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

AIDS. 2008 Jan 2;22(1):83-7. doi: 10.1097/QAD.0b013e3282f163b5.


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.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Counseling
  • Disease Notification
  • Female
  • HIV Infections / prevention & control*
  • HIV Infections / transmission*
  • HIV-1
  • Humans
  • Infant
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Malawi / epidemiology
  • Patient Acceptance of Health Care / statistics & numerical data
  • Pregnancy
  • Pregnancy Complications, Infectious / prevention & control*
  • Prenatal Care
  • Retrospective Studies
  • Urban Population