Malawi's Ministry of Health led the National Evaluation of Malawi's PMTCT Program to obtain nationally representative data on maternal ART coverage and prevention of mother-to-child transmission (MTCT) effectiveness. This paper presents the early transmission data for infants aged 4–12 weeks. In multivariable logistic regression analysis, the odds of early MTCT were higher in mothers starting ART post partum (adjusted odds ratio 16·7, 95% CI 1·6–171·5; p=0·022) and in those not on ART with an unknown HIV status during pregnancy (19·1, 8·5–43·0; p<0·0001) than in mothers on ART before pregnancy. Among HIV-exposed infants, 98·0% (95% CI 96·9–99·1) were reported by the mother to have received infant nevirapine prophylaxis, and only 45·6% (34·8–56·4) were already enrolled in an exposed infant HIV care clinic at the time of study screening. These data suggest that Malawi's decentralisation of ART services has resulted in higher ART coverage and lower early MTCT. However, the uptake of services for HIV-exposed infants remains suboptimal.
Department of HIV and AIDS of the Ministry of Health. Clinical management of HIV in children and adults. Malawi integrated guidelines for providing HIV Services. Malawi Ministry of Health, Lilongwe; 2011
Kalua T, Tippett Barr BA, van Oosterhout JJ, et al. Lessons learned from option B+ in the evolution toward “test and start” from Malawi, Cameroon and the United Republic of Tanzania. J Acquir Immune Defic Syndr. 2017; 75: S43-S50
UNAIDS. Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, 2011–15. Joint United Nations Programme on HIV/AIDS, Geneva; 2011.