Research

Prevention of mother-to-child transmission of HIV: a

cross-sectional
study in Malawi
M van Lettow,a M Landes,b JJ van Oosterhout,a E Schouten,c H Phiri,c E Nkhoma,c T Kalua,d S Gupta,d
N Wadonda,e A Jahnd & B Tippett-Barrf

Objective To estimate the use and outcomes of the Malawian programme for the prevention of mother-to-child transmission (MTCT)
of human immunodeficiency virus (HIV).
Methods In a cross-sectional analysis of 33 744 mother–infant pairs, we estimated the weighted proportions of mothers who had
received antenatal HIV testing and/or maternal antiretroviral therapy and infants who had received nevirapine prophylaxis and/or HIV
testing. We calculated the ratios of MTCT at 4–26 weeks postpartum for subgroups that had missed none or at least one of these four
steps.
Findings The estimated uptake of antenatal testing was 97.8%; while maternal antiretroviral therapy was 96.3%; infant prophylaxis was
92.3%; and infant HIV testing was 53.2%. Estimated ratios of MTCT were 4.7% overall and 7.7% for the pairs that had missed maternal
antiretroviral therapy, 10.7% for missing both maternal antiretroviral therapy and infant prophylaxis and 11.4% for missing maternal
antiretroviral therapy, infant prophylaxis and infant testing. Women younger than 19 years were more likely to have missed HIV testing
(adjusted odds ratio, aOR:
4.9; 95% confidence interval, CI: 2.3–10.6) and infant prophylaxis (aOR: 6.9; 95% CI: 1.2–38.9) than older women. Women who had never
started maternal antiretroviral therapy were more likely to have missed infant prophylaxis (aOR: 15.4; 95% CI: 7.2–32.9) and infant
testing (aOR: 13.7; 95% CI: 4.2–83.3) than women who had.
Conclusion Most women used the Malawian programme for the prevention of MTCT. The risk of MTCT increased if any of the main
steps in the programme were missed.

Introducti more of the four main steps in the cascade of care provided,
on for PMTCT, by the national HIV programme, the results of
such studies cannot be considered nationally
Recent global efforts in the fight against human immunodefi- representative.10,11
ciency virus (HIV) have been focused on the virtual elimina- The summary reports produced by Malawi’s national HIV
tion of paediatric HIV infection1 and improvements in the programme use data that are aggregated at health-facility
so-called cascade of care for the prevention of mother-to- level and do not provide insight into individual risk factors
child transmission of HIV (PMTCT). This cascade includes associ- ated with the use of the cascade of care for PMTCT.
antenatal HIV testing, uptake of maternal antiretroviral In 2014, the Malawi Ministry of Health began a national
therapy (ART), infant antiretroviral prophylaxis and early evaluation of Malawi’s PMTCT programme. Here we
infant HIV testing.2 present some of the methods, results and conclusions of that
In 2011, Malawi adapted the relevant World Health evaluation, which aimed to determine the effectiveness of the
Organization (WHO) guidelines to design a national, public- Option B+ strategy in a nationally-representative sample of
health-oriented strategy for PMTCT.3,4 In this strategy, mother–infant pairs enrolled at 4–26 weeks postpartum.
called Option B+, all pregnant and breastfeeding women
found infected with HIV are offered lifelong ART,
regardless of their CD4+ T-lymphocyte counts or WHO Metho
clinical stage. The strategy’s development was supported by ds
emerging evidence that universal ART provision in resource-
Study
constrained settings could markedly reduce HIV
transmission.5–7 The strategy was designed to remove setting
institutional barriers to care, provide ma- ternal health Implementation of the Malawi integrated PMTCT/ART
benefits, reduce maternal mortality and increase ART guide- lines began in July 2011. In theory, this gave all
coverage for future pregnancies in high-fertility settings.4 pregnant and breastfeeding women access to HIV testing,
During the strategy’s early implementation, ART initiations HIV counselling and ART. At the time of HIV status
among pregnant women increased sixfold and the ascertainment, each HIV- infected pregnant woman should
proportions of women who, having initiated ART while be given enough nevirapine to provide her baby with six
pregnant, were still receiving HIV care 12 and 24 months weeks of prophylaxis from birth. She should also be asked to
later were 72% and bring her child, for HIV testing, to a clinic for the care of
68%, respectively.8,9 children younger than five years, known as an under-5
Although a few studies in large Malawian health clinic in Malawi, as soon as the course of prophylaxis is
facilities have indicated that many mother–infant pairs complete at an age of six weeks.4
miss one or

0 Bull World Health Organ 2018;96:256–265 | doi:

http://dx.doi.org/10.2471/BLT.17.203265
 Research
a
Dignitas International, PO Box 1071, Zomba, Malawi.
b
Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
c
Management Sciences for Health, Lilongwe, Malawi.
d
Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi.
e
United States Centers for Disease Control and Prevention – Lilongwe, Lilongwe, Malawi.
f
United States Centers for Disease Control and Prevention – Zimbabwe, Harare, Zimbabwe.
Correspondence to M van Lettow (email: m.vanlettow@dignitasinternational.org).
(Submitted: 21 September 2017 – Revised version received: 9 January 2018 – Accepted: 6 February 2018 – Published online: 28 February 2018 )

