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Objective. With high rates of HIV-infection among pregnant women living in sub-Saharan Africa (SSA), risks of mother-to-child transmission (MTCT) remain concerning in spite of current progress. Thus, identifying gaps in the era of option-B+ would generate specific evidence-based interventions. Methods. A baseline assessment for “SAVE THE FAMILIES FOR AFRICA” project, a retrospective study was conducted throughout 2014 at the Likuni Mission Hospital in Malawi based on performance indicators of the prevention of MTCT (PMTCT) cascade and pediatric antiretroviral therapy (ART) care. Results. In 2014, 7.5% (199/2658) newborns were vertically exposed to HIV and all HIV-infected mothers (199) received PMTCT intervention. A rate of 40.8% and 55.1% HIV-infected pregnant/breastfeeding mothers were lost to follow-up at six and 12 months, respectively. Amongst infants (6 [IQR: 6-8] weeks) tested for HIV-1 early infant diagnosis (EID), 79.0% (166/210) EID results were withdrawn, with a median turn-around time (TAT) of 36 [IQR: 30-60] days. 82.5% mothers were on lifelong ART 4 weeks before delivery. Infants received cotrimoxazole (100.0%), nevirapine prophylaxis (91.2%) and exclusive breastfeeding (90.8%). HIV-1 MTCT was 2.8% (6/215), with higher age (p=0.07) and longer TAT (p=0.367) among infected-infants. For pediatric ART, dispensing practices and drug supply were excellent (100%), while on-time drug pick-up (69.7%) and retention in care (70.9%) were poor. Conclusions. Progress in option-B+ and pediatric ART care are encouraging in this SSA setting, but may be hampered by lost to follow-up and poor adherence. Eliminating MTCT and sustaining pediatric ART performance in SSA require a holistic interventional approach for universal access to healthcare.
Objectif. La forte prévalence du VIH chez les femmes enceintes en Afrique sub-Saharienne (SSA) suggère un risque considérable de la transmission mère-enfant (TME) malgré progrès enregistrés. Dans cette optique, identifier les goulots d’étranglement dans l’ère option-B+ permettrait la mise en œuvre des interventions probantes. Méthodes. Une étude retrospective a été menée dans le cadre du projet “SAVE THE FAMILIES FOR AFRICA” durant l’année 2014 à l’Hôpital Missionnaire de Likuni au Malawi, sur la base de la performance des indicateurs de la cascade en prévention de la TME (PTME) et prise en charge du VIH pédiatrique (ART). Résultats. Durant cette année, 7,5% (199/2658) de nouveaux nés avaient subi une exposition verticale au HIV et toutes les femmes enceintes infectées par le VIH (199) étaient enrôlées dans la PTME MTCT. Un taux de 40,8% et 55,1% des femmes enceintes/allaitantes était perdue de vue à six et à 12 mois après enrôlement. Parmi les enfants (6 [IQR: 6-8] d’âge semaines) testés pour le diagnostic précoce du VIH (EID), 79,0% (166/210) des résultats étaient retirés, dans une délai de 36 [IQR: 30-60] jours. 82.5% des mères étaient sous trithérapie antirétrovirale (TARV) 4 au moins 4 semaines avant l’accouchement. La prophylaxie au cotrimoxazole était de 100,0% chez les enfants, prophylaxie à la nevirapine de 91,2% et l’allaitement maternel and exclusif de 90,8%. le taux de TME était de 2,8% (6/215), légèrement élevé avec l’âge avancé (p=0,07) et le temps de retrait de résultats (p=0,367). Concernant la TARV pédiatrique, les practices de dispensation et la délivrance des médicaments étaient excellentes (100%), les taux de retrait des médicaments dans les délais (69,7%) et de rétention (70,9%) étaient faibles. Conclusions. L’option-B+ s’accompagne d’excellents progrès en PTME et prise en charge pédiatrique du VIH au Malawi. Une optimisation des performances nécessite des interventions visant à limiter les perdues de vue et les cas d’inobservance, a travers une approche holistique autour du couple mère-enfant.


