Malawi government to start new ART/PMTCT guidelines in July

The Ministry of Health will start implementing the new ART and
Prevention of Mother to Child Transmission (PMTCT) guidelines which
were recommended in 2010 by the World Health Organization (WHO) inresource limited countries, Deputy Director for HIV and AIDS in the
ministry Austin Nthambala has disclosed
Speaking to journalists in Lilongwe on Tuesday, Nthambala said the
recommendations were based on current research evidence and aim at increasing access to quality ART and PMTCT services.

Among others, WHO recommended earlier initiation of ART to slow disease progression, increase survival and reduce HIV transmission, phasing out of stavudine (d4T) based regimens to avoid disfiguring,

unpleasant and potentially life threatening toxicity and use more efficacious PMTCT regimes, starting at 14 weeks gestation and continuing through labour and breast feeding to further reduce transmission and improve maternal and child health outcomes.

Nthambala said the new drug combinations create a potential for virtual elimination of mother to child transmission and also has lesser side effects than Triomune but with the same effectiveness.

He also disclosed that the Malawi government has adopted a phased approach to provide the new ART.

“Phase one will start from July 2011 where all HIV infected pregnant and breastfeeding women will be offered life-long ART regardless of the CD4 count and infants up to six weeks old born to HIV infected
mothers will be provided with nevirapine to prevent HIV infection.

“All children under 15 years of age starting ARVs will be provided with new standard first regiment that comprises zidovuline, lamivudine and nevirapine, children with confirmed HIV infection under the age of two years will be provided with life-long ART regardless of a CD4 count,” said Nthambala.

The first phase will also see a fixed dose combination of tenofovir, lamivudine and efavirenz which will be provided to all HIV positive pregnant and breastfeeding women, all patients starting on TB treatment and all ART clients with confirmed abnormal fat distribution.

Nthambala said depending on availability of resources, phase two will start in July 2012 which will cover the early initiation of ART to all new clients with CD4 count below 350 cells per cubic millimeter, change of drug regimen from Triomune to the fixed dose combination of tenofovir, lamivudine and efaavirenz to all existing ART clients aged from 15 years and scale up of routine viral load monitoring for all patients on ART.

On the implications of the adopting these recommendations, he said PMTCT and ART programs have been integrated to advance one agenda which will see many people that will be put on the treatment than before.

“There is also a potential of virtual elimination of mother to child transmission of HIV and new drugs have to be procured and provided to those that are eligible for ART,” he said

He however, cautioned all people who are on current treatment regime not to stop as there are still effective.

Since 2003 when the government started providing ARVs, the number of recipients has increased with 345 598 patients ever initiated on treatment, 250 987 patients were alive and on ART by 2010 representing
73 percent.

Currently, 91 percent of all ART clients are on first line treatment combination of three drugs called Triomune with the remaining few on second line and others on non standard regimen, all HIV positive pregnant women are provided with a single dose ARVs for prevention of mother to child transmission taken at the onset of labour while infants are provided with single dose nevirapine within the first week of life.

The treatment monitoring exercise routinely conducted by the Ministry of Health show that only two percent of all people on AR had documented side effects while others may experience mild effects.