Baylor College of Medicine Children’s Foundation supports rollout of improved HIV treatment for children in Malawi
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Globally, an estimated 919,000 children under 14 years old were on antiretroviral therapy (ART) in 2016: about 43% of all children living with HIV.[1] While adult treatment has evolved to become simpler and easier to take – from multiple pills several times a day to one pill once a day – better treatment formulations for children have lagged behind. Treatment for young children who are unable to swallow pills has often taken the form of bitter-tasting syrup requiring refrigeration, a condition difficult to meet in countries such as Malawi, where most people do not have consistent access to electricity.
In 2013, the World Health Organization recommended ritonavir-boosted lopinavir (LPV/r) as part of first-line ART for children under three years old. Malawi’s Ministry of Health adopted this recommendation, as the medication was becoming more widely available at reduced cost and was shown to be superior to other options in clinical trials. However, this could not be implemented until early in 2017, when a new formulation of LPV/r became available in Malawi: pellets. LPV/r pellets are small enough to be swallowed by young children and can be given with food. |
A Baylor-Malawi staff member explains how to use the LPV/r pellets to clients in Lilongwe, Malawi
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The Ministry of Health (MoH) adopted a phased roll-out approach for implementation of the LPV/r pellets, requesting Baylor College of Medicine Children’s Foundation Malawi (Baylor-Malawi) to develop protocols and educational tools for the formulation and pilot implementation at its Center of Excellence, which provides specialist pediatric HIV care in Lilongwe. Baylor-Malawi successfully piloted the medication with 55 children over a period of seven months, demonstrating the effectiveness of the treatment as well as how caregivers could be trained to appropriately administer the medication. Baylor-Malawi subsequently supported the MoH to expand the pilot program to 20 other large sites[2] across the country, training and supporting staff who began prescribing the medication in August 2017. The MoH anticipates further scaling up implementation at all HIV clinics across the country in the next several years.
“Now our son reminds us to give him his medicine”
Grace and George[3] were married in 2010. George, a friend of Grace’s uncle, says he fell in love with her because she is beautiful and clever, and Grace loves George for his humility, passion, and understanding. Late in 2014, Grace became pregnant and started attending ante-natal care visits at her local health center. At one of these visits, she participated in routine HIV testing provided to all pregnant women, and tested HIV-positive.
“I felt sad and surprised,” Grace said. “I told my husband about my status. He was friends with staff at Baylor’s Center of Excellence, and they came to speak with us. They told us that HIV was not the end of life, and that they knew many people living healthy with HIV.” This advice made it easier for George to make the decision to test several months later, after his son was born. George brought four-month-old Hope to the Center of Excellence, where both of them tested HIV-positive and began antiretroviral therapy.
Baylor-Malawi staff asked George and Grace to participate in the LPV/r pilot program. In the beginning, Hope wouldn’t take the medicine: he would spit it out. The family tried giving the pellets with banana, okra, nsima[4], and peanut butter. The best approach, they found, was putting it on his morning porridge. “Now Hope reminds us to give him his medicine,” Grace noted. “He says, ‘Mommy, you need to give me my medicine, I want to go to school.’”
Hope has gained weight steadily and is waiting for his latest viral load results. Grace and George appreciate Baylor-Malawi’s support. “Baylor cares about us,” Grace shared. “They call to remind us about appointments and ask how Hope is doing. When Hope started the new medicine, they came to our house to advise us on strategies to give the pellets. If we tell them that Hope is coughing, they test for everything. That is the whole care that we want and shows that they really care about our baby’s life.”
Grace and George are hopeful for their son’s future. “We want to see him grow like any other child,” Grace said. “We look forward to him joining Baylor’s Teen Club to learn how to work hard and meet other children like him.” They are not considering having another child yet, as they want to ensure that all of Hope’s needs are met. Grace plans to grow her salon business so they can “send Hope to the best school and build a good life for him.”
[1] UNAIDS. Ending AIDS: Progress Towards the 90-90-90 Targets. 2017.
[2] These include several central hospitals
[3] The client names in this story are pseudonyms
[4] Nsima is a staple food made from maize flour
“Now our son reminds us to give him his medicine”
Grace and George[3] were married in 2010. George, a friend of Grace’s uncle, says he fell in love with her because she is beautiful and clever, and Grace loves George for his humility, passion, and understanding. Late in 2014, Grace became pregnant and started attending ante-natal care visits at her local health center. At one of these visits, she participated in routine HIV testing provided to all pregnant women, and tested HIV-positive.
“I felt sad and surprised,” Grace said. “I told my husband about my status. He was friends with staff at Baylor’s Center of Excellence, and they came to speak with us. They told us that HIV was not the end of life, and that they knew many people living healthy with HIV.” This advice made it easier for George to make the decision to test several months later, after his son was born. George brought four-month-old Hope to the Center of Excellence, where both of them tested HIV-positive and began antiretroviral therapy.
Baylor-Malawi staff asked George and Grace to participate in the LPV/r pilot program. In the beginning, Hope wouldn’t take the medicine: he would spit it out. The family tried giving the pellets with banana, okra, nsima[4], and peanut butter. The best approach, they found, was putting it on his morning porridge. “Now Hope reminds us to give him his medicine,” Grace noted. “He says, ‘Mommy, you need to give me my medicine, I want to go to school.’”
Hope has gained weight steadily and is waiting for his latest viral load results. Grace and George appreciate Baylor-Malawi’s support. “Baylor cares about us,” Grace shared. “They call to remind us about appointments and ask how Hope is doing. When Hope started the new medicine, they came to our house to advise us on strategies to give the pellets. If we tell them that Hope is coughing, they test for everything. That is the whole care that we want and shows that they really care about our baby’s life.”
Grace and George are hopeful for their son’s future. “We want to see him grow like any other child,” Grace said. “We look forward to him joining Baylor’s Teen Club to learn how to work hard and meet other children like him.” They are not considering having another child yet, as they want to ensure that all of Hope’s needs are met. Grace plans to grow her salon business so they can “send Hope to the best school and build a good life for him.”
[1] UNAIDS. Ending AIDS: Progress Towards the 90-90-90 Targets. 2017.
[2] These include several central hospitals
[3] The client names in this story are pseudonyms
[4] Nsima is a staple food made from maize flour
Baylor-Malawi: Supporting the national HIV response and achievement of the UNAIDS 90-90-90 targets
Baylor-Malawi’s Center of Excellence, the country’s only stand-alone pediatric HIV clinic, was opened in 2006. Baylor-Malawi is also implementing the Tingathe program, supporting more than 60 health facilities in four high-prevalence districts through the USAID-funded Innovative HIV Services for Malawi program under the EQUIP mechanism. Through this program, the organization is supporting the delivery of high-quality comprehensive HIV services to help Malawi achieve the UNAIDS 90-90-90 targets.
Baylor-Malawi’s assistance to provide optimal ART to children across the country contributes to enhancing treatment access as well as retention in care – ultimately leading to better health outcomes.
Baylor-Malawi’s Center of Excellence, the country’s only stand-alone pediatric HIV clinic, was opened in 2006. Baylor-Malawi is also implementing the Tingathe program, supporting more than 60 health facilities in four high-prevalence districts through the USAID-funded Innovative HIV Services for Malawi program under the EQUIP mechanism. Through this program, the organization is supporting the delivery of high-quality comprehensive HIV services to help Malawi achieve the UNAIDS 90-90-90 targets.
Baylor-Malawi’s assistance to provide optimal ART to children across the country contributes to enhancing treatment access as well as retention in care – ultimately leading to better health outcomes.