1 http://dx.doi.org/10.2471/BLT.17.203265
Study design and
Table 1. Characteristics of mother–infant pairs visiting clinics for
sampling children younger than fve years, Malawi, October 2014–May
Our aim was to draw a representative 2016
sample for national estimates of the ra-
tios of mother-to-child transmission of Characteristic Weighted
HIV (MTCT) in Malawi. The sampling Unweighted percentagea
frame included all 579 health facilities no. (95%
Location CI)
that provided PMTCT services in Ma- Recordedb 33 744 N/A
lawi in 2012–2013. We estimated that Rural facility in Central or North regions 8 991 23.2 (15.0–34.2)
we would need to enrol at least 3376 Urban facility in Central or North regions 13 748 20.5 (12.1–32.4)
HIV-exposed infants to determine the
Rural facility in South region 6 106 50.9 (37.6–64.1)
ratio of MTCT at 24 months
Urban facility in South region 4 899 5.4 (3.6–8.1)
postpartum reliably. Probability-
Mother’s age in years
proportional-to- size selection was
used, without replace- ment, to select Recordedb 33 744 N/A
the 54 study facilities: ≤ 19 6 427 20.5 (19.1–22.1)
14 rural and nine urban facilities in the 20–24 11 504 33.3 (32.5–34.1)
North or Central regions and 22 rural 25–29 7 423 19.7 (15.8–21.1)
and nine urban in the South region. We ≥ 30 8 315 26.3 (25.2–27.4)
subjected data obtained at all 54 study Unknownc 75 0.2 (0.1–0.3)
facilities to a cross-sectional analysis. Age of last born child in weeks
Data collection and Recordedb 33 744 N/A
laboratory procedures 4–12 22 170 63.1 (60.2–35.9)
13–26 11 574 36.9 (34.1–39.8)
Between October 2014 and May 2016, Type of last birth
women attending under-5 clinics at Recordedb 33 744
each of the study facilities were
Singleton 33 579 99.1 (98.7–99.4)
screened for study eligibility. To be
Multiple 165 0.9 (0.6–1.3)
enrolled, a woman had to be a
Parity
mother of or a legal caregiver for an
infant aged 4–26 weeks and be Recordedb 33 744 N/A
willing and able to give informed 1 10 943 30.5 (29.0–32.0)
consent. Information about age, 2–3 14 179 39.6 (38.6–40.7)
parity, uptake of antenatal care, HIV 4–6 7 810 27.1 (25.5–28.7)
testing and whether the woman’s HIV 7–9 717 2.7 (2.1–3.4)
status had been ascertained during or ≥ 10 31 0.1 (0.1–0.1)
before the index pregnancy, if ever, Unknownc 64 0.2 (0.1–0.3)
was collected in standardized inter- ANC attendance
views. Whenever possible, interviewers Recordedb 33 744 N/A
checked the mothers’ health booklets Did attend ANC during last pregnancy 33 681 99.8 (99.7–99.9)
to check the accuracy of the mothers’ Missed ANC uptake 63 0.2 (0.1–0.3)
responses. Women who had only dis-
Site of ANC uptake
covered that they were HIV-infected
Recordedb 33 744 N/A
through study screening were not asked
Same site as enrolment site 26 225 76.3 (70.8–81.0)
about their uptake of maternal ART,
infant nevirapine prophylaxis or infant Other site 7 449 23.5 (18.7–29.0)
HIV testing. After being interviewed, Unknownc 70 0.2 (1.2–0.3)
each enrolled woman was tested, HIV status ascertained at ANC
within the study facility, for HIV. Recordedb 33 744 N/A
Maternal HIV testing, which was Found HIV-negative during index pregnancy 30 043 88.5 (86.8–90.0)
based on an initial rapid Determine Known to be HIV-positive before index pregnancy 1 637 6.4 (5.6–7.3)
HIV-1/2 test (Alere Medical, Tokyo, Found HIV-positive during index pregnancy 1 596 5.1 (4.3–6.2)
Japan) and confirma- tion with
Unigold HIV-1/2 (Trinity Biotech,
Bray, Ireland), followed na-
tional guidelines.12 The Joint Clinical Missed having HIV status ascertained at ANC or 468 2.2 (1.1–4.4)
Research Centre in Kampala, Uganda, unwilling to reveal result
performed qualitative tests for HIV-1 Maternal HIV status 4–26 weeks
postpartum
deoxyribonucleic acid (DNA), based of America), on batched dried spots of blood from all identified HIV-exposed
on COBAS AmpliPrep and version 2.0 infants.
of the COBAS TaqMan assay (Roche
Diagnostics, Indianapolis, United States
Recordedb
33 744 N/A Confirmed
HIV-uninfected
30 057 87.5 (85.5–89.0)
Confirmed HIV-infected
3 233 11.3 (9.8–12.9) Newly
identified HIV-infected
286 0.9 (0.6–1.2) Had
inconclusive results
168 0.4 (0.5–0.5)
(continues. . .)
 Research
M van Lettow et Prevention of mother-to-child HIV transmission in Malawi
al.
 Research
Prevention of mother-to-child HIV transmission in Malawi M van Lettow et
(. . .continued) categories. We used χ2 al.
tests to compare
Characteristic Weighted weig hte d MTCT rat ios. We us e d
Unwei percentagea a weighted multivariable binary
ghted (95% logistic regression to identify factors
no. CI) associated with missing steps 1, 2, 3
ART status and timing of ART and/or 4 of
initiation among confirmed HIV-
infected
Recordedb 3 233 N/A
the cascade of care or a missed HIV
diagnosis. In each model, weighted
On ART since before index pregnancy 1 572 54.0 (49.9–57.9)
odds ratios with 95% CI were adjusted
On ART, having started during index pregnancy 1 475 40.7 (35.6–46.0)
for region and maternal age, parity and
On ART, having started postpartum 49 1.6 (0.9–2.9)
uptake of antenatal care, at the study
Off ART, having started and stopped 34 0.6 (0.3–1.1) site or a different site, to give adjusted
Off ART and never started 50 1.2 (0.6–2.4) odds ratios (aOR). In the models for
Unknownc 53 1.9 (0.7–4.9) missed maternal ART uptake, missed
Infant nevirapine prophylaxis given to known nevirapine prophylaxis and missed
HIV-exposed infants infant HIV testing, we also adjusted for
Recordedb 3 233 N/A ascertained maternal HIV status. We
From birth to an age of 6 weeks 2 676 75.9 (66.3– also adjusted for maternal ART status
83.5) For less than 6 weeks 323 16.4 (9.5– and timing in the model for missed
26.9)
Missed indicated nevirapine prophylaxis uptake or 234 7.7 (6.1–9.6) uptake of nevirapine prophylaxis and
unwilling to reveal for uptake of nevirapine prophylaxis in
Uptake of early infant diagnosis among HIV- the model for missed infant HIV
exposed infants over 8 weeks of age testing. All analyses were conducted
using SPSS
Recordedb 1 465 N/A Statistics 23 (IBM, Chicago, USA), and
Tested at an age of at least 6 weeks 790 53.2 (46.3– adjusted for the complex design of the
60.0) Not tested 675 46.8 whole national evaluation of Malawi’s
(40.0–53.7) HIV status of HIV-exposed infants aged 4–26 PMTCT programme. Each observation
weeks was weighted according to sampling
Recordedb 3 519 N/A interval and the probabilities of
HIV-uninfected 3 345 95.3 (93.6–96.6) districts, clusters and subjects being
HIV-infected 174 4.7 (3.4–6.3) selected.13
ANC: antenatal clinic; ART: antiretroviral therapy; CI: confidence interval; HIV: human Ethic
immunodeficiency virus; N/A: not applicable. s
a
Weighted according to sampling interval and the probabilities of districts, clusters and subjects
being selected. Ethical approval was provided by Ma-
b
Number used as unweighted denominator.
lawi’s National Health Sciences
c
Unknown because the relevant question was not answered, the recorded answer could not be read
or multiple answers were recorded when only one was allowed. Research Committee (#1262), the
United States Centers for Disease
Control and Preven- tion (#2014–054–7)
and the University of Toronto (#30448).
All mothers or caregiv- ers provided
written informed consent.
HIV-uninfected. Similarly, mothers who
Statistical number of known HIV-infected
claimed to be HIV-positive and were
analyses mothers with infants that were more
subsequently found positive in the rapid
than eight weeks old, i.e. with infants
We focused on five main steps in the test were categorized confirmed HIV-
that should have been tested for HIV.
PMTCT cascade of care: attendance at infected. The HIV status of the other
Moth- ers who claimed to be HIV-
an antenatal clinic – known as step 0; mothers was categorized either as missed
negative and were subsequently found
ascertainment of HIV status during an- HIV diagnosis, if the mother claimed to
negative in the rapid test were
tenatal care (step 1); uptake of maternal be HIV-negative or not know her HIV
categorized as confirmed
ART (step 2); use of infant nevirapine status, but was subsequently found posi-
prophylaxis (step 3); and HIV testing, tive in the rapid test, or as inconclusive,
before the study, of HIV-exposed if the rapid test results were inconclusive.
infants when more than eight weeks old We recorded ratios of MTCT at 4–26
(step 4). The denominators used to weeks postpartum as the percentage of
calculate weighted proportions for infants tested for HIV-1 DNA that were
step 1, steps 2 and 3 and step 4 were, found positive. We calculated an overall
respectively, the total number of MTCT ratio and also separate ratios for
mother–infant pairs included in the the mother–infant pairs who had missed
cohort, the total number of known none or one or more PMTCT cascade
HIV-infected mothers and the total steps or who were categorized as missed
 Research
M van Lettow et Prevention of mother-to-child HIV transmission in Malawi
HIV diagnosis.
al.
We report unweighted numbers Resu
and weighted categorical proportions lts
with 95% confidence inter vals (CI).
Missing data were treated as additional Although 34 637 mothers or
caregivers were interviewed and
tested for HIV infection, 657 (1.9%)
had to be excluded, because of non-
eligibility or incomplete data. All
236 (0.7%) caregiver–infant pairs
had to be excluded because the
caregivers gave inconsistent
answers to the questions on PMTCT
services. The remaining 33 744
mothers, who attended care with
infants aged 4–26 weeks old, were
included in our analysis.
Maternal
characteristics
The characteristics of the enrolled
moth- ers and their uptake of each
step in the PMTCT programme are
summarized in Table 1. All
percentages and aOR report- ed below
are weighted values. Mothers’ ages
ranged from 12 to 53 years; 17 931
(53.8%) were under 25 years of age
and
6247 (20.5%) were adolescents
aged
12–19 years. Parity ranged from 1 to 14 42 who had claimed not to know their The overall ratio of MTCT at 4–26
and 10 943 (30.5%) of the mothers HIV status. w e e ks, a m o n g 3519 HIV-e xp o
were primiparous. Of the 3233 confirmed HIV-in- s e d mother–infant pairs, was 4.7%.
During the index pregnancy, 33 fected women, 3096 (96.3%) were on
681 (99.8%) of the mothers attended
Characteristics
ART (step 2); 1572 (54.0%) had started
an antenatal clinic (step 0), 33 276 associated with missed
ART before the index pregnancy, 1475
(97.8%) had their HIV status steps
(40.7%) during the index pregnancy
ascertained at such a clinic (step 1) and 49 (1.6%) postpartum. Thirty-four Overall, 468 (2.2%) mothers claimed
and 26 225 (76.3%) reported that (0.6%) of the confirmed HIV-infected that they had not had their HIV sta-
they had attended an antenatal women had stopped ART and 50 tus ascertained during antenatal care.
clinic at the site where they were (1.2%) had not started ART. For 53 In multivariable analysis, adolescent
enrolled. (1.9%) women the ART status was mothers (aOR: 4.9; 95% CI: 2.3–10.6)
Of the women who reported that unknown. and those aged 20–24 years (aOR: 2.0;
they had had their HIV status ascer- Of the confirmed HIV-infected 95% CI: 1.4–2.8) were more likely to
t aine d at an antenat a l clinic, mothers, 2676 (75.9%) reported giving have missed this step than older moth-
1637 (6.4%) and 1596 (5.1%) their infant nevirapine prophylaxis ers and mothers who had had two or
reported that they had been found from birth to an age of six weeks (step three (aOR: 2.1; 95% CI: 1.2–3.7) or at
HIV-positive be- fore and during the 3) and least four (aOR: 2.5; 95% CI: 1.3–4.6)
index pregnancy, respectively. 323 (16.4%) had given such prophylaxis previous deliveries were more likely to
HIV testing at the time of our for less than six weeks. Although, when have missed this step than primiparous
study identified 3519 (12.1%) mothers they were interviewed, 139 of the 323 mothers (Table 2).
with HIV infection, including 3233 had infants that were under six weeks of Of the 3519 HIV-infected women
(11.3%) confirmed HIV infections and age. Of the 1465 identified HIV- identified at screening, 286 (7.1%) had
286 (0.9%) missed HIV diagnoses. The exposed infants that were older than missed being diagnosed earlier. Such
latter represented by 244 mothers who eight weeks when their mothers were missed diagnosis was associated with
had claimed they were HIV-negative enrolled, 790 (53.2%) had been tested having attended an antenatal clinic
and for HIV-1 DNA before the study
screening (step 4).

