The relationship between prevention of mother to child transmission of HIV and stakeholder decision making in Uganda: implications for health policy

OBJECTIVES: To explore a selection of stakeholders' use of evidence and other reasons in the relative ranking of the prevention of mother to child HIV transmission with nevirapine in a setting of extreme resource scarcity. DESIGN: Group interviews using nominal group technique with provision of evidence. SETTING: One rural and one urban district in Uganda. PARTICIPANTS: People living with HIV/AIDS, people from the general population, planners, health workers and people with hypertension. MAIN OUTCOME MEASURE: relative ranking of prevention of vertical HIV transmission with nevirapine compared to nine other interventions for different conditions and evaluation of participants' use of evidence in the ranking. RESULTS: In the overall final ranking, prevention of vertical HIV transmission with nevirapine was ranked as number five compared to the other eight conditions. Treatment for childhood diseases and highly active anti retroviral treatment (HAART) for HIV/AIDS were ranked higher. Group specific ranking followed the same pattern, although the people living with HIV-group ranked HAART consistently as number one. CONCLUSIONS: Stakeholders seem to rank prevention of vertical HIV transmission lower than treatment for malaria, pneumonia and diarrhoea. Policies considering prevention of vertical transmission of HIV should consider its implications. This study shows that stakeholders are open to considering evidence in assessing the relative priority of different interventions competing for scarce resources. More research is needed to develop methods that can involve representative stakeholders, including the public, in good and legitimate decisions on priorities.