Related Conditions

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Elimination of Mother to Child Transmission (EMTCT)

  • Test all pregnant women and their sexual partners for hepatitis B at first antenatal visit. Link all hepatitis B positives for treatment eligibility screening
  • In districts with high HIV incidence: Give an HIV self-test at discharge from maternity for sexual partners who don’t come for professional testing to the facility
  • Re-test all breastfeeding women not known to be HIV positive at family planning/ MNCH/ EPI clinics between 6 to 9 months after delivery
  • Give 6 weeks of AZT/3TC/NVP (2P) prophylaxis to high-risk HIV exposed infants; low risk infants receive 6 weeks nevirapine syrup as infant prophylaxis

Post Exposure Prophylaxis (PEP)

  • PEP involves giving ARV's following possible exposure to HIV to prevent infection. PEP should be given as soon as possible and within 72hrs of high-risk exposure. For more information, refer to 2021 Clinical Management of HIV in Children and Adults (5th edition, 2021)

Weight

Standard

Alternative

3.0-19.9kg

15PP:    ABC 120mg / 3TC 60mg +DTG 10mg

AZT 60mg / 3TC 30mg

20-24.9kg

15PA:    ABC 120mg / 3TC 60mg

+ DTG 50mg

AZT 60mg / 3TC 30mg

25-29.9kg

15A:      ABC 600mg / 3TC 300mg + DTG 50mg

AZT 300mg / 3TC 150mg

≥ 30.0kg

13A:      TDF 300mg / 3TC 300mg / DTG 50mg

AZT 300mg / 3TC 150mg

Pre-Exposure Prophylaxis (PrEP)

  • PrEP is being rolled out as a public health intervention for HIV prevention in Malawi.
  • Offer PrEP as an additional primary prevention method for HIV negative persons who are at substantial risk of acquiring HIV
  • Emphasize the need for combination with other HIV prevention methods such as consistent condom use, VMMC etc.
  • For screening and Eligibility for PrEP refer to 2021 Clinical Management of HIV in Children and Adults (5th edition, 2021).

 

Cotrimoxazole Preventive Therapy (CPT)

  • CPT prevents Pneumocystis pneumonia (PCP), diarrhoea, malaria, toxoplasmosis, and other HIV-related diseases and prolongs survival.
  • Start all the following on CPT:
    •  HIV exposed children from age 6 weeks
    •  HIV infected children from age 6 weeks
    •  HIV infected adults
  • Stop CPT in HIV exposed children when confirmed negative when discharged from exposed infant follow-up (following a negative HIV diagnostic test 6 weeks after stopping of breastfeeding)

Adults

  • Give Cotrimoxazole 960mg once daily to any HIV infected person who is 30kg and above, including HIV + pregnant women.
  • Do not combine CPT with SP – HIV positive pregnant women only take CPT (and ART).

Children

  • Give Cotrimoxazole 120mg dispersible tablets 6-8mg/kg once daily to all HIV exposed children under 14kg until HIV infection has been ruled out, and to all HIV infected children.

Document all serious side effects on the yellow pharmacovigilance forms and submit to PMRA or report using the MEDSAFE-360 USSD platform.

Tuberculosis Preventive Therapy (TPT)

  • A single course of TPT can prevent active TB in people who are at high risk. Give TPT to:
    • HIV infected children, adolescents and adults.
    • Children under 5 years – regardless of HIV status – who are household contacts of clients with bacteriologically confirmed TB (microscopy, gene X-pert or LF TB LAM):  give IPT – 6H.
  • HIV patients who have completed 6 months of IPT in the past do not need another course of TPT.
  • Do not give TPT to a patient who has any signs suggestive of active TB: such patients need full investigation for TB and may require full TB treatment to avoid TB drug resistance.
  • New patients: Start TPT together with ART and CPT.
  • Two alternative TPT options are similarly effective:
    • 3HP: 3-month course of weekly doses of Isoniazid + Rifapentine
      • Preferred regimen for patients newly initiating ART
    • 6H: 6-month course of daily dose of Isoniazid – do not give to women in first trimester
      • Use as an alternative regimen for those with contraindications to 3HP
      • Suitable for children and can be combined with all ART regimens
  • Both 3HP and 6H should not be routinely given in pregnancy and 3 months postpartum due to increased risk of hepatotoxicity and potential adverse birth outcomes (low birth weight and preterm delivery).
  • Document all serious side effects on the yellow pharmacovigilance forms and submit to PMRA or report using the MEDSAFE-360 USSD platform.
  • DO NOT RESTART TPT if any significant side effect is experienced.
  • For more information, Refer to Malawi TB control guidelines/Manual (2018).