Table 2. Factors associated with missing antenatal testing for HIV infection and with frst identifcation of
such infection 4–26 weeks postpartum, Malawi, October 2014–May 2016

Characteristic Missed antenatal HIV testing Newly identifed

Unweighted HIV infectionsa
denominator Unweight Weighted Unweight Weighted
ed, no. aORb ed, no. aORb
(%) (95%c (%) (95%
Location (n = 33 744) NIIM
Rural facility in Central or North regions 8 991 73 (0.8) 54 (0.6) 0.8 (0.4–1.6)
Urban facility in Central or North regions 13 748 80 (0.6) 96 (0.7) 0.5 (0.2–1.1)
Rural facility in South region 6 106 278 (4.6) 52 (0.9) 1.0 (0.4–2.2)
Urban facility in South region 4 899 37 (0.8) 42 (0.9) Reference
Mother’s age in years (n = 33 669)
≤ 19 6 427 119 (1.9) 4.9 (2.3–10.6) 24 (0.4) 0.6 (0.3–1.3)
20–24 11 504 232 (2.0) 2.0 (1.4–2.8) 93 (0.8) 1.1 (0.6–2.2)
25–29 7 423 105 (1.4) 1.3 (0.8–1.5) 66 (0.9) 1.1 (0.6–2.1)
≥ 30 8 315 11 (0.1) Reference 61 (0.7) Reference
Parity (n = 33 680)
1 10 943 139 (1.3) Reference 42 (0.4) 1.0 (0.5–2.0)
2–3 14 179 186 (1.3) 2.1 (1.2–3.7) 148 (1.0) 2.0 (1.2–3.6)
≥4 8 558 143 (1.7) 2.5 (1.3–4.6) 54 (0.6) Reference
ANC attendance (n = 33 744) NIIMd NIIMd
Yes 33 681 425 (1.3) 244 (0.7)
No 63 43 (68.3) 0 (0.0)
Location of ANC (n = 33 674)
At study site 26 225 349 (1.3) Reference 163 (0.6) Reference
At different site 7 449 77 (1.0) 0.7 (0.3–1.9) 81 (1.1) 2.2 (1.5–3.1)
ANC: antenatal clinic; aOR: adjusted odds ratio; CI: confidence interval; HIV: human immunodeficiency virus; NIIM: not included in model.
a
Mother missed HIV diagnosis, she claimed to be HIV-negative or not to know her HIV status, but was found infected in the study.
b
Weighted according to sampling interval and the probabilities of districts, clusters and subjects being selected and adjusted for all other variables in the model.
c
Excluded from model because of skewed data caused by three rural health facilities in South region having no test kits available when women would have
been seeking antenatal care.
d
Too few events to be included in the model.
somewhere other than the study site before, the index pregnancy (aOR: 3.2; had received antenatal care at the study
(aOR: 2.2; 95% CI: 1.5–3.1) and with 95% CI: 1.3–8.0). site (aOR: 1.9; 95% CI: 1.1–3.3); and
parity, with an aOR of 2.0 (95% CI: Among all known HIV-exposed (iii) a mother who had either stopped
1.2–3.6) for a parity of 2–3 compared infants, 234 (7.7%) had reportedly not ART (aOR: 6.4; 95% CI: 1.5–28.0) or
with one of at least 4 (Table 2). received any nevirapine prophylaxis never started ART (aOR: 15.4; 95% CI:
Fifty (1.2%) of the 3233 confirmed (Table 3). An infant that had missed 7.2–32.9) than a mother on ART.
HIV-infected women had not started prophylaxis was more likely to have: Overall, 675 (46.8%) of all known
ART (Table 3). Not having started (i) a mother aged 20–24 (aOR: 3.1; HIV-exposed infants that were older
ART was associated with having 95% CI: 1.8–5.5) or 25–29 (aOR: 1.8; than eight weeks when their mothers
attended an antenatal clinic 95% CI: were interviewed had reportedly not
somewhere other than the study site 1.4–2.4) years than one older than 30 been tested for HIV-1 DNA at that time
(aOR: 4.7; 95% CI: years; (ii) a mother who had attended (Table 4). Mothers with infants that
1.5–14.8) and with having been diag- an antenatal clinic somewhere other had not been tested were more likely
nosed with HIV during, rather than than the study site than a mother who to be

Table 3. Factors associated with mothers known to be infected with HIV missing their uptake of
antiretroviral therapy or missing nevirapine prophylaxis for their infants, Malawi, October
2014–May 2016

