Reviewing the Studies on the Pratt Pouch Implementation in Africa Thus Far

In a unique agreement with a spinout from Duke University, Maternova now shepherds the intellectual property surround the Pratt Pouch.  This novel drug delivery system is the result of years of development at Duke and intensive testing of the four layers of the pouch that allow antiretrovirals to be pre-packaged and pre-dosed.  Studies 

Why is this important?  Imagine a mother who has come to an antenatal care visit but lives far from any health care provider.  That one antenatal visit is absolutely crucial for testing the mother's health and providing counseling and education about the birth and the period after.  What if in this one encounter with the health system, the mother tests HIV positive but plans (or is only able to) give birth at home? (25 % of infants are born at home in Uganda). 

Without the Pratt Pouch and at say month 7 of the pregnancy, the mother would need to be sent home with a bottle of antiretrovirals, which need to be kept at 25 degrees Celsius or below.  If the last antenatal appointment is too far before the birth, the bottle could expire.  In addition, mothers would need to measure the doses themselves, a process prone to error and spillage.

With the Pratt Pouch, the mothers can be sent home with pre-dosed, single dose packets that are stable at higher temperatures and last for months.  She can immediately begin protecting her child, within the 72 hour post-birth window needed for PMTCT to be effective.  

In Uganda, 19 health facilities with the highest HIV positivity rates among pregnant women across 9 districts in southwest and central Uganda were assigned to control and intervention groups.  Among out-of-facility deliveries, a higher proportion of infants received nevirapine within 72 hours of birth in the intervention (Pratt Pouch) versus control group, 95.8% versus 77.9%.  Women in the Pratt Pouch intervention group reported their infants completed the full 6 weeks infant prophylaxis regimen as compared to the control group (299/313, 95.5% versus 210/242, 86.8%) (p = 0.0002).

Results from a clinical feasibility study of the Pratt pouch in Zambia, showed a stunning three-fold increase (35% to 94%) in the number of HIV exposed infants accessing antiretroviral drugs.  

In terms of cost-effectiveness, an external review of the Ugandan data found that the Pratt Pouch intervention was 'very cost-effective."