Duke students' ketchup-sachet pouch lets mothers dose newborns with HIV drugs

The BBC reported in July 2015 on a pouch, shaped like a fast-food ketchup sachet, used to give antiretroviral medicine to babies born to HIV-positive mothers. Babies must be given medication within 24 hours of birth and during their first weeks. One mother in Guayaquil, Ecuador, said the earlier small bottle with a dropper spilled and the dose was hard to measure; syringes and spoons had the same problem. With the pouch, she said, it is easy to put all the liquid in the baby's mouth without spilling or spoiling it.

The pouch gives an exact dose and keeps out air, so the medicine lasts up to a year. Duke University Pratt School of Engineering students, mostly Ecuadorian, designed it; it reached Guayaquil's Enrique Sotomayor maternity hospital through Humberto Mata, who founded the VIHDA foundation and calls it the bridge between the public sector that pays for drugs and the hospital. A programme with the hospital, Ecuador's government, VIHDA and Duke has seen at least 1,000 babies born without the infection.

The pouch is also used in Tanzania and Zambia, with Uganda soon, where many women give birth at home, so pouches are handed out at antenatal appointments and kept at home. Dr Malkin, who led the design, said 30,000 pouches were then in circulation, and that it is pointless where mothers rarely have antenatal visits or HIV testing, as in Yemen.

Droppers and syringes need measuring at the moment a mother is least able to, so a pre-measured pouch removes the step.

Sealing out air preserves the liquid for up to a year, which suits storage at home.

An everyday-looking sachet shape is simple for anyone to open and use.

Local champions linked the public drug funding and the hospital where cases were concentrated.

For a dosing problem, redesign the container, not the instructions: a sealed single dose removes measuring errors.

By 2015 the pouch was in clinics in Ecuador, Tanzania and Zambia, with Uganda planned. The hospital still saw a small number of HIV-positive babies even with the pouch and other measures; its infection-control chief said earlier testing and sex education were also needed.