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Sustained availability of treatments and reducing drop out rates are key to tackling HIV in mothers and their infants in Malawi, but COVID-19 is making it harder

By Dr Jeanette Reece,

At the main public hospital in Blantyre, Malawi the facilities were basic. The health system was stretched with malaria, tuberculosis and HIV/AIDS cases, with some patients sleeping on the floor due to bed shortages.
It was 2018 and I was there with my colleague senior biostatistician Dr Elasma Milanzi to investigate the high rates at which pregnant HIV-infected mothers and breastfeeding mothers and their infants were dropping out of HIV integrated care providing antiretroviral therapy.

This is a deadly serious issue because without antiretroviral therapy, there is a 20-45 per cent risk of an HIV positive mother passing the infection on to their unborn child, and a 16 per cent chance of passing it on to their infant through breastfeeding.

Adherence to sustained antiretroviral therapy can substantially reduce HIV viral loads, significantly reducing the risk of mother-to-child transmission.

Finding an ‘early warning’ for preeclampsiaRead moreIn fact, antiretrovirals can reduce the risk of sexual transmission to near zero.
In collaboration with University of Malawi public health researcher Professor Victor Mwapasa, we were able to analyse data from around 1000 HIV-positive mothers and their HIV-exposed infants from southern Malawi where the problem is most acute and HIV prevalence is around 17 per cent.

We found that despite mothers and infants having access to HIV-related treatments, once mothers received their infant’s HIV test result, that infant was 70 per cent more likely not to attend care with their mother than infants that had no test results.

This means these infants could no longer be tested for HIV infection, which still had the potential to occur through continued breastfeeding (whether through breast milk or abrasions and similar on or near the nipples).

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