Characteristic Missed maternal ART uptakea

Unweighte Missed infant
d nevirapine
denominat prophylaxisa
or
Unweight Weighted Unweight Weighted
ed, no. aORb ed, no. aORb
(%) (95% (%) (95%
Location (n = 3 233)
Rural facility in Central or North regions 803 9 (1.1) 1.5 (0.6–4.0) 63 (7.8) 1.5 (0.8–3.0)
Urban facility in Central or North regions 857 19 (2.2) 0.8 (0.3–2.3) 69 (8.1) 1.1 (0.5–2.4)
Rural facility in South region 881 9 (1.0) 1.3 (0.4–4.4) 59 (6.7) 1.3 (0.6–2.5)
Urban facility in South region 692 13 (1.9) Reference 43 (6.2) Reference
Mother’s age in years (n = 3 224)
≤ 19 191 3 (1.6) 1.5 (0.1–14.1) 20 (10.5) 1.9 (0.7–4.8)
20–24 617 16 (2.6) 1.2 (0.2–5.6) 60 (9.7) 3.1 (1.8–5.5)
25–29 790 14 (1.8) 0.6 (0.1–3.3) 52 (6.6) 1.8 (1.4–2.4)
≥ 30 1626 17 (1.0) Reference 100 (6.2) Reference
Parity (n = 3 230)
1 401 8 (2.0) 1.8 (0.4–8.5) 40 (10.0) 0.5 (0.2–1.2)
2–3 1328 27 (2.0) 1.1(0.3–3.2) 95 (7.2) 0.6 (0.2–1.5)
≥4 1501 15 (1.0) Reference 98 (6.5) Reference
ANC uptake (n = 3 233) NIIMc NIIM
Yes 3225 50 (1.6) 233 (7.2)
No 8 0 (0.0) 1 (12.5)
Location of ANC (n = 3 225)
At study site 2559 24 (0.9) Reference 172 (6.7) Reference
At different site 666 26 (3.9) 4.7 (1.5–14.8) 61 (9.2) 1.9 (1.1–3.3)
HIV status ascertained at ANCa (n = 3 233)
Known HIV-positive before index pregnancy 1637 9 (0.5) Reference 100 (6.1) Reference
Found HIV-positive during index pregnancy 1596 41 (2.6) 3.2 (1.3–8.0) 134 (8.4) 0.8 (0.5–1.6)
ART status and timing of ART initiation
among confirmed HIV-infected
mothers (n = 3 180)
On ART since before index pregnancy 1572 N/A N/A 92 (5.9) Reference
On ART, having started during 1475 N/A N/A 76 (5.2) 0.6 (0.3–1.3)
index pregnancy
On ART, having started postpartum 49 N/A N/A 5 (10.2) 1.4 (0.3–6.5)
Off ART, having started and stopped 34 N/A N/A 7 (20.6) 6.4 (1.5–28.0)
Off ART and never started 50 50 (100) N/A 23 (46.0) 15.4 (7.2–32.9)
ANC: antenatal clinic; aOR: adjusted odds ratio; ART: antiretroviral therapy; CI: confidence interval; HIV: human immunodeficiency virus; N/A: not applicable; NIIM: not
included in model.
a
As reported by mothers 4–26 weeks postpartum.
b
Weighted according to sampling interval and the probabilities of districts, clusters and subjects being selected and adjusted for all other variables in the model.
c
Too few (0) events to be included in the model.
 Programme use and
Table 4. Factors associated with missed infant virological testing MTCT
among infants over 8 weeks of age who had been born to
mothers known to be HIV infected, Malawi, October 2014–May The relationship between MTCT ratios
2016 and the missing of one or more steps in
the cascade of care is illustrated in Fig.
1.
Characteristic Missed infant Among the mothers who missed HIV
Unweighted testinga
denominat diagnosis, the MTCT ratio was 22.0%
Unweigh Weighte
or (66/286; 95% CI: 16.6–28.4). Of the
t- ed, d aORb
3233 confirmed HIV-infected mothers,
no. (%) (95% CI)
Location (n = 1 2613 (74.7%; 95% CI: 64.6–82.7)
465) completed
Rural facility in Central or North regions 344 166 (48.3) 1.3 (0.5–3.3) steps 1–3. The MTCT ratio for these
Urban facility in Central or North regions 402 146 (36.3) 0.8 (0.5–1.5) 2613 mothers was 3.6% (66/2613;
Rural facility in South region 444 251 (56.5) 1.6 (0.9–3.0) 95% CI: 1.8–7.3). Among the 1435
Urban facility in South region 275 112 (40.7) Reference mothers who, when inter viewed,
Mother’s age in years (n = 1 462) had known HIV-exposed infants
≤ 19 87 48 (55.2) 6.9 (1.2–38.9) older than eight weeks, 711 (39.2%;
20–24 272 130 (47.8) 2.7 (1.3–5.6) 95% CI: 32.4–46.4) completed steps
1–4. The MTCT ratio for these 711
25–29 366 174 (47.5) 1.8 (1.1–3.0)
mothers was 5.7% (19/711;
≥ 30 737 322 (43.7) Reference
95% CI: 1.8–16.7).
Parity (n = 1 464)
Among the 50 mothers who missed
1 179 82 (45.8) Reference step 2, MTCT was 7.7% (6/50; 95%
2–3 586 253 (43.2) 1.4 (0.6–3.3) CI: 2.5–21.2). Steps 2 and 3 were both
≥4 699 340 (48.6) 3.3 (1.1–10.1) missed by 23 (0.7%; 95% CI: 0.3–1.6)
ANC uptake (n = 1 465) mothers and their MTCT ratio was
NIIM Yes 1460 674 (46.2) 10.7% (5/23; 95% CI: 3.1–31.3). Just
No 5 1 (20.0) 14 (1.2%; 95% CI: 0.5–3.1) of the 1435
ANC location (n = 1 459) mothers who, when interviewed, had
At study site 1109 505 (45.5) Reference known HIV-exposed infants aged over
At different site 350 168 (48.0) 0.9 (0.6–5.6) eight weeks had reportedly missed steps
HIV status ascertained at ANC (n = 1 465) 2–4 and their MTCT ratio was 11.4%
Known HIV-positive before index pregnancy 724 312 (43.1) Reference (4/14; 95% CI: 3.0–35.2).
Found HIV-positive during index pregnancy 741 363 (49.0) 1.8 (0.6–1.4) The MTCT ratio among mothers
who had missed HIV diagnosis was
ART status and timing of ART initiation
among confirmed HIV-infected mothers significantly higher than that among
(n = 1 435) mothers who had completed steps 1–3
On ART since before index pregnancy 692 297 (42.9) Reference (P < 0.01) or 1–4 (P < 0.01) or
missed step 2 (P = 0.04). None of the
other dif-
On ART, having started during 672 303 (45.1) 0.7 (0.2–2.1) ferences seen between MTCT ratios,
index pregnancy e.g. between mothers who had com-
On ART, having started postpartum 23 8 (34.8) 0.2 (0.1– pleted and missed steps or between
0.8) Off ART, having started and stopped 21 18 (85.7) 7.7 (2.2– mothers who had missed HIV diagnosis
27.0) Off ART and never started 27 23 (85.2) 13.7 and those who had missed steps 2–3 or
(4.2–83.3) Infant nevirapine prophylaxis given to 2–4, reached statistical
known HIV-exposed infants (n = 1 significance.
465)
From birth to an age of 6 weeks 1241 522 (42.1) Reference
For less than 6 weeks 95 49 (51.6) 0.8 (0.4–1.4)
Discussi
Not given or unknown 129 104 (80.6) 2.0 (1.2–3.4) on
ANC: antenatal clinic; aOR: adjusted odds ratio; ART: antiretroviral therapy; CI: confidence interval; We estimated that 12.1% of infants of
HIV: women attending under-5 clinics across
human immunodeficiency virus; NIIM: not included in model.
Malawi were HIV-exposed. This value
a
As reported by mothers at least 8 weeks
postpartum. is higher than an aggregated estimate
b
Weighted according to sampling interval and the probabilities of districts, clusters and subjects (8.1%) based on data collected in ante-
being selected and adjusted for all other variables in the model. natal-care facilities across Malawi,8 but
consistent with the prevalence of HIV
infection reported among women aged
younger than 19 years (aOR: 6.9; 95% to have stopped (aOR: 7.7; 95% CI:
15–49 years (12.1%) as part of the recent
CI: 1.2–38.9) or aged 20–24 (aOR: 2.2–27.0) or never started ART (aOR: 14
2.7;
 HIV impact assessment in Malawi.
95% CI: 1.3–5.6) or 25–29 years (aOR: 13.7; 95% CI: 4.2–83.3) than to be on
The high uptake of PMTCT ser-
1.8; 95% CI: 1.1–3.0) than to be aged at ART and to have given no nevirapine
vices we report aligns with estimates
least 30 years. They were also more prophylaxis to their infants than to 14,15
