Abstract
BackgroundIn 2011, Malawi initiated an ambitious program for the prevention of maternal to child transmission (PMTCT) of HIV, called 'Option B+,’ which employs a universal test and life-long treatment strategy for all pregnant women. Priority setting should take place in defining a national research agenda for evaluating Option B + rollout in Malawi.MethodsIn April 2011, a three-day workshop took place for all major stakeholders in PMTCT aiming to provide an update on current PMTCT operational research in Malawi, find consensus on key questions not yet being addressed, identify opportunities for collaboration, and develop multi-partner research proposals.ResultsOverall, 24 participants attended the workshop including representatives from the Ministry of Health, the National AIDS Commission and 12 multilateral, non-governmental organizations and academic partners.Three interrelated clusters emerged as priorities for research: i) pregnancy intentions and family planning needs; ii) evaluation of models of care; and iii) determinants of uptake, adherence, and retention of women for Option B+. In addition, two cross-cutting themes arose: partner involvement in PMTCT services and cost-effectiveness as a guide to priority setting.Within each cluster a coordinator was designated and a proposed plan for research and potential collaborators were discussed. The results of the workshop were presented to the national technical working groups and the National AIDS Commission. Several large-scale, collaborative proposals have been developed and funded to address the research areas defined.ConclusionsOption B + represents a significant change in PMTCT policy in Malawi and the process for evaluation of the Malawi PMTCT strategy is outlined. This workshop contributed to defining and coordinating the national agenda for research priorities.
Highlights
In 2011, Malawi initiated an ambitious program for the prevention of maternal to child transmission (PMTCT) of HIV, called ‘Option B+,’ which employs a universal test and life-long treatment strategy for all pregnant women
Among the attendees were the Ministry of Health (MoH), the National AIDS Commission, six multilateral and NGO implementing partners involved in program support and evaluation (i.e., Médecins Sans FrontièresBelgium, Management Sciences for Health, Dignitas International, Elizabeth Glaser Pediatric AIDS Foundation, U.S Centers for Disease Control and Prevention, United Nations Programme on HIV/AIDS (UNAIDS)), and five primarily academic and research based institutions (University of North Carolina-Chapel Hill Malawi Project, Medical Research Council Clinical Trials Unit-UK, College of Medicine, DREAM Clinic, Malawi Liverpool Wellcome Trust/College of Medicine, International Union Against TB and Lung Disease)
Option B + is an ambitious PMTCT policy adopted by the MoH in Malawi and aimed at dramatically reducing the impact of HIV on maternal and child health outcomes
Summary
In 2011, Malawi initiated an ambitious program for the prevention of maternal to child transmission (PMTCT) of HIV, called ‘Option B+,’ which employs a universal test and life-long treatment strategy for all pregnant women. In 2011, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that 330,000 new HIV infections occurred through vertical transmission [1]. In 2010, in light of evidence questioning the effectiveness of the current PMTCT cascade of services (from HIV testing, treatment, delivery, and breastfeed recommendations to early infant diagnosis), along with the changing WHO Guidelines for PMTCT, the Malawi Ministry of Health (MoH) decided to embark on a universal test and treat strategy for all pregnant women, called “Option B+” [3]. The overall aim of the strategy is to improve uptake and retention of HIV-infected women and infants within PMTCT by streamlining treatment, as all pregnant and lactating women are offered lifelong ART regardless of CD4 count or WHO staging
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