Preventing Mother to Child Transmission of HIV in Mwandi, Zambia- A Success

Welcome to this installment of the AIDS Pandemic, a podcast hosted
by Dave Wessner of the Department of Biology at Davidson College. I
am Sarah Bertram.

This past summer, I traveled to Mwandi, Zambia through a Davidson
biology and pre-medical program. Mwandi is a predominantly Lozi
village of about 7,000 people and the catchment area totals about
25,000 people. We spent 5 weeks in Africa, 3 of which were spent
working in the Mwandi Mission Hospital, the Mwandi AIDS clinic, the
Orphans and Vulnerable Children’s center, and the Mother and Child
Health Center. We all went with a research topic to study that was
based on some aspect of Mwandian life. I looked at Mwandi’s
Prevention of Mother to Child Transmission of HIV, otherwise known
as the PMTCT program, and its effectiveness over the past three
years. Here, I will talk about my findings.

About out of every five pregnant women in Zambia is infected with
HIV and without any prevention or treatment interventions, more
than 300,000 babies would contract HIV from their mothers each
year. Starting in 1999, many Zambian mission and government
hospitals started PMTCT programs. The Mwandi PMTCT program was
launched in 2005 by an American Pediatrician in conjunction with
the Mwandi missionary who was going to serve as the leader of the
program. The procedure for PMTCT at the Mwandi Mission Hospital is
as follows: 1) discuss the PMTCT program and HIV/AIDS information
during group antenatal care visits, 2) offer private pre-test
counseling, 3) test the mother for HIV and CD4 counts and give her
the results, and 4) offer post-test counseling and discuss further
treatment and a re-test in three months. According to the hospital
staff in Mwandi, HIV testing of any pregnant mother is required by
law in Zambia.

If a woman tests positive, she is evaluated at the Pastoral Care
Center for AIDS treatment. If she is considered a WHO stage IV or
has multiple symptoms for WHO stage III, HAART treatment is usually
started unless the woman chooses to undergo short-course treatment
instead. Many of the HIV positive mothers choose to undergo HAART
treatment because of its documented increased ability to treat
HIV/AIDS symptoms and to lower the viral load by decreasing viral
replication. The Mwandi hospital staff is good about giving options
to the positive mothers and explaining each option and its risks
and benefits. Due to the staff’s willingness to counsel and inform
the HIV positive pregnant mothers of treatment options, a majority
of these women decide to take part in a course of HIV/AIDS
treatment in order to help themselves and to prevent the
transmission of HIV to their babies.

Although record-keeping is sparse and sometimes hard to find and
evaluate, some records for the PMTCT program proved helpful in
evaluating the program’s success over the years. From March of 2005
to September of 2007 (before HIV testing was mandatory), 1,205
women attended an antenatal care appointment to sign up for the
PMTCT program and of these 1,205 women, only 35 women or about 3%
refused the HIV test. Of the 1,170 women who agreed to be tested,
24.4% tested positive for HIV. This statistic is quite high, but
reflects the belief that about 1/3 to ¼ of Mwandi’s population is
infected with HIV. Because the PMTCT program was in place, the HIV
positive women were able to learn their status, get treatment, and
prevent (for the most part) the transmission of HIV to their babies
during pregnancy, delivery, and breastfeeding.

Mwandi’s PMTCT program has changed drug regimens in order to stay
current with the most effective treatments. Originally, the program
was based on a single dose of nevirapine given to the mother during
delivery and to the baby right after birth. In April of 2006, the
PMTCT program switched to a dual therapy involving both nevirapine
and AZT for both mothers and babies. Starting in November of 2007,
Mwandi updated its treatment regimen to the most current and
effective triple therapy drug treatment. This drug therapy involves
a mixture of AZT, 3TC, and NVP for the mother and baby. This new
therapy has proven to be very effective and the PMTCT program
workers approximate that transmission from mother-to-child rates
have decreased to less than 10% and possibly even as low as 6% or
7%.

Possibly the most enticing aspect of the PMTCT program for pregnant
women is the free formula feeding program provided to HIV-negative
babies of HIV-positive mothers. Breastfeeding is the most common
type of mother-to-child HIV transmission, so by providing free
formula for those babies who test negative (after 6 weeks of age),
the worry of transmission by breastfeeding can be alleviated.
Currently there are over 100 babies receiving infant formula and
most, but not all, are HIV-negative babies of HIV-positive mothers
who participated in the PMTCT program. The program has never
resulted in a case of child dysentery, a common negative outcome of
formula feeding programs, which is often a result of incorrectly
boiled water used to make the formula. This clean record is a
result of the care and attention put forth into teaching the
mothers how to correctly make the formula and clean the
bottles.

Compared to many other Sub-Saharan African PMTCT programs, Mwandi’s
program is doing a very good job of keeping the program advancing,
as far as the number of women being treated and the updates to
newer forms of drug therapies. The program could however still make
larger strides in incorporating more women from far out in the
catchment area and by possibly providing more rural village
outreaches for the sole purpose of PMTCT.