likely have
produced by the health minstr y.
to have a parity of at least 4 (aOR: 3.3; given such prophylaxis (aOR: 2.0;
The PMTCT uptake was similar across
95% CI: 1.1–10.1) than be primiparous, 95% CI: 1.2–3.4; Table 4).
regions or between rural and urban
sites.
 relatively poor in facilities where
Fig. 1. Ratio of mother-to-child transmission of HIV, as women were asked to initiate ART on
recorded 4–26 weeks postpartum, Malawi, October the same day that they discovered they
2014–May 2016 were HIV- infected.25 For the women
involved, HIV diagnosis during
40 pregnancy and the concept of life-
95% CI long treatment are both
35 challenging.26,27 Further understanding
of the impact of a HIV diagnosis
30 during pregnancy and of the optimal
model of care is required.
25 In our study, around a quarter of
HIV-exposed infants did not receive
the full six-week course of nevirapine
20
prophylaxis and almost half of the
HIV- exposed infants above eight weeks
15
of age had not been tested for HIV-1
DNA. De- layed or missed infant HIV
10
diagnoses, which have previously been
highlighted as key challenges in
5
Malawi,8,28 lead to delayed ART and
place HIV-infected infants at high
0 risk.
If we project our findings to the
Completed Completed Missed Missed steps Missed steps Missed HIV
steps 1–3 steps 1–4 step 2 2 and 3 2–4 diagnosis Malawian population and burden of
Programme utilization HIV, we estimate that, in 2017, about
16 874 Malawian women, i.e. 2.2% of
CI: confidence interval. the 767 000 Malawian women who
gave
Notes: Ratios were recorded for the mother–infant pairs who missed or did not miss some of the birth,29 did not receive antenatal HIV
main
steps along the cascade of care provided by the national programme for the prevention of mother- testing. If we assume a 12.1%
to-child transmission of human immunodeficiency virus. Step 1: ascertainment of HIV status during prevalence of HIV infection among
antenatal care; step 2: uptake of maternal ART; step 3: use of infant nevirapine prophylaxis: step 4: the fertile women,14 we can estimate
HIV testing, before the study, of HIV-exposed infants when more than eight weeks old. The values that 92 807 pregnant Malawian
were weighted according to sampling interval and the probabilities of districts, clusters and subjects
women were HIV- infected, including
being selected.
6589 (7.1%) who missed HIV
diagnosis in pregnancy.
Our results add to the evidence indicat- research is needed to improve our among, young women and to assess the
ing that, within Malawi, the scale-up of understand- ing of the retention of, potential benefits of youth-friendly
the implementation of the Option B+ and outcomes initiatives such as peer-support groups
strategy has provided widely decentral- for pregnant adolescents.
ized and equitable coverage of PMTCT We identified a substantial number
services.8,16 of women who missed HIV diagnosis
The elimination of paediatric HIV during the index pregnancy and these
infections will probably depend on were associated with a relatively high
the full use of PMTCT services.17–19 In MTCT ratio. Some of these women may
South Africa, a third of early infant have had the very high viral loads during
HIV infections were attributed to the acute HIV infection that are strongly a
miss- ing of one or more steps in the s s o ci ate d w it h MTCT. 23 We n
PMTCT cascade of care and, as eed more research on the identification
observed in our study, the MTCT ratio and engagement of this high-risk
increased as more steps were missed.10 subgroup.
We found that young women and The impact of service integration
adolescent girls were particularly prone and timing of HIV diagnosis on uptake
to missing antenatal HIV testing. Data of ART was demonstrated by the fact
previously collected in Kenya, 20 Ma- that HIV-infected women were rela-
lawi,21 and South Africa 10,22 indicated tively unlikely to be on ART if they had
that adolescents were especially likely to received antenatal care at a different
miss parts of the PMTCT cascade.10,20– facility to the one hosting the under-5
22
clinic they attended and if they had been
In our study, adolescents found HIV- found HIV-infected during, rather than
positive usually started ART and before, the index pregnancy. In earlier
infant nevirapine prophylaxis, but often studies in Malawi, a facility’s model of
missed infant HIV testing. Further care was found to influence mothers’ en-
gagement in the PMTCT cascade24 and Among the women who knew that
retention on ART has been found to be they were HIV-positive when
pregnant, an estimated 1035 (1.2%)
will not have started ART, 6639
(7.7%) of their infants will not have
received any nevirapine prophylaxis
and 40 350 (46.8%) of their infants
will not have been tested for HIV-1
DNA after they were aged six weeks.
An estimated 69 327 (74.7%) of the
mothers will have received antena-
tal HIV testing and, if found
infected, started maternal ART and
given ne- virapine prophylaxis to
their infants, of whom an estimated
2496 (3.6%) will have been infected.
Among the 6589 mothers who
missed HIV diagnosis,
1450 (22.0%) will have transmitted
HIV to their infants. Based on our
findings and these projections, the
focus of future targeted interventions
needs to be on reducing the numbers
of missed HIV diagnoses in
pregnancy and increasing the
proportion of HIV-exposed infants
tested for HIV-1 DNA.
T h e l arge s ampl e s iz e an d
t h e study’s national
representativeness are strengths of
this study. However, by screening at
under-5 clinics, we may
have biased our sample towards analyses were small, the reported con- development of interventions to
women who usually take up health fidence inter vals are wide and need acceler- ate progress towards the
care. We made no attempt to recruit to be interpreted with care. The same elimination of MTCT from Malawi. ■
women who do not attend clinics and small numbers limited the statistical
those with infants who died younger significance of the between-subgroup Funding: This study was supported by
than four weeks. As a result, our differences seen in MTCT ratios. the President’s Emergency Plan for
estimates of the use of the PMTCT In c on clu s i on, t h e s c a l e- AIDS Relief through the United States
programme may be too high. We up of Option B+ ser vices appears Centers for Disease Control and
also acknowledge the potential for to have provided universal access to Prevention and under the terms of a co-
responder bias in terms of reported PMTCT care. The findings that young operative agree- ment (U2GGH000721-
uptake of services, although maternal age, high parity and use of 02).
interviewers checked mothers’ health services at different clinics were
booklets to confirm responses. Lastly, associated with incomplete care should Competing interests: None
as some of the numbers in the help to guide the declared.
subgroup

