PMTCT SERVICES IN MALAWI

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PMTCT SERVICES IN MALAWI

• PRESENTED BY
• Dr Leopold Buhendwa
• PMTCT coordinator/MSF/B-Malawi

2
BACKGROUND

• HIV/AIDS is the major killer of children in some
  high HIV prevalence countries.
  
• MTCT/-640,000 new infections yearly.
• The current coverage and uptake of PMTCT is still
  too low to impact the epidemic among children.

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MALAWI

• Small landlocked country in southern Africa
• Population 11.3 million,85 rural
• Annual growth of 3.4
• 65 below poverty level
• 50 of women illiterate
• MMR 1120/100,000 live births
• HIV Sero-prevalence in ANC is 19.8
• /- 40,000 babies infected annually through MTCT

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PMTCT SITUATION

• Initiation of PMTCT in 2001 3 sites
• 2004
• 550,000 annual pregnancies
• 108,000 pregnancies among HIV women
• 43,345 tested for HIV
• 600 babies received NVP
• 2.5 of the 108,000 reached by NVP prophylaxis
• End 2005
• 36/542 sites of PMTCT(6.6)
• 61 ART sites standard national
  guideline,Triomune as 1st line regimen
  
• 19 ART sites to children

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GOAL OF PMTCT PROGRAMME

• To reduce mother-to-child transmission of HIV in
  child bearing women and improve health status of
  women and children in Malawi

6
OBJECTIVES

• To equip health workers with information on
  prevention of Mother to Child Transmission to be
  disseminated to the community in order to
  facilitate utilisation of Prevention of Mother to
  Child Transmission of HIV services
• To advocate for government, donors and
  stakeholders in the provision of resources for
  Prevention of Mother to Child Transmission of HIV
  services
• To promote the provision of quality obstetric
  care with emphasis on Prevention of Mother to
  Child Transmission of HIV

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• To promote, protect and support breast feeding
  and provide information in infant feeding options
  for HIV positive women
  
• To provide guidance on the provision of quality
  Voluntary Counselling and Testing in Prevention
  of Mother to Child transmission of HIV services
  

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• 6. To provide guidance in the use of
  antiretroviral therapy for the Prevention of
  Mother to Child Transmission of HIV

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Package of PMTCT interventions

• Group education
• Shortened individual counselling
• HIV testing
• Post test counselling infant feeding
  options,family planning discussions, nutritional
  support,single dose Nevirapine for the mother and
  the child at delivery, partner involvement and
  community mobilization.
• OIs and ART management

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ACTIVITIES UNDERWAY

• PMTCT Trainers Manual
• PMTCT Checklist
• ARV guidelines
• Revision of Obstetric Protocol (to be printed)
• PMTCT scaling up strategy
• PMTCT plus policy

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PROTOCOLS

• Currently there are different protocols being
  used by different organisations
  
• The guidelines developed will help standardise
  the protocols
  
• National HIV/AIDS Policy
• PMTCT Policy Guidelines
• ARV Guidelines
• Nutrition Policy Guidelines

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MAIN PARTNERSHIP

• Ministry of Health and Population
• National AIDS Commission
• UNICEF
• UNAIDS
• WHO
• Christian Health Association of Malawi
• USAID
• NGOs MSF F, MSF-L, Linkages
• Research institutions UNC, John Hopkins

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Partnership continued

• The current PMTCT services are mainly supported,
  technically and financially by NGOs. However,
  all these NGOs operate within government or CHAM
  health facilities using existing staff or employ
  additional ones.
• There is multi-sectoral Task Force established by
  MOHP to oversee strengthening of PMTCT through
  development of guidelines and training materials
  
• Boehringer Ingelheim-Abbot free donation of HIV
  test kits, NVP tablets, NVP syrup and 1ml syringes

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Partnership continued

• Central Medical stores storage and distribution
  of PMTCT supplies.
  
• UNICEF
• Supply additional test kits mostly during stock
  outs
  
• Direct implementation of PMTCT services in some
  districts.

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PMTCT Program in Malawi Strengths

• Number of partners to support Government
  efforts.
  
• National PMTCT policy and guidelines in place.
• Existence of a training curriculum
• Existence of PMTCT technical working group
• The 36 sites using different PMTCT models will
  inform the scale up.

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STRENGTHS,2

• All sites using rapid tests with result the same
  day.
  
• Rapid ART roll out
• 14 CD4 testing machines in Malawi
• The national policy recommends routine and
  integrated offer of HIV testing to all pregnant
  women
  
• ANC uptake is high among pregnant women

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PMTCT Program In Malawi Weaknesses,1

• Low coverage of PMTCT services6.6 services,
  7.8 of pregnant women
  
• Implementation of PMTCT mainly driven by NGOs
  with little coordination at national level
  
• Limited management capacity at all levels
• Low uptake of HIV testing

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WEAKNESSES, 2

• Lack of standardization of protocols and tools.
• PMTCT services not well integrated into maternal
  and child services and not linked to ART
  services.
  
• Staff capacity and skills are limited at all
  levels.
  
• Reliance on SD-NVP

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WEAKNESSES,3

• Up to 50 of women do not deliver in health
  facilities
  
• Poor supply management resulting in stock outs.
• No ME and quality assurance system in Place
• Limited place for counseling
• No capacity for infants HIV diagnostic
• No system in place for follow up mother infant
  pairs

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OPPORTUNITIES for PMTCT programming

• Existence of multi-sectoral PMTCT Task Force
• High level of government commitment (development
  of policy and guidelines PMTCT as part of EHP,
  increased financial allocation to HIV/AIDS)
  
• Good partnership with NGOs
• Increased donor interest
• Potential funding from Global Fund
• Access to ANC high 95 nationally
• ART rollout

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Opportunities continue

• Free offer of Niverapine and potential offer of
  Determine reagents for PMTCT services
  
• Research institutions

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LESSONS LEARNT

• Community sensitisation and mobilisation are key
  to a successful PMTCT program
  
• Understanding of local cultural factors is
  essential
  
• Male involvement is important
• Issues in Infant feeding-still a challenge
• Follow up to 18 months still not adequate
• There is need to strengthen the national and
  regional level to boost the PMTCT scale up in
  Malawi by hiring one or two PMTCT advisors
  working with MOH.

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Conclusions

• PMTCT in Malawi requires massive scale up
  including community mobilization and resources
  
• There is urgency in need to prioritize PMTCT
  mothers for HAART.
  
• PMTCT programs in Malawi require coordination and
  constant Evaluation and Monitoring

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ACKNOWLEDGEMENT

• UN Economic Commission for Africa(UNECA)
• World Bank
• WHO-Afro
• MOH of Malawi government