In Malawi, Marching Towards the End of AIDS
This week, I am concluding my trip to our country offices in Malawi, the first country in Africa to create a policy at the national level using the World Health Organization (WHO)’s “Option B+” strategy, which provides life-long antiretroviral treatment (ART) to all HIV-infected pregnant women regardless of their immunity (CD4) levels.
Malawi is also the country that recently recorded the greatest reduction in new HIV infections in Africa. According to a recent UNAIDS report, new HIV infections in Malawi dropped by 72 percent from 2001 to 2011.
On Tuesday, I visited Bwaila Hospital, Malawi’s largest maternity hospital, and the Martin Preuss center in Malawi’s capital, Lilongwe. During my visit, we reviewed Malawi’s implementation of Option B+. All pregnant women visiting the maternity ward at Bwaila are counseled, tested for HIV, provided with post-test support, and offered life-long HIV antiretroviral treatment before they leave the clinic.
The Martin Preuss center, supported by the Malawi-based organization Lighthouse Trust, has over 8,000 individuals on ART and the clinic with the largest number of tuberculosis patients in Malawi. 90 percent of tuberculosis patients at the clinic are told their HIV status before leaving the center. In both facilities, the patient registry and records are automated to enhance HIV and TB detection, adherence to treatment, and further follow-up.
The manner in which Malawi has adopted and rolled out Option B+ is impressive and important. In Lilongwe, there is considerable excitement over the substantial increase in treatment uptake seen over the 18 months Malawi has implemented Option B+. But vital questions remain about retention in care, adherence to medication, and potential outcomes. We must find answers to determine if we can reach the less-than-five percent HIV transmission rate required to achieve elimination.
Today, together with Malawi health minister Catherine Gotani Hara, U.S. Deputy chief of mission Lisa Vickers, and U.S. Centers for Disease Control and Prevention (CDC) country director Dr. Sundeep Gupta among others, EGPAF launched an expanded PEPFAR and CDC-funded five-year program at Mchinji District Hospital, a 90-minute drive west of Lilongwe. The program has two goals: strengthening health system capacity at the district level, and improving both the offering and quality of HIV and maternal and child health (MCH) services consistent with Malawi’s national health strategy and Option B+ policy. The program will operate in seven districts: Rumphi, Mzimba North, Mzimba South, Nitchisi, Dedza, Ntcheu, and Mchinji.
The targets of the new program, which began in September of 2012, include providing HIV counseling and testing to 1.26 million individuals, including more than 378,456 pregnant women, and offering preventive treatment (known as prophylaxis) to 3,000 healthcare workers and persons exposed to HIV due to sexual and gender-based violence. The program will also provide antiretroviral treatment to 72,000 people newly diagnosed with HIV, including more than 8,500 children.
We are pleased with the government of Malawi and the U.S. government for their confidence in our ability to support the Malawi government’s steady march towards an AIDS-free generation. We are committed to focusing on the district and health facility levels, working with district health teams to make health systems stronger and improving the quality of HIV and overall health services over the next five years.
Chip Lyons is EGPAF's President and CEO, based in Washington, D.C.