“Zero babies born with HIV”

Dr. Agnes Moses, a medical doctor in Malawi, is physician/senior clinical researcher for the AIDS Clinical Trial Network, a University of North Carolina project. She was the recipient of the 2009 Elizabeth Glaser Pediatric AIDS Foundation’s International Leadership Award. This week she is in Washington meeting policymakers and stakeholders on AIDS issues, on behalf of the Center for Global Health Policy, an organization of physicians and scientists dedicated to promoting the effective use of U.S. funding for addressing the global HIV/AIDS and TB epidemics.
LILONGWE, Malawi – Starting nine years ago, I began trying to reduce the numbers of babies born in Malawi with HIV. Then, an estimated 6250 babies a year were born HIV positive in the south West zone according to our routine data collection – an astounding and horrifying number in my country, which has a population of 12 million people.

Now, the number has been sharply reduced – to perhaps roughly 2800 babies born HIV positive a year in the Central West zone. And that number, while representing a clear accomplishment from the past, is not acceptable.

In Malawi, we seek a different goal. We want zero babies born with HIV, regardless of social economic status.

That may seem unrealistic to some. But for us in Malawi, it’s the only option. Stopping transmission of HIV from mother to child is entirely preventable, and each time a baby is infected it is a tragedy.

This week, representatives of the G-8 countries will begin meeting in Toronto, and on their agenda is to do more to reduce maternal and infant mortality – making progress specifically around MDGs 4 and 5, improving child and maternal health.

One concrete way to do this in Africa is to invest more, not less, in efforts to fight AIDS, specifically around stopping the transmission of HIV from mother to child during birth.

We know how to do this. Before antiretroviral drugs were widely available in Africa, experts have estimated that 30 to 35 percent of all births by HIV-positive mothers resulted in their babies also being infected. But with the advent of first single-dose nevirapine, and later combination therapy, we were able to reduce transmission to 16 percent of the babies in 2007, and to fewer than 10 percent today using combination ART prophylaxis.

But we still have huge challenges. One is that high percentages of pregnant women who test positive for HIV are lost in the process and do not receive the necessary follow-up care with antiretroviral drugs during pregnancy. A couple of years ago, we were losing roughly 60 percent during the process; we’ve been able to cut that to 40 percent.

We are ready to do much better. One huge effort has been to bring more husbands and boyfriends into the antenatal clinics with their pregnant wives or girlfriends. These clinics had been almost strictly the domain of women, but we found that if men are involved, the women are more likely to return for follow-up care. So we made the clinics more male-friendly – reconfiguring our clinic’s space to include a waiting room for partners and then adding a men’s bathroom. The results have been terrific: before we saw almost no men in our Lilongwe clinic, but now we see an average of 15 to 20 a day, along with an average of 80 women a day.
Secondly, we are experimenting with new tools that could tell us an HIV-positive women’s CD4 count – which measures the virus’ strength. For all women with a CD4 count under 350, we immediately start them on antiretroviral therapy. We need to know the CD4 count while women are with us in the clinic – so we can get them enrolled immediately and not lose any in the process.

I am hopeful that we can dramatically reduce – again – the numbers of babies born with HIV.

Eight years ago, an HIV-positive woman came to our clinic to deliver twins. It was the early days in Malawi of using nevirapine to stop transmission of the virus. We administered nevirapine to her, and in the months after the births, we tested the babies several times for their HIV status. They were HIV free, and today, these girls are healthy and active second graders.

I think of them quite a bit. These children are our future, and we in Malawi are doing all we can to deliver healthy babies for the future well-being of our country. We are hoping our partners will do all they can to reach this important goal: Zero babies born of HIV in Malawi.