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Prevention of mother-to-child transmission: program changes and the effect on uptake of the HIVNET 012 regimen in Malawi

Moses, Agnesa; Zimba, Chifundoa; Kamanga, Esmiea; Nkhoma, Jacquelinea; Maida, Aliceb; Martinson, Francisa; Mofolo, Innocenta; Joaki, Georgea,✠; Muita, Janec; Spensley, Allisond; Hoffman, Irvinge; van der Horst, Charles Mefor the UNC Project Call to Action Program

doi: 10.1097/QAD.0b013e3282f163b5
Clinical Science

Objective(s): To evaluate uptake of HIV testing in a prevention of mother-to-child transmission program (PMTCT) in Lilongwe, Malawi from April 2002 until December 2006.

Design: Retrospective analysis of monthly reports from the beginning of the program.

Setting: Four antenatal clinics in Lilongwe, Malawi.

Methods: Pregnant women attending urban antenatal clinics in Lilongwe were invited to participate in a PMTCT program. Women were given information and education on antenatal care and PMTCT in groups of 8 to 12. Written informed consent for HIV testing was obtained privately. Women returned for the test result 1–2 weeks later. Mothers and infants were given the HIVNET 012 regimen. Rapid HIV testing and ‘opt-out’ testing were instituted in July 2003 and April 2005, respectively. Infants were tested using HIV DNA PCR and, if HIV positive, a CD4 cell percentage was obtained and the infants were referred for further medical evaluation and treatment.

Results: The program reached 20 000 pregnant women in the first 12 months. Acceptance of HIV testing increased from 45% to 73% (P < 0.001) when rapid, same day testing was instituted. When opt-out testing was instituted, 99% of the mothers agreed to testing. Of the infants tested, 15.5% were HIV positive.

Conclusion: Rapid HIV testing using the opt-out method increased acceptance of HIV testing in the PMTCT program to 99% in urban Lilongwe, Malawi.

From the aUNC Project, USA

bMalawi Ministry of Health and Population, USA

cUNICEF, Lilongwe, Malawi, USA

dElizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA

eUniversity of North Carolina, Chapel Hill, North Carolina, USA.


Received 22 February, 2007

Revised 14 August, 2007

Accepted 20 August, 2007

Correspondence to Dr C. van der Horst, University of North Carolina, CB 3368, Chapel Hill, North Carolina, 27599-3368, USA. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.