Moving From Single Dose Nevirapine to Option B+: Big Leap Towards Elimination of Mother To Child Transmission of HIV for Malawi? Open Access

Abstract

Background: Malawi officially launched its National Prevention of Mother to Child Transmission (PMTCT) of HIV programme in 2003 and used single dose Niverapine as the antiretroviral (ARV) drug given to HIV positive pregnant women and their live birth infants until 2008 when a duo combination of Zidovudine and Lamivudine was used. In July 2011, Malawi adopted a novel approach to the implementation of PMTCT called Option B+ in which pregnant women and lactating mothers who are found HIV+ are initiated on antiretroviral therapy (ART) for life regardless of their CD4 count. This approach is aimed at eliminating the vertical transmission of HIV through MTCT of HIV.

Aims of the Study: The purpose of the study was to assess progress made in implementation of Option B+ in Malawi and to understand the factors which hamper the utilization of the service. The objectives of the study were: 1) to determine trends in PMTCT utilization among pregnant women attending ANC services in Malawi from 2010-2014, a period that encompasses pre Option B+ (1 year) and post-Option B+ implementation; 2) to focus on Mchinji District in central Malawi as an example of district level implementation; and 3) to identify social, behavioural, financial and cultural factors hampering utilization of PMTCT services and uptake of Option B+ in Malawi.

Method: National level PMTCT program data and district specific PMTCT program data for Mchinji was analyzed to determine trends in utilization of PMTCT services and uptake of Option B+. Key national and international documents and relevant peer-reviewed studies conducted during the same period were reviewed to identify factors hampering implementation of PMTCT services and uptake of Option B+ in Malawi.

Results: This study has generally shown that Malawi has made progress in the delivery of Option B+. The implementation of Option B+ has led to a significant increase in the number of pregnant and lactating women on ART both at national level as well as in Mchinji district, up to a seven fold increase in the number of women starting ART for PMTCT in the first year of the programme alone. The programme has also led to the low numbers of children now being born HIV+. However, Option B+ still faces a challenge of high default rates in its Early Infant Diagnosis (EID) program coupled with lower retention of women on Option B+ at 12 months and 24 months than expected.

Conclusion: While results do demonstrate that good progress has been made in the implementation of Option B+ in Malawi, the results also demonstrate that there are still some challenges that need to be addressed as not all HIV+ pregnant and lactating mothers and their children are reached with this service. The eMTCT plan for Malawi expires September 2015, this provides an opportunity to focus the PTMCT program and the Option B+ strategy on specific challenges that will be necessary for the program goals to be achieved.

Table of Contents

1.0 Introduction 1

2.0 Background Information on Malawi and its Responses to the HIV Epidemic 5

2.1 Geographical, Political and Administrative Structure 5

2.2 Socio -Demographic and Economic Situation 6

2.3 HIV and Socio-economic Characteristics 6

2.4 Health Care Delivery System 9

2.5 Elimination of Mother to Child Transmission of HIV Program (EMTCT) 15

2.6 The Delivery of Option B+ Services in Malawi 16

3.0 Problem Statement and Objectives 19

3.1 Problem statement 19

3.2.1 General Objective 21

The general objective of this study was to identify factors influencing utilization of PMTCT services in Malawi from 2010-2014 21

3.2.2 Specific Objectives 21

4.0 Methodology 21

5.0 Results 23

Objective 1: To assess trends in PMTCT utilization among pregnant women attending ANC services in Malawi from 2010-2014, a period that encompasses pre Option B+ (1 year) and post-Option B+ implementation and to concentrate on Mchinji District in central Malawi as an example 23

5.1 HIV testing and counselling among pregnant women 23

5.2 Access to Option B+ 29

5.3 Trends in ARV coverage in Malawi 31

Objective 2: To identify social, behavioral, financial and cultural factors hampering utilization of PMTCT services and uptake of Option B+ in Malawi 35

5.4 Social, Behavioral, Financial and Cultural Factors affecting implementation of the Option B+ program in Malawi 35

6.0 Discussion 41

7.0 Conclusion and Recommendations 44

References 48

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	HIV MTCT OPTION B+
Committee Chair / Thesis Advisor	McFarland, Deborah A, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti)

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