Role of traditional birth attendants in preventing perinatal transmission of HIV

Every year a million women infected with HIV deliver babies without professional help. Marc Bulterys and colleagues suggest here that traditional birth attendants could be involved in preventing perinatal transmission of HIV by offering services such as HIV testing and counselling and short courses of antiretroviral drugs. A research doctor in the Gambia comments on this suggestion

In many poor parts of the world, the HIV and AIDS epidemic has eroded hard won gains in the survival of infants and children.1 In eastern and southern Africa, infant mortality is one third to two thirds higher than it would have been in the absence of HIV and AIDS, and child mortality continues to rise, leading to a dramatic reduction in life expectancy. 1 2

In rich nations, rates of perinatal transmission of HIV less than 2% are now reported because of the use of combinations of antiretroviral drugs, elective caesarean section, and avoidance of breastfeeding.3^–5 Transmission rates of 5% or lower may be achievable in middle income countries and some urban areas of the developing world with the use of short courses of combinations of antiretroviral drugs, appropriate infant feeding choices, and possibly elective caesarean delivery. 1 6 However, being able to extend the benefits of these recent advances to most women infected with HIV is a tremendous challenge, particularly in rural communities, in which more than two thirds of the population of sub-Saharan Africa lives.

The simplicity and low cost of nevirapine's single dose regimen 7 8 suggest that this highly efficacious drug might be very useful in rural settings. Obstacles to its use—including weak, underlying healthcare infrastructures9 and low rates of offering and uptake of voluntary counselling and testing—will be magnified in rural areas. 1 10 As global efforts to prevent perinatal transmission of …