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Preliminary findings of a routine PMTCT Option B+ programme in a rural district in Malawi

Preliminary findings of a routine PMTCT Option B+ programme in a rural district in Malawi. Rebecca M. Coulborn 1 , Laura Triviño Duran 1 , Carol Metcalf 2 , Yvonne Namala 1 , Zengani Chirwa 3 , Michael Murowa 4 , Kingsley Mbewa 4 , Daniela Garone 1.

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Preliminary findings of a routine PMTCT Option B+ programme in a rural district in Malawi

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  1. Preliminary findings of a routine PMTCT Option B+ programme in a rural district in Malawi Rebecca M. Coulborn1, Laura Triviño Duran1, Carol Metcalf2, Yvonne Namala1, Zengani Chirwa3, Michael Murowa4, Kingsley Mbewa4, Daniela Garone1 1Médecins Sans Frontières (MSF), Thyolo, Malawi; 2MSF, South African Medical Unit, Cape Town, South Africa; 3Ministry of Health, HIV Unit, Lilongwe, Malawi; 4Ministry of Health, District Health Office, Thyolo, Malawi

  2. Background 1. Radical simplification of PMTCT program Health benefit of earlier treatment and avoiding the risks of interrupting ARTs 3. Protection from MTCT in future pregnancies Protection for negative partners in sero-discordant couples 5. Reduction in HIV related maternal mortality July 2011:Malawi government adopted PMTCT Option B+

  3. Study Objectives • To document the experience of implementing B+ in Thyolo District and important lessons learned; • To describe the maternal outcomes of B+, specifically long-term adherence to taking cART and the incidence of subsequent pregnancies; • To describe the infant outcomes of PMTCT B+, specifically access to HIV testing/diagnosis and incidence of HIV infection

  4. Setting: Thyolo district Thyolo district is located in the southwest Malawi with > 620.000 pop In 2010 (MDHS 2010): • ANC prevalence 12-14% • Fertility rate 5.7% • 35% of PMTCT coverage In 2012: • > 32.000 patients on ART • ~ 800 initiations a month across 31 PMTCT sites • ~80% of uptake of ANC HIV testing

  5. Methods • Study design: Programme evaluation carried out over the course of routine health service provision • Study sites: 5 health centres and 1 district hospital • Study population: HIV+ pregnant or breastfeeding women who are eligible for PMTCT Option B+ and their infants • Data collection: Routinely-collected data from patient cards & health facility records. • Ethical considerations: Approved by Malawi National Health Sciences Research Committee and MSF Ethical Review Board

  6. Preliminary results: mother status • From April '12 – March '13: • 911 women and 279 babies were enrolled • Median age at enrolment: 27 years (12-43 years) • 194/750 (26%) women delivered after enrolment • Median time from enrolment to delivery: 13 weeks (0-27 weeks)

  7. B+ initiation and eligibility WHO 2010 GL 52.3% increase in the ART uptake due to B+ *CD4 <350 cells/µL or WHO clinical stage 3 or 4

  8. Mother outcomes

  9. Preliminary results: 6 month mother Viral Load

  10. Babies outcomes: HIV testing

  11. Baby outcomes LTFU: Lost-to-follow-up; RIC: Remaining in care

  12. Conclusions Exponential increase of PMTCT uptake Excellent uptake of Nevirapine prophylaxis Very promising low HIV new infants infections Uptake for HIV baby testing still not optimal. Lost to follow-up rates of mother and their baby, particularly after the first clinical visit, represents a challenge of the B + program

  13. Conclusions (2) Attention to the programmatic challenges is needed to reach the full benefit of the PMTCT B+ strategy and to increase field effectiveness

  14. Acknowledgements Mothers and their babies Malawi Ministry of Health Malawi HIV unit Staff in Thyolo clinics MSF SAMU and Thyolo research team

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