HIV eMTCT infant feeding option early infant diagnosis pediatric care.

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Fokam, J., Santoro, M. M., Chimbiri, I., Chindiura, J., Deula, R., Rombe, A., Massari, R., Lungu, A., & Perno, C.-F. (2019). Programmatic Challenges in Implementing PMTCT Option B+ and Pediatric HIV Care: Baseline Assessment from “Save the Families for Africa” in Malawi. HEALTH SCIENCES AND DISEASE, 20(3).


  1. Berhan Y, Berhan A (2014). Antenatal Care as a Means of Increasing Birth in the Health Facility and Reducing Maternal Mortality: A Systematic Review. Ethiopian J of Health Sciences 24, 93-104.
  2. Billong SC, Fokam J, Billong EJ, Nguefack-Tsague G, Essi MJ, Fodjo R, Sosso SM, Gomba A, Mosoko-Jembia J, Loni-Ekali G, Colizzi V, Bissek AC, Monebenimp F, Nfetam JB. [Epidemiological distribution of HIV infection among pregnant women in the ten regions of Cameroon and strategic implications for prevention programs]. Pan Afr Med J. 2015: 20:79. doi: 10.11604/pamj.2015.20.79.4216. eCollection 2015.
  3. Billong SC, Fokam J, Nkwescheu AS, Kembou E, Milenge P, Tsomo Z, Dion GN, Aghokeng AF, Mpoudi EN, Ndumbe PM, Colizzi V, Elat Nfetam JB. Early warning indicators for HIV drug resistance in Cameroon during the year 2010. PLoS One. 2012;7(5):e36777. doi: 10.1371/journal.pone.0036777
  4. Bigna JJ, Noubiap JJ, Plottel CS, Kouanfack C, Koulla-Shiro S. Factors associated with non-adherence to scheduled medical follow-up appointments among Cameroonian children requiring HIV care: a case-control analysis of the usual-care group in the MORE CARE trial. Infect Dis Poverty. 2014 Dec 3;3(1):44. doi: 10.1186/2049-9957-3-44. eCollection 2014.
  5. Chitete L, Puoane T. What Health Service Provider Factors Are Associated with Low Delivery of HIV Testing to Children with Acute Malnutrition in Dowa District of Malawi? PLoS One. 2015 May 1;10(5):e0123021. doi: 10.1371/journal.pone.0123021. eCollection 2015.
  6. Dube Q, Dow A, Chirambo C, Lebov J, Tenthani L, Moore M, Heyderman RS, Van Rie A; CHIDEV study team. Implementing early infant diagnosis of HIV infection at the primary care level: experiences and challenges in Malawi. Bull World Health Organ. 2012 Sep 1;90(9):699-704.
  7. Edmonds A, Feinstein L, Okitolonda V, Thompson D, Kawende B, Behets F. Decentralization does not assure optimal delivery of PMTCT and HIV-exposed infant services in a low prevalence setting. J Acquir Immune Defic Syndr. 2015 Aug 17.
  8. Escamilla V, Chibwesha CJ, Gartland M, Chintu N, Mubiana-Mbewe M, Musokotwane K, Musonda P, Miller WC, A Stringer JS, Chi BH. Distance from household to clinic and its association with the uptake of prevention of mother-to-child HIV transmission regimens in rural Zambia. J Acquir Immune Defic Syndr. 2015 Jun 26.
  9. Fokam J, Salpini R, Santoro MM, Cento V, Perno CF, Colizzi V, Ndumbe PM, Fokunang Ntungen C, Ndiang Tetang SM, Nanfack AJ, Takou Komego DA, Cappelli G. Drug resistance among drug-naive and first-line antiretroviral treatment-failing children in Cameroon. Pediatr Infect Dis J. 2011 Dec;30(12):1062-8. doi: 10.1097/INF.0b013e31822db54c.
  10. Fokam J, Elat JB, Billong SC, Kembou E, Nkwescheu AS, Obam NM, Essiane A, Torimiro JN, Ekanmian GK, Ndjolo A, Shiro KS, Bissek AC. Monitoring HIV Drug Resistance Early Warning Indicators in Cameroon: A Study Following the Revised World Health Organization Recommendations. PLoS One. 2015 Jun 17;10(6):e0129210. doi: 10.1371/journal.pone.0129210.