‫صخلم‬
‫لفطل لىإ مالاأ نم يشربل ةعانلما زوع سويرف لقاتنا نم ةياقاول‬: ‫يولماب تاعاطقل ةددعتم ةسارد‬
‫ لفطل‬4.7% ‫و ايلجمإ‬%7.7 ‫جلعال اوتوف نيذل جاوزلــل‬ ‫نم ةياقولل هجئاتنو يوللما جمانبرل مادختسا مييقت ضرغل‬
‫ةيرقهقل تاسويرفل تاداضم مادختساب جلعاــو ةيــرقهقل‬، ‫و‬10.7% ‫نتوف تيللا‬ ‫) لفطل لىإ ملا نم‬HIV( ‫يشربل ةعاانلما زوع سويرف لقتنا‬
‫تاســويرفل تاداضــم مادختســاب جلعال نــم لك تاداضــم مادختســاب جلعال‬ .)MTCT(
‫لفطلا ةياقو‬، ‫و‬%11.4 ‫نتوف نلم‬ ‫ لياولــح تاعاــاطقل ددعاتــم ليلتــح انيرجــأ ةقايييرطل تاهمللا‬33744 ‫نم اجوز‬
.‫لفطلا رابتخاو لفطلا ةياقو جلعاو ةيرقهقل تاسويرفل رابتخا تيوفتل ةضرع‬ ‫عاضــرلو تاهملا ةعاانلمــا زوع ســويرفب‬، ‫ةحجرلما بسنل هللخا نم انردقــو‬
‫ نم رغصلا ءاسنل نوكت‬19 ‫رثكأ اماع‬ ‫و‬/‫ةباصلا نع فشكل رابتخل نعضــخ تيلل مادختســاب جلعال ينقلــت تيلل وأ‬
4.9‫ ؛‬:aOR ‫ةلدعالما ةيلماتحلا بسن) يشربل ةعاانلما زوع سويرف لفطلا ةياقو‬ ‫ةيــرقهقل تاســويرفل‬، ‫لملحــا ةت ــرف ف ــي يشــربل اوقلــت نيــذل لفطلا كلــذكو‬
1.2–38.9( ‫ اهرادقم ةيحجرأ ةبسنب نم‬95%: 2.3–10.6( ‫جلعاو‬ ‫و ينبــايرفينلب ةيــاقول جلع فــي‬/‫تاداضم اذه نــع فشــكل رابتخل اوعاضــخ وأ‬
6.9‫ ؛‬95% ‫ةيحجرلا ةبسنل رادقمك‬: :aOR( ‫مادختساب جلعال نأدبي لم‬ ‫ســويرفل لــم يتل ةيعــرفل تائفلــل‬. ‫لفطل لىإ ملا نم ىودعال لقتنا بسن باسـحب انمــق‬
‫انــس بــركلا ءاســنلا ةياقو جلع تيوفتــل ةضــرع رثكــأ ةيــرقهقل‬. ‫تيلل ءاسنل نــوكت‬ ‫ ينب مايف ةترفل‬4 ‫ لىإ‬26 ‫ةدلول دعاب اعاوبسأ‬
‫تاسويرفل تاداضم‬ .‫لقلا لىع ةدحاو ةوطخ تتوف وأ ةعابرلا تاوطلخــا تــوفت لملحا ةت ــرف‬
-7.2 :15.4‫ ؛‬95% ‫ ةيحجرلا ةبســنل رادقمك‬:aOR( ‫لفطلا ةبســنل‬ ‫فــي رابتخللا ردقلما باعايتسلا ةبســن تنــاك جئيياتنل تاداضم مادختســاب جلعال‬
‫ ؛‬95% ‫رادقمك‬aOR: 13.7( ‫) لفطلا رابتخاو‬32.9 %96.3‫ لفطلا ةيــاقو جلع ةبســنو ؛‬97.8%‫ةبســن تنــاك ينــح فــي ؛‬
.‫ةيحجــرلا نــم‬: 4.2–83.3( ‫هيــف نــأدب تيلل ءاســنل نــم‬ %‫ةيــرقهقل تاســويرفل لفطللا يشــربل ةعاانلمــا زوع ســويرف رابتخــا ةبســنو ؛‬
‫ةياقولل يوللما جمانبرل ءاسنل مظعم مدختست جاتنتسلاأ سويرفل لقتنــا رطامــخ‬ 53.2%. ‫ لىإ ملا نم سويرفل لقتنل ةردقلما بسنل تناك‬92.3
‫نبلا لىإ ملا نم سويرفل لقتنا‬. ‫دادزت‬
.‫جمانبرل تاوطخ نم ةوطخ ةيأ تيوفت مت اذإ لفطل لىإ ملا نم‬

