Q&A with Peggy Chibuye: Preventing Mother-to-Child Transmission of HIV in Malawi
MSH: What is your role at MSH?
I am the Prevention of Mother-to-Child Transmission (PMTCT) Technical Advisor placed at the Ministry of Health (MOH) in Malawi.
MSH: What is the situation in Malawi with respect to the AIDS epidemic? What are Malawi’s greatest challenges in tackling HIV & AIDS?
Malawi is experiencing a severe epidemic. Since 1985, when the first AIDS case was diagnosed, HIV prevalence has increased significantly in the 15–49 age group. It rose to 16.2 percent in 1999, before coming down and stabilizing at around 12 percent in 2005. HIV prevalence among sexually active adults is higher among females (at 13 percent) than males (10 percent).
These rates translate into 800,000 to 1 million Malawians living with AIDS, including 100,000 children under age 15. The overall HIV prevalence rate for youth, 15–19 years, is estimated at 2.1 percent: 0.4 percent for male and 6.2 percent for female adolescents.
Almost three-quarters of HIV infections are acquired through unprotected heterosexual intercourse with an infected person, and almost one-quarter of the new infections are in children born to HIV-positive mothers. A few infections are transmitted through blood transfusions and injections with contaminated instruments, but the percentages are small.
MSH: How does your work as PMTCT Technical Advisor address the AIDS epidemic in Malawi?
I provide technical assistance in many areas, including:
- developing leadership in PMTCT at all levels through capacity-building strategies;
- devising strategies to address implementation and service quality issues in the PMTCT and pediatric HIV care program;
- integrating PMTCT and pediatric HIV care in maternal and child health services and strengthening linkages to other HIV, medical, and support services, including family planning;
- developing technical documents—such as policy guidance, guidelines, training materials, and job aids—to expand and consolidate the PMTCT and pediatric HIV care program.
MSH: Which challenges affect your day-to-day work the most?
Capacity issues prevent us from transferring skills to our counterparts at all levels. For example, resources are limited to help Malawi implement effective PMTCT and pediatric HIV care programs to reduce pediatric HIV infections—the goal of the PMTCT program in Malawi. Nevertheless, the number of sites providing PMTCT services increased from 99 in December 2006 to 518 in March 2009. And service data tell us that the uptake of PMTCT services is now over 89 percent. But there is room for improvement: prophylaxis with antiretroviral medicines for HIV-positive women is at 55 percent, and for exposed infants it’s at just 35 percent.
Rapid expansion of the program has required concentrated efforts to implement several interventions at the same time while also dealing with limited resources and staff shortages at all levels.
MSH: How is MSH/BASICS making an impact in the field of HIV & AIDS, especially in Malawi?
BASICS (Basic Support for Institutionalizing Child Survival) has contributed significantly to the success of the antiretroviral therapy (ART) and PMTCT programs in Malawi by assisting in coordination.
We have played a role in developing the policy and direction of HIV programs. For example, MSH/BASICS helped the MOH develop a pediatric HIV care manual aimed at intensifying identification of exposed and infected infants and children. In addition, we have helped the National AIDS Commission develop Global Fund proposals, including advising the Commission on objectives and activities for HIV programs. We have also developed monitoring and evaluation tools.
MSH: What local organizations do we work with in Malawi?
We work with the Christian Health Association of Malawi (CHAM), which provides about one-third of the health services in the country; with Banja La Mtsogolo, a leading nongovernmental organization that works in sexual and reproductive health; and with the Red Cross, among others.
MSH: Have you seen significant changes over time in the way people view AIDS and those affected by the disease?
Yes, a number of HIV-positive mothers now appreciate the importance of living positively with AIDS and are using care and treatment services. Stigma is still a problem for pregnant women, however, and they often do not disclose their HIV-positive status to spouses because they are afraid of being blamed for bringing HIV into the home and being divorced.
MSH: How has the National Strategic Plan for Accelerated Child Survival and Development in Malawi affected public health in the country?
Infant mortality and morbidity has declined from 132 per 100,000 to 89 per 100,000 in 2008.
MSH: Can you explain the correlation between improved child health and accomplishments in HIV & AIDS prevention, care, and treatment?
This question is not an easy one to answer because of the lack of national data on AIDS-related child deaths and pregnancy outcomes. The new prenatal care and maternity registers with HIV information will assist in monitoring pregnancy outcomes and thus show trends in the future.
MSH: How do you see the future of HIV & AIDS in Africa? Can there be a true end to the disease?
I am not optimistic that ending HIV & AIDS can be a reality in the near future—at least, not until African governments commit themselves to reducing HIV infections in their countries by not only putting more resources into the fight against this scourge but also giving it the urgency required to address this epidemic.
MSH: What has been the most rewarding part of your work with BASICS in Malawi?
Specifically, the opportunity to help Malawi achieve the following:
- Increasing the number of sites providing PMTCT services from 147 to 518 sites in two years;
- Increasing the number of pregnant women accessing PMTCT services from 38,000 in 2006 to more than 405,694 in two years;
- Introducing the combination regimen (AZT+3TC+SD-NVP) to reduce further the risk of mother-to-child transmission to less than 2 percent for those women who start the regimen from 28 weeks’ gestation, compared to single-dose nevirapine, which reduces the risk of transmission by only 20 percent.
Ministry of Health (MOH). “First Quarter ART Service Data.” Lilongwe: MOH, 2009.
MOH. “First Quarter PMTCT Service Data.” Lilongwe: MOH, 2009.
MOH. “Health Management Information Bulletin.” Lilongwe: MOH, 2007.
MOH. “HIV Testing and Counselling Service.” Lilongwe: MOH, December 2008.
MOH. “PMTCT Service Data from 493 PMTCT Sites.” Lilongwe: MOH, December 2008.
MOH. “PMTCT Service Data from 395 PMTCT Sites.” Liliongwe: MOH, December 2007.
MOH. “Report of a Country-wide Survey of HIV/AIDS Services in Malawi for the Year 2006.” Lilongwe: MOH, July 2007.
National Statistics Office, Republic of Malawi. “Health Cluster Survey.” Liliongwe: MOH, 2007.
UNICEF. “PMTCT Service Data from 35 PMTCT Sites in Malawi.” Lilongwe: UNICEF, 2006.
WHO, UNICEF, and IATT. “Guidance on Scaling-Up of Prevention of Mother to Child Transmission of HIV.” Geneva: WHO, 2007.