title: Uptake and outcomes of a prevention-of mother-to-child transmission (PMTCT) program in Zomba district, Malawi.
abstract: BACKGROUND
  HIV prevalence among pregnant women in Malawi is 12.6%, and mother-to-child transmission is a major route of transmission. As PMTCT services have expanded in Malawi in recent years, we sought to determine uptake of services, HIV-relevant infant feeding practices and mother-child health outcomes.
  
  
  METHODS
  A matched-cohort study of HIV-infected and HIV-uninfected mothers and their infants at 18-20 months post-partum in Zomba District, Malawi. 360 HIV-infected and 360 HIV-uninfected mothers were identified through registers. 387 mother-child pairs were included in the study.
  
  
  RESULTS
  10% of HIV-infected mothers were on HAART before delivery, 27% by 18-20 months post-partum. sd-NVP was taken by 75% of HIV-infected mothers not on HAART, and given to 66% of infants. 18% of HIV-infected mothers followed all current recommended PMTCT options. HIV-infected mothers breastfed fewer months than HIV-uninfected mothers (12 vs.18, respectively; p < 0.01). 19% of exposed versus 5% of unexposed children had died by 18-20 months; p < 0.01. 28% of exposed children had been tested for HIV prior to the study, 76% were tested as part of the study and 11% were found HIV-positive. HIV-free survival by 18-20 months was 66% (95%CI 58-74). There were 11(6%) maternal deaths among HIV-infected mothers only.
  
  
  CONCLUSIONS
  This study shows low PMTCT program efficiency and effectiveness under routine program conditions in Malawi. HIV-free infant survival may have been influenced by key factors, including underuse of HAART, underuse of sd-NVP, and suboptimal infant feeding practices. Maternal mortality among HIV-infected women demands attention; improved maternal survival is a means to improve infant survival.
authors.affiliation: Dignitas International, Zomba, Malawi. m.vanlettow@dignitasinternational.org
authors.forename: Monique
authors.initials: M
authors.lastname: van Lettow
authors.forename: Richard
authors.initials: R
authors.lastname: Bedell
authors.forename: Megan
authors.initials: M
authors.lastname: Landes
authors.forename: Lucy
authors.initials: L
authors.lastname: Gawa
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gatto
authors.forename: Isabell
authors.initials: I
authors.lastname: Mayuni
authors.forename: Adrienne K
authors.initials: AK
authors.lastname: Chan
authors.forename: Lyson
authors.initials: L
authors.lastname: Tenthani
authors.forename: Erik
authors.initials: E
authors.lastname: Schouten
mesh_terms: D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006679:HIV Seropositivity / Q000175:diagnosis / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D049590:Postpartum Period; D011247:Pregnancy; D015397:Program Evaluation