摘要
预防艾滋病毒母婴传播 ：马拉维共和国的一项横断面研究
目的 评估马拉维共和国人类免疫缺陷病毒（HIV，又 治疗的为 10.7%，遗漏孕产妇抗逆转录病毒治疗、婴
称艾滋病毒）母婴传播 (MTCT) 预防计划的使用和结 儿预防治疗和婴儿测试的为 11.4%。相较于年长女性，
果。 19 岁以下的女性更容易遗漏艾滋病毒检测（调整后比
方法 在 33 744 组母婴的横断面分析中，我们估算了接 值，aOR ：4.9 ；95% 置 信 区 间，CI ：2.3–10.6）和 婴
受过产前艾滋病毒检测和 / 或孕产妇抗逆转录病毒治 儿预防治 疗（aOR ：6.9 ；95% CI ：1.2–38.9）。从未
疗的母亲以及接受过奈韦拉平预防和 / 或艾滋病毒检 接
测的婴儿的权重比例。我们计算了在产后 4 至 26 周 受过抗逆转录病毒治疗的女性比接受过抗逆转录病毒
四个步骤无一遗漏或至少遗漏一个的亚群体的母婴传 治疗的女性更有可能遗漏婴儿预防治疗（aOR ：15.4 ；
播 (MTCT) 的比例。 95% CI ：7.2-32.9）和 婴 儿 检 测（aOR ：13.7 ；95% CI
结果 产前检测的估计值为 97.8% ；孕产妇抗逆转录病 ：
毒治疗为 96.3% ；婴儿预防治疗为 92.3% ；婴儿艾 4.2–83.3）。
滋 结论 大多数女性参与了预防人类免疫缺陷病毒母婴传
病毒检测为 53.2%。母婴传播 (MTCT) 的总体估计比 播 (MTCT) 的马拉维预防计划。如果遗漏了该预防计
例 为 4.7%，遗漏孕产妇抗逆转录病毒治疗的母婴组 划的任何主要步骤，母婴传播 (MTCT) 的风险就会增
为 7.7%，遗漏孕产妇抗逆转录病毒治疗和婴儿预防 加。
Résumé
Prévention de la transmission mère-enfant du VIH: étude transversale au Malawi
Objectif Évaluer l’utilisation et les résultats du programme manqué le traitement antirétroviral maternel, à 10,7% dans le cas
malawite pour la prévention de la transmission mère-enfant (TME) des paires qui avaient manqué le traitement antirétroviral maternel
du virus de l’immunodéficience humaine (VIH). et le traitement prophylactique pour nourrisson, et à 11,4% dans
Méthodes Dans le cadre d’une analyse transversale de 33 744 le cas des paires qui avaient manqué le traitement antirétroviral
paires mère-nourrisson, nous avons estimé la part pondérée maternel, le traitement prophylactique pour nourrisson et le
des mères qui avaient bénéficié d’un dépistage prénatal du VIH dépistage du VIH chez le nourrisson. Les femmes âgées de moins
et/ou d’un traitement antirétroviral maternel et la part pondérée de 19 ans étaient davantage susceptibles d’avoir manqué le
des nourrissons qui avaient bénéficié d’un traitement prophylactique dépistage du VIH (rapport des cotes ajusté, RCa: 4,9; intervalle de
par la névirapine et/ou d’un dépistage du VIH. Nous avons calculé confiance, IC, à 95%: 2,3-10,6) et le traitement prophylactique pour
les rapports de TME à 4-26 semaines post-partum pour des sous- nourrisson (RCa: 6,9; IC à 95%: 1,2-38,9) que les femmes plus âgées.
groupes qui n’avaient manqué aucune de ces quatre étapes ou qui Les femmes qui n’avaient jamais commencé de traitement
en avaient manqué au moins une. antirétroviral maternel étaient davantage susceptibles d’avoir
Résultats Le recours à un dépistage prénatal a été estimé à 97,8%, manqué le traitement prophylactique pour nourrisson (RCa:
le recours à un traitement antirétroviral maternel à 96,3%, le recours 15,4; IC à 95%: 7,2-32,9) et le dépistage du VIH chez le nourrisson
à un traitement prophylactique pour nourrisson à 92,3% et le (RCa:
recours à un dépistage du VIH chez le nourrisson à 53,2%. Les 13,7; IC à 95%: 4,2-83,3) que les autres femmes.
rapports de TME ont été estimés à 4,7% en tout et à 7,7% dans le Conclusion Une majorité de femmes a eu recours au programme
cas des paires qui avaient malawite pour la prévention de la TME. Le risque de TME
augmentait lorsque l’une des principales étapes du programme
n’était pas suivie.

