectively administer medicine to newborns away from a health facility. The pouch contains exact doses of antiretroviral medicine, so a mother can easily tear open the pouch and put the contents into her baby’s mouth.
Seen here is a mother using the pouch in Moshi, Tanzania
The pouch was designed and invented at the Pratt School of Engineering at Duke University. It is a foilized multi-layer pouch, the most important of which is the layer touching the drug. In fact, the shape and material of the pouch and its layers is the ‘secret sauce,’ the key to preserving the drug for up to a year, even when stored at home. The significance of greatly extending the shelf life from previous home-treatment methods is that the health system barriers can be partially overcome in sub-Saharan Africa. If an HIV-positive pregnant woman goes to a health clinic, even months before birth, she can take home pre-dosed Pratt Pouches with pictoral instructions. The medicine can be given until either six weeks after birth, or one week after the end of the breastfeeding period.
The Pratt Pouch works through an assembly-system by pharmacists in-country. The pouches are shipped to a hospital, where a local pharmacist fills the pouch with a specific dose of ARV medicine (most commonly Nevirapine, or NVP). The pouches are then heat-sealed, protecting the medicine and readying them to be used by mothers.
Seen here is the pouch-filling process by Fundacion VIHDA, an organization paired with Ecuador’s largest Maternity Hospital in Guayaquil
The pouch is currently being used by Fundacion VIHDA in Guayaquil, Ecuador, where it has prevented mother-to-child transmission in over 1000 babies. It is also being piloted or expanded in a number of countries in Sub-Saharan Africa, including Uganda The goal now is to bring access to the pouch to as many HIV-positive pregnant women as possible. According to an estimate from USAID, the Pratt Pouch could save 400,000 babies from infection each year. Despite this grand possibility, every day 600 children are infected with HIV. With this innovation, we have the means to prevent mother-to-child transmission in some of the hardest to reach regions of the world. Taking full advantage of this innovation will significantly decrease the number of babies born with HIV for a safer, healthier future.
About the writer: : Leah Hardenbergh is a sophomore from Anchorage, Alaska, studying at Brown University. She works for Maternova Inc., a company that accelerates access to life-saving global health technologies through a pioneering ecommerce platform.