  11. Giuliano M, Liotta G, Andreotti M, Mancinelli S, Buonomo E, Scarcella P, Amici R, Jere H, Sagno JB, Di Gregorio M, Marazzi MC, Vella S, Palombi L. Retention, transfer out and loss to follow-up 2 years after delivery in a cohort of HIV+ pregnant women in Malawi. Int J STD AIDS. 2015 May 6. pii: 0956462415585450.
  12. Government of Malawi. Malawi AIDS Response Progress Report 2015. April 2015.
  13. Herce ME, Mtande T, Chimbwandira F, Mofolo I, Chingondole CK, Rosenberg NE, Lancaster KE, Kamanga E, Chinkonde J, Kumwenda W,Tegha G, Hosseinipour MC, Hoffman IF, Martinson FE, Stein E, van der Horst CM. Supporting Option B+ scale up and strengthening the prevention of mother-to-child transmission cascade in central Malawi: results from a serial cross-sectional study. BMC Infect Dis. 2015 Aug 12; 15:328. doi: 10.1186/s12879-015-1065-y.
  14. Herlihy JM, Hamomba L, Bonawitz R, Goggin CE, Sambambi K, Mwale J, Musonda V, Musokatwane K, Hopkins KL, Semrau K, Hammond EE, Duncan J, Knapp AB, Thea DM. Integration of PMTCT and antenatal services improves combination antiretroviral therapy cART uptake for HIV-positive pregnant women in Southern Zambia - A prototype for Option B+? J Acquir Immune Defic Syndr. 2015 Jul 15.
  15. Horwood CM, Youngleson MS, Moses E, Stern AF, Barker PM. Using adapted quality-improvement approaches to strengthen community-based health systems and improve care in high HIV-burden sub-Saharan African countries. AIDS. 2015 Jul; 29 Suppl 2:S155-64. doi: 10.1097/QAD.0000000000000716.
  16. Kim MH, Ahmed S, Hosseinipour MC, Yu X, Nguyen C, Chimbwandira F, Paul ME, Kazembe PN, Abrams EJ. Impact of Option B+ on the Infant PMTCT Cascade in Lilongwe, Malawi. J Acquir Immune Defic Syndr 2015;70:99–103
  17. Ladner J, Besson MH, Rodrigues M, Saba J, Audureau E. Performance of HIV Prevention of Mother-To-Child Transmission Programs in Sub-Saharan Africa: Longitudinal Assessment of 64 Nevirapine-Based Programs Implemented in 25 Countries, 2000-2011. PLoS One. 2015 Jun 22;10(6):e0130103. doi: 10.1371/journal.pone.0130103. eCollection 2015.
  18. McCollum ED, Johnson DC, Chasela CS, Siwande LD, Kazembe PN, Olson D, Hoffman I, van der Horst C, Hosseinipour MC. Superior uptake and outcomes of early infant diagnosis of HIV services at an immunization clinic versus an "under-five" general pediatric clinic in Malawi. J Acquir Immune Defic Syndr. 2012 Aug 1;60(4):e107-10. doi: 10.1097/QAI.0b013e31825aa721.
  19. Mwendo EM, Mtuy TB, Renju J, Rutherford GW, Nondi J, Sichalwe AW, Todd J. Effectiveness of prevention of mother-to child HIV transmission programmes in Kilimanjaro region, northern Tanzania. Trop Med Int Health. 2014 Mar;19(3):267-74. doi: 10.1111/tmi.12255. Epub 2014 Jan 6.
  20. Osoti AO, John-Stewart G, Kiarie JN, Barbra R, Kinuthia J, Krakowiak D, Farquhar C. Home-based HIV testing for men preferred over clinic-based testing by pregnant women and their male partners, a nested cross-sectional study. BMC Infect Dis. 2015 Jul 30;15:298. doi: 10.1186/s12879-015-1053-2.
