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The World is Watching: Malawi’s First Step towards an HIV-free Generation

Two years ago, Dr. Megan Landes, a research scientist with Dignitas International and an emergency physician at the University Health Network in Toronto, sought to answer a vitally important question, one whose answer could affect the futures of hundreds of thousands of born and unborn babies around the world.

The question: How effective are current efforts to stop the transmission of HIV from mother to baby?

After analyzing data gathered from across Malawi by Dignitas International, the reality Dr. Landes uncovered was, as she puts it, “not encouraging.” Despite that Malawi’s government was offering pregnant women free HIV testing and treatment – using the same methods employed across much of Africa – “transmission of the virus and mortality was still quite high,” explains Landes.

That disheartening conclusion is leading to a hopeful tomorrow. Dignitas is currently working alongside Malawi’s government to implement a new mother-to-child transmission program, the most rigorous of its kind in Africa.

Now, Dr. Landes and her team are studying the outcomes of this program, known as Option B Plus, in hopes of preventing HIV in babies and improving the health of mothers at the same time.

Under Malawi’s previous treatment program, which is still used in much of Africa, mothers who tested positive for HIV faced a complicated journey – they were required to check in at health centres and take medication only at specific windows during pregnancy, delivery and breastfeeding. The women were then required to bring their baby back for follow-up after birth. In other words, the burden was on the women themselves to seek the health care they needed.

“A lot of things can go wrong. Communication can break down. Perhaps services aren’t there on a given day,” explains Dr. Landes.

More than 80% of the women who tested positive for HIV in antenatal care clinics “dropped off somewhere along the process,” as Dr. Landes explains, with only two-thirds taking nevarapine – a drug that prevents transmission – at birth.

In a country that has limited resources to scientifically monitor and evaluate the quality of many of its health programs, Dignitas International’s comprehensive research aims to investigate what’s working – and what’s not – so that families and communities receive the best health care possible.

What is particularly innovative about the research is that it didn’t just look at the health of babies, but also that of their mothers. The study found that babies whose mothers were in poor health or had died fared much worse than babies whose mothers were healthy. “This study showed a strong link between maternal health and child outcomes. Now this isn’t rocket science and has been shown in other studies, but we absolutely need this evidence to change health policy and practice,” says Dr. Landes.

Informed by this research, Malawi’s new transmission prevention program – known as Option B Plus – now automatically starts all women who test positive for HIV on daily, antiretroviral medication. Because women take the same medication every day and can obtain it from health centres in their communities, the chances of transmission due to a missed health care appointment are greatly diminished.

Already, Dr. Landes says they’re seeing an increase in pregnant women taking antiretroviral drugs. Now, Dignitas is analyzing the data to see if fewer babies are born positive under the new prevention program. If Option B Plus is as successful as many think it will be, Dignitas International will encourage its adoption across Africa.

“Dignitas is really going beyond in terms of shaping national policy in Malawi and moving to influence international policy,” says Dr. Landes. “The world is watching Malawi right now.”

You can give the gift of life by supporting Dignitas International’s Prevention of HIV Mother-to-Chld Transmission efforts. Please donate today.

Dignitas InternationalThe World is Watching: Malawi’s First Step towards an HIV-free Generation