Testing early, saving lives in Malawi

By Rebecca Phwitiko, UNICEF Malawi

Testing children early can save many lives.
© UNICEF Malawi/2017/

Its barely 8 o’clock in the morning but the waiting room is already full. You cannot hear much above the noise, hospital attendants moving around, calling out numbers and names while some of the women try to calm their crying babies.

Every weekday Bwaila Family Health Unit receives a minimum of 300 clients. These are pregnant women and new mothers who come for antenatal and postnatal care. By 8am the clinic is already crowded. The women are assigned numbers depending on what service they require; some are here for the first time while others are returning clients. They receive a package of care which combines attention to mother and child. There are about 8 different rooms offering as many services; registration, physical examination, immunization, family planning, HIV testing and counselling, anti-malaria care, post-natal check-up. Couples are prioritized as a way of encouraging them to come to the clinic together.

Couples are encouraged to come together for prenatal and postnatal visits.
© UNICEF Malawi/2017/

First time clients get pre-test HIV counselling before they are tested in a different room. If found positive they are immediately put on Anti-Retroviral Treatment (ART) within the antenatal setting.

HIV positive mothers are advised to bring their newborns for HIV testing at 6 weeks. Ordinarily, it might take up to a month to get the results from the central laboratory. At Bwaila clinic, UNICEF through its implementing partner the University of North Carolina (UNC) Project, is piloting a new point-of-care diagnostics system that gets the test done in just under an hour.

Mary Kacheyo, an HIV testing services counsellor says this has greatly improved early infant diagnosis. “Every day we can test up to eight children and after 50 minutes they get the results. If we have more than eight mothers waiting in line we tell the rest to come the next day,” explains Mary.

Mary sets up to run a test. 
© UNICEF Malawi/2017/

Early infant diagnosis and timely ART treatment initiation can significantly improve survival prospects of newborns who have been exposed to HIV. As the women wait 50 minutes to get the results, they are able to carry on with any other appointments at the clinic.

Malawi is a long way from its first HIV diagnosis in 1985. Over the years, the country has registered significant success in preventing mother to child transmission. Since July 2011 when Option B plus was introduced, all HIV positive pregnant and breastfeeding women are put on universal ART. Mother-to-child transmission rates have since reduced by 66%. In 2016, Malawi launched a bold Test and Treat initiative. It automatically places all people living with HIV on ART immediately after diagnosis, regardless of viral load.

Despite these successes, the HIV burden on children in Malawi is still high. HIV remains a contributing factor to under five mortality and is a leading cause of death among adolescents in Malawi, with approximately 6,900 adolescent deaths due to HIV per year. The new testing and treatment procedures are a positive step in bridging the gaps between diagnosis and treatment in Malawi.

“In three weeks, we have managed to test 108 children. This procedure is revolutionary; the fact that mothers no longer have to wait a month to get the results also increases their interest in getting the test done,” explains Mary.

Through the Optimizing HIV Treatment Access (OHTA) Initiative, funded by the Governments of Sweden and Norway, UNICEF is supporting the Government of Malawi’s HIV response efforts to strengthen the capacity of health workers and help those infected to remain on treatment.

“HIV progresses rapidly in very young children. Waiting too long for test results and delaying treatment may cause serious illness or even death for children living with HIV. Our focus now is to support the Government in strengthening healthcare systems so that all mothers and children receive treatment as early as possible,” says Judith Sherman, UNICEF Malawi Chief of HIV.

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