ART for life looks promising for women of Malawi

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Science Speaks is in Atlanta, Georgia this week and will be live-blogging from the 20th CROI — Conference on Retroviruses and Opportunistic Infections from Sunday to Wednesday, covering breaking developments from investigators on cure research, new antiretroviral agents, hepatitis, tuberculosis and treatment as prevention.

ATLANTA, GA — Striking data on early outcomes from 18 months Malawi’s bold experiment with Option B + showed the country’s “ART for Life” campaign led to a 763 percent increase in the number of pregnant women on antiretroviral therapy with a 49 percent increase in ART enrollment among this group during the last two quarters of 2012.
Beth Tippett Barr from the Centers for Disease Control and Prevention in Malawi presented the outcomes Tuesday at the 20th Conference on Retroviruses and Opportunistic Infections, in Atlanta.

Among the gratifying and surprising yields to health care officials the presentation showed, has come from the scores of women who have presented to the now integrated antenatal and ART clinic sites during breastfeeding requesting antiretroviral treatment.

Malawi made a decision to launch a public health approach to prevention of mother to child transmission and to test and treat all HIV-infected pregnant women. A positive HIV test is the only condition for ART initiation. High rates of fertility and perinatal transmission coupled with limited capacity to test and monitor patients’ immune cell counts informed this decision. The reasoning included that a test-and-treat or Option B + approach would limit the stop and start of antiretroviral in this high fertility setting, make breastfeeding safe, keep mothers alive and healthy and prevent sexual transmission to these women’s uninfected sexual partners.

The health ministry trained 4,000 health workers in 3 months beginning in July 2011. Antenatal clinic settings integrated antiretroviral treatment into their services, supported by clinical mentoring and site supervision. Prior to the launch of this program, antiretroviral treatment scale up had flattened in Malawi, but the program facilitated major uptake in treatment, bringing it closer to people’s homes. Of all the women initiated on antiretroviral treatment, 41 percent started treatment during breastfeeding, many of them presenting at clinics as public awareness of the new program grew.

At 12 months, 78 percent of the women are still alive and on therapy, a rate comparable to the retention rate of the general population. At first, the program recommendation was to initiate treatment on the day of diagnosis, but this proved challenging for many women who needed more time to process the news of their diagnosis. Now, women are given the opportunity to return with a “treatment partner” within seven days.

Monitoring maternal and infant outcomes over time and documenting the public health impact of the program will continue. Health officials are also working to understand the community and family influence over ART initiation during breastfeeding.

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