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ART initiation among pregnant women in Malawi shows progress
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The number of pregnant and breast-feeding women in Malawi, Africa, with HIV who initiated antiretroviral therapy increased more than 700% in 1 year because of the Option B+ program implemented by the Malawi Ministry of Health, CDC researchers wrote in Morbidity and Mortality Weekly Report.
Only 1,257 women started ART in the second quarter of 2011, but in the third quarter 2012, 10,663 initiated ART, an increase of 748%.
“An important barrier to prevention of mother-to-child transmission in Malawi is the limited laboratory capacity for CD4 cell count, which is recommended by WHO to determine which ART medications to start,” the researchers wrote. “[With Option B+] all HIV-infected pregnant and breast-feeding women are eligible for lifelong ART regardless of CD4 count.”
WHO recommends that pregnant women with CD4 counts of 350 cells/mm3 or less receive lifelong ART. Pregnant women with HIV who are not eligible for ART are recommended prophylaxis with either zidovudine during pregnancy and additional medications during labor, delivery and postpartum period (Option A), or triple-drug ART during pregnancy and breast-feeding (Option B).
However, the Malawi Ministry of Health determined that there was not adequate infrastructure to provide universal CD4 count testing, leading them to option B+: lifelong ART for all HIV-infected pregnant and breast-feeding women. Malawi’s implementation of Option B+ was supported by the Office of the Global AIDS Coordinator through the US President’s Emergency Plan for AIDS Relief (PEPFAR).
Option B+ led to the integration of ART into all antenatal care settings, as well as training for 4,839 health care workers. In June 2011, there were 303 ART sites in Malawi, but in September 2012, after the implementation of Option B+, there were 641 integrated antenatal care and ART sites.
“The success of Option B+ in increasing ART coverage demonstrates the combined effect of streamlined ART initiation, decentralized and integrated service delivery, policy changes to allow nurses to start ART and direct supervision of every site,” the researchers wrote. “Continued progress in Malawi demands consistent provision of high-quality HIV testing in antenatal care and continuing efforts to ensure lifelong ART adherence among women started on ART through Option B+.”
For more information:
CDC. MMWR. 2013;62:148-151.Disclosure: The researchers report no relevant financial disclosures.