One pill a day to combat HIV

With a new treatment strategy for preventing mother-to-child transmission of HIV in place, there is hope that the next generation of children in Malawi may be born HIV free.

Earlier this year, Lexina Lungu tested HIV-positive when she went to an antenatal clinic for a routine check-up on her pregnancy with her second child.

“It was very painful, very painful indeed,” she recalls. “I didn’t expect to test positive. I rushed home to tell my husband Frank, who immediately returned to have an HIV test.” He also tested positive.

The Lungus’ story is not uncommon in Malawi. One in every 10 people have been found to be HIV-positive. What has changed, though, is access to the treatment needed to protect children such as Lungu’s baby from the risk of infection during pregnancy.

Option B+
In 2011, the government of Malawi developed a new treatment strategy to prevent the next generation of children born to HIV-positive mothers from being infected.

The ministry of health, in collaboration with the United Nations Children’s Fund (Unicef) and other partners, came up with a multi-pronged approach, now known as Option B+.

This treatment option is available for free to expectant mothers in Malawi and includes a simple “one pill daily” treatment, easier for health workers to prescribe and for pregnant mothers to follow.

The strategy is proving remarkably effective.

Clinical officer at the Kasungu district hospital Elton Chavura explains: “If we place 100 women on Option B+, then by the time the children are two years old, we expect 95 of those children to be HIV free.”

Instead of managing several pills each day, mothers now take just one pill. This single pill combines three antiretrovirals.

And, while old approaches called for a special CD4 test to show whether a mother living with the virus needed treatment for her own health, the new approach starts all pregnant women on antiretrovirals right away, with a positive HIV test result alone.

Senior advisor for HIV and Aids at The Global Fund Dr Ade Fakoya explains: “If you look at the countries where there is the biggest burden for prevention-of-mother-to-child-transmission services, there are 22 countries that account for 90% of the burden. And 20 of them are low-income countries. It costs about U$1-billion a year to maintain those services, and some countries such as Malawi need that additional financial support so that they can deliver these services.”

Happy proof
For Lungu, the proof of Option B+ was evident when her daughter, Chriselda, was born. When she was 6 weeks old, Lungu took Chriselda back to the clinic for her first HIV test. She was free of the virus.

There are more tests to come, and Lungu must continue to take her one pill a day faithfully to protect her own health and the health of her baby. But, for now, this family remains protected by the lifelong Option B+ treatment.

Life-long ART

In 2011, the government of Malawi pioneered offering lifelong simplified treatment for all pregnant and breastfeeding women (previously known as Option B+), using a provider-initiated (not mandatory) “test and treat approach” regardless of CD4 count or any other pre-conditions.

Children under five years are also prioritised in this way, without pre-conditions.

For pregnant women living with HIV, simplified treatment consisting of a single fixed-dose drug combination pill taken once per day, was made widely available. After a year, the number of pregnant and breastfeeding women on antiretroviral treatment (ART) and living with HIV had increased from 1 257 in the second quarter of 2011 to 10 663 in the third quarter of 2013. By June this year, 13 of the 22 Global Plan priority countries had adopted the same policy of offering lifelong ART for all pregnant and breast-feeding women living with HIV.

Lesotho and Uganda recently joined Malawi in implementing this approach.

This article forms part of a supplement paid for by Unicef. Contents and photographs were supplied and signed off by Unicef