Malawi: Antenatal Access Key to Preventing Mother-to-Child Transmission of HIV

Malawi is leading the developing world in the Option B+ approach to preventing transmission of HIV from mothers to their children. Option B+ provides lifelong HIV medication to all HIV-positive pregnant and breastfeeding women.

In 2010, UNAIDS released a Global Plan towards the elimination of new HIV infections among children by 2015. This aims to reduce the rate of transmission of HIV from an infected mother to her child to less than 5% and to reduce infection among young children by 90%.

Closer to virtual elimination

Mchinji, a district which borders Zambia, has an estimated population of 549,000 and a 9.8% HIV prevalence. Around 15,400 people have registered to receive antiretroviral drugs since 2004.

Medical experts at the district hospital say Mchinji is getting closer to a 90% reduction in the number of new paediatric HIV infections, because it has managed to reach all women through antenatal testing for HIV. The hospital reports that women see the benefit of delivering at a health facility rather than with traditional birth attendants, who are not medically trained.

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), an American NGO, with support from the US government, has also significantly contributed to children exposed to HIV.

EGPAF supports HIV prevention, care and treatment services through a combination of technical help, supplies, equipment, training and mentoring.

Clinician Eric Mittochi is the coordinator for antiretroviral treatment and prevention of mother-to-child transmission for Mchinji. He says that since Option B+ was introduced in 2011, 19 women have completed the programme, with all children free from HIV.

But, according to Mittochi, under-staffing is a major challenge the facility is facing, since on average only two or three nurses provide services to 40 women in a day. Most of the time there is only one nurse to check all the children.

The district hospital receives referrals from 14 health centres. Mchinji hospital also refers patients to Kamuzu Central Hospital in Malawi’s capital, more than 100 kilometres away.

Infant testing saves lives

Esther Jamu, 30, from Mkanda, is among those to benefit from the programme. She said: “An HIV-free generation is possible. I was diagnosed with HIV during the fourth month of my pregnancy. I was enrolled and following the doctor’s advice, I exclusively breastfed for six months and my baby tested negative in all the tests. This is proof that Option B+ works.”

Ironically, Jamu’s first child died in 2009 of unknown causes. Jamu named her second child in vernacular as ‘Thokozani’ which simply means ‘thank you’ because of the Option B+ initiative.

According to Elton Masina, EGPAF technical officer for Mchinji, the first test is done once the baby is six weeks old, followed by another test at 12 months. The final test to confirm the child is HIV-free is done at 24 months or six weeks after the mother has stopped breastfeeding.

A survival analysis is also incorporated for HIV infected pregnant and lactating women on Option B+ at six months, one year and two years.

In Malawi, the focused antenatal care approach, which emphasises the quality of care over the quantity of visits, is part of an essential healthcare package of maternal and neonatal guidelines by the Ministry of Health.

Impact in Malawi

Nicole Buono, EGPAF country director, said her organisation has supported programmes providing more than 826,000 women with services to prevent mother-to-child transmission. This includes testing more than 602,000 women for HIV and providing more than 44,000 HIV-positive women and 41,000 HIV-exposed infants with life-saving antiretroviral drugs.

EGPAF is committed to providing comprehensive services including HIV testing and health assessment for pregnant women, family planning services for all women, high-quality treatment and prevention regimes for pregnant women living with HIV and infant feeding support for HIV-positive mothers.

Elizabeth Hamilton, EGPAF country officer for Malawi, said: “If this story touches you, you can find out more about how EGPAF is working to eliminate paediatric AIDS not only in Malawi, but around the world on or follow us on Twitter @EGPAF. Just $19 or £12 could reach one pregnant woman with the services she needs to prevent transmission of HIV to her baby.”