The DREAM protocol of prevention of transmission of the HIV virus from mother to child has been officially approved by Malawi’s National Committee for Health Research. This means that our so-called “vertical” prevention now forms part of – as operational research – the country’s official health programmes.
To date, the only therapeutic protocol used in Malawi for vertical prevention has been that of administering an antiretroviral, Nevirapina (NVP), to mothers at the time of delivery and then giving the same dosage to the newborns within 72 hours of its birth. It is a protocol which – if correctly applied – could reduce transmission of the virus to the newborn by 50%.
But the experience of DREAM in Mozambique in recent years has proved to be far more effective, with a reported rate of 95%, owing to the fact that our treatment protocols stipulate administration of tri-therapy (Zidovudina, Lamivudina and Nevirapina) to the mother starting from the 25th week of pregnancy, independently of CD4 count, and continuation of the prophylaxis until the baby is six months old. The administration of tri-therapy to pregnant women enables the swift and significant reduction of the quantity of the virus in the blood, avoiding its transmission to the baby through placenta (7% of cases of infection), secretion at time of delivery (53% of cases of infection), and breastfeeding (40% of infections). If the prophylaxis is carried out carefully, administration of NVP at time of delivery would no longer be necessary and a woman may give birth wherever she likes (although a health structure is always advisable), in the near-total certainty that she will not transmit the virus to her baby, not even through breastfeeding.
This is where the interest of the Malawian authorities springs from. Malawi needs an intervention strategy capable of responding to the needs of thousands of villages that are far from existing health centres. The strategy that could have been most effective in reducing transmission of the virus has so far remained, at least partially, not implemented, because only 5% of women living in rural areas – where the overwhelming majority of the population lives – deliver their babies in health structures with the assistance of a doctor or paramedic.
In this context, even the simple administration of NVP to the mother at time of delivery becomes difficult, and in fact, most health centres are unable to carry it out.
Hence, approval of the DREAM protocol is not just a simple bureaucratic act. Rather, it paves the way toward an ambitious and capillary plan of vertical prevention that aims to reach the entire population of the country in the shortest time possible, and in doing so, to save the life of the next Malawian generation.
Four health centres equipped with “ante-natal care”, that is with ante-natal services, have been identified by DREAM in the area of Blantyre to start vertical prevention: Bangwe, South Lunzu, Chilomoni and Machinjiri. In the area of Lilongwe, meanwhile, the programme destined to reach out to pregnant women will have its centre in Mthengo wa Ntenga hospital, 30 km away from the capital, where a new maternity clinic was recently opened. Moreover, there are plans to expand our activities to the more distant centres of Mponela and Dzoole, with the outsourcing of some services close to villages. And finally, there is the imminent opening of the maternity clinic of the Montfortian mission of Balaka (between the capital and