Week 2 (9/29): MTCT

The research methods that Kourtis et al. used to determine when HIV is transmitted from mother-to-child and what percent of transmission cases occur at which times really intrigued me. The design of the experiment, taking into account both breastfeeding and non-breastfeeding mothers, was carefully thought out, and its results provide important data in crafting the most effective regimen for preventing/reducing MTCT.

However, since reflecting upon the article, I am wondering how realistic some of these prevention methods are for (prospective) mothers living in rural areas, especially in Africa. A number of questions come to mind when considering how to implement these findings in such areas.

First, due to both a lack of money and of trained staff, the possibility of administering these regimens to pregnant women seems difficult. Currently, single-dose nevirapine is the cheapest and easiest choice, as it requires little to no training from medical staff. Yet, these single-doses also increase the likelihood of resistant viruses in both the mother and infant. So, what resources will it take to implement zidovudine regimens in rural villages, and correspondingly, how likely is it that this goal will be realized?

In addition, the possibility for women to get a C-section in these villages is unlikely, as well, considering that there are few trained doctors who would be able to carry out this procedure. As a result, it seem as though preventative measures during breastfeeding are the best (and by ‘best,’ I mean most feasible) option for pregnant women. Yet, as we discussed in class, breastfeeding is important both to many cultures and to a mother’s psychological wellbeing. Although mothers may know about the options they have for breastfeeding, from what I’ve observed, not all mothers actually implement this knowledge – I met two women in Tanzania who were living with HIV, and they both had children. Even though they knew about the different ways to prevent MTCT, they didn’t actually use any of them. While I’m not sure if this gap between having knowledge and then implementing it is widespread, I am wondering how we can encourage and ensure behavior change in this area.