The ‘Pratt Pouch’ is unassuming in appearance: a foil polyethene packet, it resembles a ketchup sachet. The humble pouch however, has revolutionized HIV preventative treatment in infants.
Today, antiretroviral drugs make the transmission of HIV from mother to newborn preventable. Medications such as Nevirapine (NVP) or Zidovudine (AZT) can be administered by oral syringe to newborns to prevent them from becoming HIV-positive during birth or breastfeeding. Yet for these drugs to be effective, the baby must receive the drug within a 72-hour window after delivery. The drug also loses its potency one it is placed into the syringe, making it difficult to distribute prior to birth. While many clinics in low-to-middle income countries provide the medication, a substantial proportion of women give birth at home. In Sub-Saharan Africa, where 92% of worldwide HIV at-risk births occur, this means that millions of newborns are at risk of contracting the disease.
The Pratt School of Engineering has designed a new method of packaging that extends the life of these liquid antiretrovirals by up to a year. Local pharmacists in under-resourced settings can fill the single-use, heat sealed polyethylene ‘Pratt Pouch’ with the correct dosage under hygienic conditions. The pre-filled pouches are then distributed at district hospitals and clinics during antenatal care visits by nurses and healthcare workers. Instead of carrying and sterilizing a syringe, which has its own issues of sanitation and social stigma, mothers can easily tear open the pouch and squeeze the medication into the baby’s mouth after birth.
After clinical trials in Zambia and Ecuador, the pouch was rolled-out in Uganda, with incredible results. Uganda has the fourth highest number of HIV-exposed infants worldwide, with 116,000 born each year. In partnership with the Ugandan Ministry of Health, 4535 HIV-positive pregnant women were given 14 pouches by health workers at their first antenatal care consultation. After the first course of the antiretroviral immediately after birth, the mothers were given a second round of 28 pouches. An independent evaluation found that out of 2,042 HIV-exposed infants, only 36 (or 2%) tested positive for HIV. Here are the results of the Uganda program thus far:
Impact modelling suggests that the use of the pouch in the Uganda pilot could lead to a46% reduction in vertical transmission of HIV from mother to child.
Maternova is proud to be the sole commercial supplier of the Pratt Pouch. Since the first distribution of the product in Uganda, Maternova has supplied 2 million pouches. The Pouch has received wide acclaim, as well as recognition from WHO and USAID. It is currently being used in Guayaquil, Ecuador’s largest city, to cover about twenty percent of births to HIV-positive women in the country. Maternova recently introduced the Pratt Pouch to Mali, where a pilot is initiating the use of this method for the first time in the country.
The BiliDx is a novel system for diagnosing jaundice. The device uniquely meets the Target Product Profile (TPP) developed as part of the NEST 360 initiative in that it allows blood-based testing at the bedside. This initiative is part of an emerging global consensus in the Every Newborn Action Plan that countries need functional WHO level-2 inpatient units to care for "small and sick newborns."
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.