Malawi and Option B Plus

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Despite its status as one of the poorest countries in Africa and its failed effort to garner a Round 10 grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria – Malawi is moving forward to implement “Option B+” for pregnant women.  This means that pregnant and lactating women are enrolled in antiretroviral therapy (ART) programs for life, regardless of CD4 count.

Dr. Zengani Chirwa from the Malawi Ministry of Health outlined the rationale for this policy decision during a panel discussion of so-called “seek, test, treat and retain” (STTR) initiatives on Tuesday at the International Treatment as Prevention conference in Vancouver.  The key reasons are lack of CD4 testing capacity, the high fertility rates of women in Malawi, and the high post-partum mortality of HIV-infected women in the country, even at CD4 count levels above 350. Average fertility rates run as high as 5.6 children per woman.

To implement the policy of universal ART for pregnant and lactating women, Malawi nearly doubled the number of ART sites in the country to 654. After about a year of implementing this policy, there are now more than 323,000 people alive and on ART in Malawi. The number of people initiated on ART in the last year was double the year before, primarily due to enrollment of pregnant and lactating women, and to expanded access to those with a CD4 less than 350.

Malawi has developed a clinical mentoring program, which is integrated within ART/prevention of mother-to-child transmission of HIV (PMTCT) supervision, at all 654 clinical sites.  According to Chirwa, the integration of ART and PMTCT has simplified and streamlined the care system.  “Removing the distinction between ART and PMTCT providers has increased provider flexibility,” he said.

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