Резюме
Профилактика передачи ВИЧ от матери ребенку: кросс-секционное исследование в Малави
Цель Оценить использование и результаты мать не получала антиретровирусную терапию, 10,7 %
малавийской программы профилактики передачи для пар, в которых не проводились ни
вируса иммунодефицита человека (ВИЧ) от матери антиретровирусная терапия матери, ни
ребенку (ПМР). профилактика младенца, и 11,4 % для пар, в
Методы В ходе кросс-секционного анализа 33 744 которых не проводились антиретровирусная терапия
пар мать- младенец авторы рассчитали взвешенные матери, профилактика и тестирование для младенца.
пропорции матерей, которые прошли антенатальное У женщин моложе 19 лет чаще отсу тствовали
тестирование на ВИЧ и (или) получали тестирование на ВИЧ (скорректированное
антиретровирусную терапию, и младенцев, которые отношение шансов, сОШ: 4,9; 95%-ный доверительный
получали невирапин в качестве профилактики и интервал, ДИ: 2,3–10,6) и профилактика для младенца
(или) прошли тестирование на ВИЧ. Авторы (сОШ: 6,9; 95%-ный ДИ:
рассчитали долю ПМР на 4–26-й неделе после 1,2–38,9) по сравнению с женщинами старше 19 лет. У
родов для подгрупп, которые не пропустили ни младенцев, чьи матери никогда не получали
одного этапа программы или у которых отсутствовал антиретровирусную терапию, чаще всего
как минимум один из этих четырех этапов. отсутствовала профилактика ПМР (сОШ: 15,4; 95%-
Результаты Расчетный показатель использования ный ДИ: 7,2–32,9) и тестирование на ВИЧ (сОШ:
антенатального тестирования составил 97,8 %, в 13,7; 95%-ный ДИ: 4,2–83,3) по сравнению с
то время как показатель использования младенцами, чьи матери получали такую терапию.
антиретровирусной терапии у матерей составил Вывод Большинство женщин использовали
96,3 %, показатель детской профилактики — 92,3 % и малавийскую программу профилактики ПМР. Риск
показатель тестирования на ВИЧ среди ПМР повышался, если они пропускали какой-либо из
новорожденных — 53,2 %. Расчетные показатели ПМР основных этапов программы.
составили 4,7 % в целом и 7,7 % для пар, в которых

Resumen
Prevención de transmisión del VIH de madre a hijo: un estudio transversal en Malawi
Objetivo Estimar el uso y los resultados del programa malawi VIH en recién nacidos fue del 53,2%. Los coeficientes estimados de
para la prevención de la transmisión de madre a hijo (MTCT) del MTCT fueron del
virus de inmunodeficiencia humana (VIH) 4,7% en general y del 7,7% para los pares que habían faltado a
Métodos En un análisis transversal a 33 744 pares de madres y terapia
recién nacidos, estimamos las proporciones ponderadas de madres
que han realizado el test de VIH prenatal y/o terapia antirretroviral
maternal y los recién nacidos que han recibido profilaxis con nevirapina
y/o el test de VIH. Calculamos los coeficientes de MTCT en las
semanas 4 a 26 de postparto para subgrupos que no habían faltado
a ninguno o al menos a uno de esos cuatro pasos.
Resultados La aceptación estimada del test prenatal fue del
97,8% mientras que la de la terapia antirretroviral maternal fue del
96,3%; la de profilaxis en recién nacidos fue del 92,3% y la del test de
antirretroviral maternal, del 10,7% para los que faltaron a ambas,
la terapia antirretroviral maternal y la profilaxis en recién nacidos; y
del
11,4% para los que faltaron a terapia antirretroviral maternal, a la
profilaxis en recién nacidos y al test de recién nacidos. Las mujeres
menores de
19 años presentaban mayores probabilidades de haber faltado al test
de VIH. (Coeficiente de posibilidades ajustado, CPa: 4,9; intervalo
de confianza, IC del 95%: 2,3-10,6) profilaxis en recién nacidos (CPa:
6,9; IC del 95%: 1,2-38,9) que en mujeres mayores. Las mujeres que
nunca empezaron la terapia antirretroviral maternal presentaban
mayores probabilidades de haber faltado a la profilaxis de recién
nacidos (CPa:
15,4; IC del 95%: 7,2-32,9) y al test de recién nacidos (CPa: 13,7; IC del
95%: 4,2-83,3) que las mujeres que habían empezado.
Conclusión La mayoría de las mujeres usaron el programa malawi
para la prevención de MTCT. El riesgo de MTCT aumenta si falta
alguno de los pasos principales del programa.
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