With a population of about 17 million people, a health workforce with just short of 400 physicians and about 5,600 nurses, where fewer than half of the 1,000 health facilities had soap and running water, Malawi by 2011 had only one viable course against its HIV epidemic — the fastest and most direct way possible. Economically the poorest country in Africa, it would have to use scant resources to maximum effect, and strive for immediate results.
That meant that Option B+, the World Health Organization-recommended approach to preventing mother-to-child HIV transmission was the only option for Malawi, Dr. Andreas Jahn of the country’s Ministry of Health told an audience in Boston last week. Allowing access to antiretroviral treatment for life for all pregnant women with HIV, the option eliminated the “diagnostic hurdle” of testing to determine immune cell, or CD4 counts, when limited access to that testing had been shown to have hobbled the country’s efforts to prevent mother to child HIV transmission, Jahn said. In addition the approach, if done right, would avert future infections, during breastfeeding, during subsequent pregnancies and to women’s uninfected partners. In fact, Jahn said, the approach has served as a stepping stone to the UNAIDS 90-90-90 testing, treatment and viral suppression goals set for 2020 if the global pandemic is to cease to be a public health threat by 2030.
In undertaking the approach Malawi showed the rest of the world what could be done, adding nearly 50 percent more patients to antiretroviral treatment rolls every three months, so that by 2015 half of all women living with HIV who became pregnant already were receiving treatment. In a country that also continues to have one of the highest fertility rates in Africa, that accomplishment alone was significant. In addition, however, adopting the approach, and the streamlining of services it encompassed, set the stage for more changes, Jahn said. It meant decentralizing care to almost double the number of sites offering antiretroviral treatment, a change that had a greater impact on treatment coverage than expanding treatment eligibility. It also meant retraining 5,000 health workers, and instituting a system of regular supervisory monitoring to ensure the quality of their work. That monitoring, in turn, Jahn noted at a later presentation has led to more accurate, efficient and current data collection.
The data, too is decentralized — you can find it, and more on Malawi’s gains and challenges in confronting HIV, at its Ministry of Health HIV web site: www.hiv.health.gov.mw.