A.20.Report from the HIV prevention of mother to child transmission program in Lilongwe, Malawi
by Zimba C , Kamanga E, Mhango Z, Mwale G, Matiki C, Muita J, Maida A, Kyathola D, Kazembe P, Krysiak R, Hoffman I, Martinson F, Chilongozi D, Jones D, Gama E, Banda T, Moses A, Fiscus S, Nkhoma J, van der Horst C.
Background: The UNC Project, in collaboration with the MOH and the Lilongwe DHO started the implementation of a PMTCT Program in April 2002 with funding from EGPAF and UNICEF. The program operates at Bottom Hospital and 3 Health Clinics. Without intervention, the Malawi MTCT rate is ~30%. With NVP prophylaxis, a recent study in Lilongwe showed an HIV transmission reduction of ~60% compared to historic results.
Objectives: To reduce the risk of MTCT through integration of HIV education, VCT and NVP prophylaxis to mother/infant pairs into the existing maternal and child health care delivery system.
Methods: Antenatal mothers are offered VCT for HIV using two parallel rapid HIV tests. Infected mothers are offered a single dose (NVP) therapy to be taken at the onset of labour and single dose to the infant within the first 72 hours of birth.
Results: In 2003 and 2004, 20,619 and 20,714 mothers reported for their first antenatal visit, respectively. Of these, 78 in 2003 and 95% in 2004 received HIV prevention education. Among all first visit mothers, 57% in 2003 and 75% in 2004 received HIV VCT. HIV prevalence was 1916/11,815 (16.2%) in 2003 and 2364/15,520 (15.2%) in 2004. In 2003, 799/1916 (41.7%) and in 2004 1180/2364 (49.9%) of mother/infant pairs received NVP prophylaxis for PMTCT.
Conclusion: The uptake of HIV education, VCT and NVP prophylaxis to mother/infant pairs into the existing maternal and child health care delivery system has improved, and is substantial in Lilongwe district. Keeping all mothers in antenatal care after they receive their HIV positive results continues to be challenging.
Recommendations: The Lilongwe District PMTCT Program can be used as a model for the expansion of similar services nationwide. An improved system to follow-up mothers receiving HIV positive results is needed.
A.21.Identification of High Transmission Areas for men in Lilongwe