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Title
Prevention of mother to child transmission and early infant diagnosis in Malawi: Accomplishments of a mature Option B+ program in a resource-limited setting
Presenter
Nellie Wadonda-Kabondo
Authors
E. Kim1, J. Cuervo-Rojas2, T. Kalua3, A. Jahn3, D. Payne4, C. West4, M. Nzima5, N. Wadonda-Kabondo4, S. Jonnalagadda6, MPHIA Study Team
Institutions
1Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi, 2ICAP at Columbia University, New York, United States, 3Ministry of Health, Lilongwe, Malawi, 4Centers for Disease Control and Prevention, Lilongwe, Malawi, 5UNAIDS, Lilongwe, Malawi, 6Centers for Disease Control and Prevention, Atlanta, United States

Background: Malawi spearheaded the development and implementation of the Option B+ policy for prevention of mother to child transmission of HIV (PMTCT). From mid-2011, all HIV-infected pregnant and breastfeeding women were eligible for life-long ART. Routine aggregate program data indicated successful rapid scale-up, but some concerns about uptake and retention remained. We measured PMTCT and early infant diagnosis (EID) coverage in the 2015-16 Malawi Population-based HIV Impact Assessment (MPHIA).
Methods: MPHIA was a nationally representative household survey; eligible women were consented and interviewed on pregnancies and outcomes, including self-reported HIV status during their most recent pregnancy, uptake of PMTCT, and EID testing. Women aged 15-49 years reporting a live birth in the 36 months before the survey were included in this analysis. Descriptive and multivariable logistic regression analyses were weighted to account for the complex survey design.
Results: A total of 3,598 women reported a live birth in the 36 months before the survey; mean age was 26.9 years and mean parity was 3.0. Of these, 96.2% (95% confidence intervals (CI): 95.5-97.0) reported being tested for HIV and receiving their results or knowing their HIV status during their last pregnancy; 7.4% (95% CI: 6.5-8.4) self-reported their HIV-positive status during pregnancy. Of the 302 women self-reporting their HIV-positive status, 98.1% (95% CI: 96.5-99.6) reported being on ART during pregnancy and 81.0% (95% CI: 75.6-86.4) reported that their child was tested for HIV; 50.6% (95% CI: 43.1-58.1) reported EID testing within two months of birth. Of those reporting that their child was tested for HIV, 3.1% (95% CI: 0.5-5.7) reported a HIV-positive result.
Adjusting for age and urban/rural residence, EID testing within 2 months of birth was associated with secondary or higher education (adjusted odds ratio (aOR) 3.1, 95% CI: 1.5-6.2), disclosure of mother´s HIV-positive status to family (aOR 2.4, 95% CI: 1.3-4.6), and uptake of cotrimoxazole (aOR 6.2, 95% CI: 2.7-14.2).
Conclusions: Data from the 2015-16 MPHIA demonstrate the success of Malawi´s PMTCT Option B+ program at a population level, with high uptake across the PMTCT cascade. However, challenges remain in the timeliness of EID testing for HIV-exposed infants according to recommended guidelines.