Late last month, Elizabeth Glaser Paediatric Aids Foundation (Egpaf) launched a new five-year programme to improve HIV services and strengthen health systems in seven districts across Malawi. Egpaf will partner with the Malawi Ministry of Health, the US President’s Emergency Programme for Aids Relief (Pepfar), and the US Centres for Disease Control and Prevention (CDC).
Malawi has in recent years distinguished itself in the fight against HIV and Aids. UNAids, noted that in the decade 2001-2011 Malawi brought down the number of new HIV infections per year by 72 percent—the best record of any country in Africa.
In September 2011, Malawi again took the lead in the fight against HIV and Aids by adopting a national policy and programme that provides lifelong anti-retroviral treatment (ART) to all HIV-infected pregnant and breastfeeding women, regardless of the extent of their HIV infection, known as Option B+.
“Option B+ gives a window of hope and opportunity in which to secure the health of mothers and protect their partners and their unborn children from infection with HIV,” said Malawi Minister of Health Catherine Gotani-Hara.
Malawi’s leadership as the first country to adopt Option B+ excited many in the HIV and Aids community with its remarkable results—a substantial increase in the uptake of antiretroviral treatment among pregnant and breastfeeding Malawian women during the18 months of the programme. These women know that if they are identified as HIV-positive at a clinic or medical facility they will immediately be offered lifelong anti-retroviral treatments (ART). According to the Ministry of Health, there has been a seven-fold increase in the number of women initiated on ART—from 1 257 in quarter two, 2011 to 10 663 in quarter three 2012.
More efforts will be needed, however, in order to achieve the “less than five percent transmission rate target needed to achieve the elimination of paediatric HIV.
First and foremost, all pregnant women should be tested and treated for HIV at the antenatal clinic. Ideally, pregnant women should seek antenatal care early, within the first three months of pregnancy—and to make no fewer than four focused visits for prenatal care before delivering at a health facility.
This can only be achieved through stronger maternal and neonatal child health services (MNCH), as well as improved access to healthcare. This will ensure all pregnant women are tested and treated for HIV. In addition, a robust health management information system must be in place to monitor the performance of HIV and MNCH services. Malawi has recognised antenatal care for mothers as important entry points into health and HIV care and treatment programmes. HIV services are now offered as part of a comprehensive suite of antenatal care services. In addition, because nurses play a remarkable role in MNCH services, Malawi recognises them as important players in HIV services, particularly in the prevention of mother-to-child transmission of HIV (PMTCT).
Secondly, male partners can make adherence to HIV treatment easier and more successful. These male partners also can benefit from services by accessing HIV testing, counselling, and care and treatment. In some cases, men may be HIV positive and their wives may be HIV negative. Men should not assume their own HIV status is the same as their wife’s.
Thirdly, vibrant programmes for community members to counter HIV stigma at the local level can help support women living with HIV and encourage them to seek treatment. These programmes can play a key role in ensuring that HIV-infected mothers and their children return to the clinic after delivery and continue to take ART as prescribed.
Many Malawian healthcare facilities reach into the community by enlisting mothers living with HIV and men who have successfully been enrolled into HIV care and treatment programmes as either “mentor mothers” or “expert clients” to counsel individuals newly diagnosed with HIV. Health surveillance assistants attached to medical facilities also help to follow up with the women in their villages, ensuring that no pregnant woman living with HIV misses out on treatment or on enrolling her child in care or treatment.
Many lessons will be learned over the coming years in Malawi about the uptake, retention, and outcomes associated with Option B+. Malawi is a pioneer and so the rest of the world has much to learn from their experience.
As the world continues to work towards the elimination of paediatric HIV, Egpaf is proud to partner with the government of Malawi in its steady march towards an Aids-free generation.