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.