Implementation of the programmes intended to prevent mother-to-child transmission of HIV/AIDS (PMTCT) is a major challenge, particularly in developing countries. Despite the controversies about Nevirapine (NVP) resistance, safety and efficacy, it is still widely acclaimed and used in most resource-limited countries because it is affordable, easy-to-use and practical. This study identifies the gaps in NVP use for PMTCT in a rural setting, where almost 42% of pregnant women have no access to healthcare facilities and deliver at home, with the support of traditional birth assistants or family members. As a result, many rural HIV-positive pregnant women deliver without the opportunity of PMTCT therapy provided by ante-natal clinics.