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Zambia Could Be First Country to Distribute Pratt Pouch Nationally

The Pratt Pouch looks like a little ketchup foil package. At first, it’s hard to believe it can save lives.

But the Pratt Pouch is a simple, creative, and efficient way for women who are HIV-positive and pregnant—but  unable to deliver at a health facility—to administer an antiretroviral dose called Nevirapine directly to their newborns within the required timeframe (six to twelve hours after birth) to help prevent mother-to-child transmission of the virus.

IntraHealth International is partnering with Duke University’s Pratt School of Engineering, which invented the Pratt Pouch, to conduct a 12-month pilot project to test the pouch at seven health facilities in Siavonga District, Zambia.

Zambia was chosen as a pilot country because of its high HIV prevalence—an estimated 13% of adults are infected—and its high home-delivery rate—over 50% of women deliver in the absence of a skilled birth attendant.

I was so relieved to have medication with me at home that could prevent my baby from getting HIV.

The pilot includes training pharmacists in Siavonga District to fill and seal the pouches, training nurses to educate clients and to demonstrate how to use the pouch, and training lay counselors to help women who deliver at home to use the pouch correctly.  

How the Pratt Pouch works

Health workers supply each HIV-positive pregnant woman with seven pouches of Nevirapine. After a client gives birth, she will give her infant one dose a day for six days. The seventh pouch is extra in case one of the others is spilled or lost.

Annie Malumo, IntraHealth project coordinator, oversees the project. She collects monthly data to track the number of women who received pouches, whether the clients used them correctly, and whether clients returned their used pouches to the health facility. Returning the used pouches is a critical part of the project, since staff members study them to see if clients have had trouble using them—for example, to make sure pouches haven’t been spilled, have been emptied completely, and have been torn open correctly.

Malumo also performs a follow-up interview with each mother to hear first-hand what moms think of the pouch.

The response has been overwhelmingly positive.

“I was so relieved to have medication with me at home that could prevent my baby from getting HIV if I didn’t make it to the health center in time to deliver,” one mother told Malumo.

And health workers are equally enthused.

“This pouch is so easy to use compared to a syringe,” says one health worker in the pilot district, “because the dosage of Nevirapine is already measured, and it is more hygienic.”

Since the project began in January, health workers have identified 86 HIV-positive pregnant women, and provided pouches to 80 of them. (A recent, nationwide stock out of Nevirapine prevented staff from giving pouches to five mothers, and one woman declined to use them for religious reasons.)

In March, Karen Clune, the US Agency for International Development’s innovation advisor, traveled to our pilot sites with Malumo and Alex Dahinten, Pratt Pouch technical coordinator, to observe first-hand how the pilot project is doing.

Clune was impressed with how quickly the program has achieved results.

They spoke with the pharmacists, lay counselors, and other health workers involved in the project, as well as with a mother who has used the pouches.

Clune was impressed with how quickly the program has been implemented and achieved results, as well as how knowledgeable and committed everyone is about the project.

She was particularly excited to hear that those involved would like the project to be taken to scale so that as many infants as possible are spared the risk of HIV infection. The District Medical Officer, who has been very supportive of the Pratt Pouch initiative since it started, echoed her enthusiasm.

If the funding becomes available, Zambia could be the first country to distribute the Pratt Pouch on a national scale. This little packet could help HIV-positive women across the country to give their newborns a virus-free start.

The Pratt Pouch Project is funded by USAID. IntraHealth worked with the Ministry of Health, the Ministry of Community Development and Maternal and Child Health, and the District Medical Offices to initiate the pilot in Siavonga District. Photo courtesy of Marc-Grégor Campredon.

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