  21. Palombi L, Galluzzo CM, Andreotti M, Liotta G, Jere H, Sagno JB, Luhanga R, Mancinelli S, Amici R, Marazzi MC, Vella S, Giuliano M. Drug resistance mutations 18 months after discontinuation of nevirapine-based ART for prevention of mother-to-child transmission of HIV in Malawi. J Antimicrob Chemother. 2015 Jun 25. pii: dkv171.
  22. Penda CI, Bebey FS, Mangamba DK, et al. Échecs thérapeutiques chez les enfants infectés par le VIH en suivi de routine dans un contexte à ressources limitées au Cameroun. The Pan African Medical Journal. 2013;15:80. doi:10.11604/pamj.2013.15.80.2754.
  23. Rawizza HE, Chang CA, Chaplin B, Ahmed IA, Meloni ST, Oyebode T, Banigbe B, Sagay AS, Adewole IF, Okonkwo P, Kanki PJ; APIN PEPFAR Team. Loss to Follow-Up within the Prevention of Mother-to-Child Transmission Care Cascade in a Large ART Program in Nigeria. Curr HIV Res. 2015;13(3):201-9.
  24. Revill PA, Walker S, Mabugu T, Nathoo KJ, Mugyenyi P, Kekitinwa A, Munderi P, Bwakura-Dangarembizi M, Musiime V, Bakeera-Kitaka S, Nahirya-Ntege P, Walker AS, Sculpher MJ, Gibb DM. Opportunities for improving the efficiency of paediatric HIV treatment programmes. AIDS. 2015 Jan 14;29(2):201-10. doi: 10.1097/QAD.0000000000000518.
  25. Saounde Temgoua EM, Nkenfou CN, Zoung-Kanyi Bissek AC, Fokam J, Billong SC, Sosso SM, Tangipumdu C, Elong EL, Domkan I, Colizzi V.
  26. HIV-1 Early Infant Diagnosis is an Effective Indicator of the Prevention of Mother-to-Child Transmission Program Performance: Experience from Cameroon. Curr HIV Res. 2015;13(4):286-91.
  27. Teerawattananon Y, Tantivess S, Werayingyong P, Kingkaew P, Tin N, Aye SS, Myint P. Evidenceinformed policy formulation: the case of the voucher scheme for maternal and child health in Myanmar. WHO South-East Asia J Public Health. 2014;3(3-4): 285–288.
  28. Tejiokem MC, Warszawski J, Ndongo FA, Ndiang ST, Ndongo JA, Owona F, Ngoupo PA, Tchendjou P, Kfutwah A, Penda IC, Faye A. Feasibility of Routinely Offering Early Combined Antiretroviral Therapy to HIV-Infected Infants in a Resource-Limited Country: The ANRS-Pediacam Study in Cameroon. Pediatr Infect Dis J. 2015 Jun 26.
  29. Tenthani L, Haas AD, Egger M, Oosterhout JJ, Jahn A, Chimbwandira F, Tal K, Myer L, Estill J, Keiser O. J. Brief Report: HIV Testing Among Pregnant Women Who Attend Antenatal Care in Malawi. Acquir Immune Defic Syndr. 2015 Aug 15;69(5):610-4. doi: 10.1097/QAI.0000000000000669.
  30. Tilahun M, Mohamed S. Male Partners' Involvement in the Prevention of Mother-to-Child Transmission of HIV and Associated Factors in Arba Minch Town and Arba Minch Zuria Woreda, Southern Ethiopia. Biomed Res Int. 2015; 2015:763876. doi: 10.1155/2015/763876.
  31. Tomlinson M, Doherty T, Ijumba P, Jackson D, Lawn J, Persson LÅ, Lombard C, Sanders D, Daviaud E, Nkonki L, Goga A, Rohde S, Sitrin D, Colvin M, Chopra M. Goodstart: a cluster randomised effectiveness trial of an integrated, community-based package for maternal and newborn care, with prevention of mother-to-child transmission of HIV in a South African township. Trop Med Int Health. 2014 Mar;19(3):256-66. doi: 10.1111/tmi.12257.
