Place holder for Photo

Peter SavosnickCountry Director, Kenya

Elizabeth Glaser Pediatric AIDS Foundation

June 17, 2010

Innovations in packaging and distributing infant NVP:

Lessons from Kenya

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Acknowledgements

• This work was a collaboration between with Elizabeth Glaser Pediatric AIDS Foundation, PATH, Family Health International, and the National HIV/AIDS and STD Control Program of Kenya to pilot and introduce the NVP infant-dose pouch in Kenya

• The NVP infant-dose pouch was developed through a public-private partnership with USAID and Boehringer Ingelheim (manufacturer of Viramune® brand NVP)

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Why Single-Dose Packaged NVP?

• In Kenya the majority of births occur in the home

• Need to reach beyond the health facility

• Need to increase uptake and improve cascade

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Project Phases & Timeline

• Concept: 2001-2002

• Development: 2003-2006

• Pilot: 2006

• Introduction: 2006-2007

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EGPAF-Supported PMTCT Sites in Kenya

2005 2006 2007 20080

100

200

300

400

500

600

Number of PMTCT sites supported

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Kenya Practice in July 2005

• Kenya at the forefront introducing a policy of NVP at “first contact”

• 1st Step: NVP tablets given to HIV+ pregnant women to take home

• 2nd Step: NVP syrup given in syringe to take home with simple wrapping

• EGPAF combined steps 1 and 2

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Simple Packaging

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Jua Kali

• No guarantee that providers would pack carefully

• No instructions

• No expiry date

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NVP Single-Dose Package:Desired Characteristics

• Easy and safe to transport and distribute

• Easy to store

• Easy to use/administer

• Inexpensive (as possible) to manufacture and procure

• Flexible to meet potential future changes in PMTCT recommendations

• Acceptable to BI

• Acceptable to PMTCT programs

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Finding the Right Dispenser

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Assessing the Dispenser

PATH evaluated for:

• Storage stability

• Dose expression

• Implementation feasibility

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Development Challenge: From Type of Dispenser to Filling

• At the manufacturer

• Local central point

• At provider level

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Key Issues

• Even when prepackaged, shelf life was an issue

• Distribution with short shelf life very difficult

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Improved Packaging Design

• Self-sealing foil laminate pouch protects the dispenser during transport and storage

• Pictorial instructions for use• Expiry date information• Sized for 1-ml Exacta-Med

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Pilot

• In February 2006, 4 month pilot at EGPAF supported sites

• Demonstrate use in health facilities providing PMTCT services

• Assess provider and end-user (HIV-positive pregnant women) acceptability

• Evaluate ease of use

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Pilot Results• Providers:– 93% found it easy to use– 96% felt there was an increase in the

quality of services they provided as a result of using the pouch

• HIV-Positive Mothers– 98% reported liking the infant-dose pouch– 100% reported that their infant received

the dose of NVP (55% in a facility; 45% at home)

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Conclusions from the Pilot• Increased the overall quality assurance with

standardized packaging

• Packaging solution that can be implemented at the facility level

• Improved ease of use for PMTCT providers and HIV-positive pregnant women

• Provided protection for the infant dose while being transported and stored by the HIV-positive pregnant woman until after giving birth

• Increased the coverage of NVP syrup provided during ANC visits from less than 30% (2005) to more than 90% (2009)at facility level

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2004 2005 2006 2007 2008 20090

1,000

2,000

3,000

4,000

5,000

6,000

Use of the NVP Pouch as a Factor in Uptake of ARVs for HIV-Positive Pregnant Women and

Infants at EGPAF-Supported Sites (2004 – 2008)

Uptake of ARVs for HIV + Preg-nant Women

Uptake of ARVs for HIV-exposed Infants

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Moving Forward• Lessons learned from this innovation can inform

packaging of mother-baby packs for more complex regimens

• Need to explore how to make it easy for HCWs to provide more complex regimens for HIV-positive mothers

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A Generation Free of HIVThank You

DISCLAIMER: This program was made possible through support provided by the Office of HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of the United States Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief, as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Call To Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). Private donors also supported costs of activities in many countries. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.