By Chancy Namadzunda

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) in
resource 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.