  32. Tubiana R, Le Chenadec J, Rouzioux C, Mandelbrot L, Hamrene K, Dollfus C, Faye A, Delaugerre C, Blanche S, Warszawski J. Factors associated with mother-to-child transmission of HIV-1 despite a maternal viral load <500 copies/ml at delivery: a case-control study nested in the French perinatal cohort (EPF-ANRS CO1). Clin Infect Dis. 2010 Feb 15;50(4):585-96. doi: 10.1086/650005.
  33. Tweya H, Gugsa S, Hosseinipour M, Speight C, Ng'ambi W, Bokosi M, Chikonda J, Chauma A, Khomani P, Phoso M, Mtande T, Phiri S. Understanding factors, outcomes and reasons for loss to follow-up among women in Option B+ PMTCT programme in Lilongwe, Malawi. Trop Med Int Health. 2014 Nov;19(11):1360-6. doi: 10.1111/tmi.12369
  34. UNAIDS. Global Report: UNAIDS report on the global AIDS epidemic 2013. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2013a. p. 116. Available from: media_asset/UNAIDS_Global_Report_2013_en_1.pdf.
  35. UNAIDS. Ambitious treatment targets: Writing the final chapter of the AIDS epidemic. Reference Discussion paper. Geneva: UNAIDS; 2013b.
  36. UNAIDS. The Gap Report. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2014. Available from: sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf.
  37. UNICEF. Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national household surveys: Antenatal care coverage, Figure 3.3. Geneva: UNICEF; 2009. Available from:
  38. UNICEF and Business Leadership Council. A business case for options B and B+: To eliminate mother-to-child transmission of HIV by 2015. Geneva: UNICEF, 2012. Available from:
  39. Uwimana J, Jackson D, Hausler H, Zarowsky C. Health system barriers to implementation of collaborative TB and HIV activities including prevention of mother to child transmission in South Africa. Trop Med Int Health. 2012 May;17(5):658-65. doi: 10.1111/j.1365-3156.2012.02956.x.
  40. Wadonda-Kabondo N, Banda R, Moyo K, M’bang’ombe M, Chiwaula M, Porter C, Jordan MR. Prevalence of Transmitted HIV Drug Resistance Among Newly Diagnosed Antiretroviral Therapy–Naive Pregnant Women in Lilongwe and Blantyre, Malawi. Clin Infect Dis. 2012 May 15; 54(Suppl 4): S324–S327. doi: 10.1093/cid/cir993
  41. Woldesenbet S, Jackson D, Lombard C, Dinh TH, Puren A, Sherman G, Ramokolo V, Doherty T, Mogashoa M, Bhardwaj S, Chopra M, Shaffer N, Pillay Y, Goga A; South African PMTCT Evaluation (SAPMCTE) Team. Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE). PLoS One. 2015: 6;10(7):e0132425. doi: 10.1371/journal.pone.0132425. eCollection 2015
  42. World Health Organisation. Using early warning indicators to prevent HIV drug resistance Report of the Early Advisory Indicator Panel meeting (11-12 August 2011). ISBN: 978 92 4 150394 5. Geneva: World Health Organisation; 2012 [cited 2015 Jun 15]. Available from:
  43. World Health Organisation. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach. Geneva: World Health Organisation; 2013 [cited 2015 Jun 15]. Available from:
  44. World Health Organisation. Global summary of the HIV/AIDS epidemic. Geneva: World Health Organisation; 2014a [cited 2015 Jun 15]. Available from:
  45. World Health Organization. HIV/AIDS: Global update on the health sector response to HIV, 2014. World Health Organization; 2014b [cited 2015 Jun 15]. ISBN: 978 92 4 150758 5. Available from:
  46. World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva: World Health Organisation; 2014c [cited 2015 Jun 15]. ISBN 978 92 4 150743 1.
  47. World Health Organisation Regional Office for Africa. Implementation of Option B+ for Prevention of Mother-To-Child Transmission of HIV: The Malawi Experience. Republic of Congo; 2014. Available from:

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