PMTCT OF HIV IN MALAWI

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PMTCT OF HIV IN MALAWI

• A MALAWI MODEL
• FOR NATIONAL EXPANSION
• ANNUAL CALL TO ACTION MEETING
• KAMPALA, UGANDA.
• 11th -14th October,2004
• Chifundo Zimba
• Outreach Program Coordinator
• Call To Action
• Lilongwe, Malawi

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Background

• Malawi with a population of 11 million is among
  the countries in Sub-Sahara Africa with a very
  high prevalence of HIV.
• It is estimated that 8.8 of general population
  and 14.4 of those aged 15-49 years are living
  with HIV (NAC 2003).
• The prevalence among pregnant women ranges
  between 16 and 30.

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Background

• The 2003 Malawi HIV sentinel surveillance,
  reports a prevalence of 16.9 among antenatal
  attendees in Lilongwe (Capital City of Malawi).
• National prevalence is estimated to be at 19.8.
  
• The estimated total Mother to Child Transmission
  rate is 27-30 (without interventions)

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Due to this high prevalence in MTCT different
stakeholders have taken the initiative to address
the problem. The current MTCT program in most
sites in Malawi is incorporated into the existing
maternal and child health care delivery system.
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National Program Goal

• The goal of the national PMTCT program is
• To reduce mother to child transmission of HIV
  among child bearing women in Malawi by the end of
  2010.
• The purpose is to improve the health status of
  all women of child bearing age and children in
  the country.

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Components of the Program

• HIV/PMTCT education to communities.
• Voluntary Counseling and Testing to pregnant
  women.
• Antenatal care to all pregnant women.
• Improved obstetric care.

• ARV prophylaxis.
• Postnatal care for the mother and the child.
• Cotrimoxazole (Bactrim) for the child.
• Support groups for HIV infected/lactating mothers
  

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MethodologyStatus of PMTCT Implementation

• The current interventions started at 4 pilot
  sites in 2001/2002.
• UNICEF at Embangweni in the North.
• MSF France in the south.
• MSF Luxembourg in the south.
• UNC Project through the Call To Action Program
  with support from EGPAF and UNICEF in the
  central.

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Methodology

• Malawi PMTCT Pilot Sites

• E

• Embangweni

• Lilongwe

• Chiradzulu

• Thyolo

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Up and Coming PMTCT sites.

• Currently, there are 12 comprehensive PMTCT sites
  that are fully functional ,
• and 24 at different levels of establishment.
• Note PMTCT program in Malawi was nationally
  launched on June 12, 2003.This was two years
  after the programs implementation in the country.

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Lessons Learnt
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Advocacy and Community Mobilization

• Different approaches have been used to stimulate
  community participation in PMTCT.
• Involvement of community leaders in finding ways
  to reach target population and how best to do it
• Use of HIV/AIDS IEC materials during antenatal
  and postnatal health talks.
• Education on specific services available for VCT
  and PMTCT.

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Community Participation

• used to advocate and provide information for
  decision-making
• community dialogue
• community theatre
• focus group discussion.

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  Integration of Services

• Antenatal attendance rate in Malawi is very high
  95.
• In order to provide comprehensive services for
  reduction of MTCT, PMTCT services need to be
  integrated into the existing reproductive health
  services.

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Social Support Groups

• HIV positive mothers find it easier to support
  each other in a group and to deal with issues
  related to their positive status.

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Training

•  PMTCT is a new intervention to Malawi and
  requires investment in training of health
  personnel. e.g.
• PMTCT
• VCT
• Infant feeding
• Whole blood rapid HIV and syphilis testing

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Infant and Young Child Feeding.

• In Malawi majority of women opt to breastfeed due
  to lack of resources.
• Infant feeding option for HIV positive women
  still remain a challenge in a culture where the
  recommend principle of exclusive breastfeeding is
  unacceptable.

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National PMTCT Expansion Plans

• After lessons learnt from pilot sites, the
  government of Malawi has come up with some
  strategies for scaling up PMTCT services using
  funds from different donors including global
  funds.
• Currently, only 3 of Antenatal women access
  these PMTCT services.

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Strategies

• Policy formulation and legislation Which guide
  implementation and resource mobilization
• Advocacy and Community Mobilization.
• Coordination of services within RH i.e. RHU,
  PMTCT taskforce and NAC.

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Expected Programme Outcome

• Strengthen primary prevention of HIV/AIDS and
  STI among pregnant women and their partners
• Increased Malawi families access to quality PMTCT
  and RH services
• Increased access to care and support services for
  HIV/AIDS infected women and their families
• Decreased maternal mortality through improved
  antenatal care, delivery and post pertum services
• Improved community capacity to addressing its
  health issues in particular in relation to safe
  motherhood and prevention of MTCT.

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Recommendation

• Similar programs could and should be implemented
  in sub-Sahara Africa, in partnership with
  Government and NGO
• Similar strategies could be set in other
  countries, where HIV prevalence is high
• Access to ART care for mother and their families
  would enhance acceptability and retention of
  these programs and also reduce future
  transmission to their babies

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Acknowledgments

• UNC Project, both in US and Lilongwe-Malawi
• For all the zeal and support for taking up the
  challenge of initiating PMTCT in Lilongwe
• Ministry Of Health
• for the support given and effort to expand the
  program
• National AIDS Commission
• for the coordination
• EGPAF, UNICEF, MSF and CHAM
• for sponsoring the program

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Zikomo Thank you
From all the people in Malawi who live healthier
lives now