Malawi's Bold PMTCT Stance Protects HIV Positive Women Beyond Childbirth

Malawi's Bold PMTCT Stance Protects HIV Positive Women Beyond Childbirth

Mother and children, Salima, Malawi, April 2011

Malawi leads the developing world as the first to propose an approach to prevention of mother to child transmission (PMTCT) of HIV that addresses the health of the mother. Recently my MSH colleague Erik Schouten and his colleagues in Malawi wrote a commentary in the Lancet about Malawi’s innovative, public health approach to PMTCT. Malawi calls its model “B+” because it complements the World Health Organization’s (WHO) B option, whereby a mother’s CD4 cell count, a measure of the volume of HIV circulating in her blood, determines her eligibility for lifelong antiretroviral therapy (ART). Under current WHO guidelines, pregnant women with a certain CD4 count corresponding to high levels of HIV infection are put on ART for life, but those pregnant women with less advanced HIV infection are put on antiretroviral prophylaxis only during pregnancy, with the sole objective of preventing HIV transmission to her unborn child. Malawi’s option B+ goes a step further than WHO’s option B by offering lifelong ART to all pregnant women who test positive for HIV, regardless of their CD4 count.

Most approaches to prevention of mother to child transmission in developing countries remove the mother from ART once the baby is born, thereby virtually ignoring the health and survival of the mother once she births her baby. Malawi’s new, innovative method exemplifies integrated maternal health and HIV prevention because it is the first in the developing world to actually address the well being of the pregnant woman for her own sake rather than to simply think of her as a vessel for the delivery of an HIV-free newborn.

Furthermore Malawi’s approach takes a truly comprehensive public health stance by recognizing the strong interrelatedness of maternal well being and child survival. We have very robust evidence of improved survival of newborns whose mothers survive compared to those infants whose mothers who do not survive. And while the evidence may not be as strong for older children as it is for infants, Malawi’s B+ approach recognizes that in fact the pregnant mother, in all likelihood, probably has several other children at home that are dependent on her for their present and future well being. Therefore Malawi’s approach shows understanding that the mother’s survival has a direct impact not only the well being of the newborn in question but also on the wellbeing and survival of all of her other children who would otherwise be left to live a life without their biological mother.

Management Sciences for Health through its USAID-supported Basic Support for Institutionalizing Child Survival (BASICS) project is proud to collaborate with the Ministry of Health of Malawi to lead the way in advocating and promoting this truly integrated public health approach to PMTCT. Malawi’s model should be replicated throughout the developing world.

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