The Baylor-Abbott Clinical Center of Excellence in Lilongwe, Malawi is open and thriving. Care and treatment services are provided to over 2,200 HIV-infected Malawian children and their families at this site and its affiliated clinics.

Press Release: Abbott Fund, Baylor College of Medicine and the First Lady of Malawi Open the First Clinic for HIV-Infected Children in Malawi (11.2.06)

Slideshow: Photos from the dedication ceremonies

Press Release: Abbott Fund, Baylor College of Medicine and the Government of Malawi Break Ground on First Clinic for HIV-Infected Children

Remarks: Minister of Health, Honourable Dr. Hetherwick Ntaba

Facts on HIV/AIDS in Malawi

Malawi, at the epicenter of the AIDS pandemic in sub-Saharan Africa, has an estimated HIV prevalence rate of more than 14 percent. This translates to an estimated 900,000 people living with HIV/AIDS in this nation of 11 million.

• It is estimated that HIV prevalence among pregnant women may be between 19 and 30 percent.
• The HIV infection rate may be as high one in four adults in urban areas and one in eight adults in rural areas.

An estimated 83,000 children (age 0-15) are living with HIV/AIDS.

• One in four children who are HIV-infected will die before the age of five – this is one of the highest death rates in the region.

At the end of 2003, an estimated 500,000 children living in Malawi had lost their mother or father or both parents to HIV/AIDS.

In 2001, the Malawi Ministry of Health (MOH) introduced subsidized antiretroviral (ARV) treatment within three referral hospitals. With the disbursement of Global Fund money in 2003, the MOH began implementing a rapid national scale-up of free ARVs as well as a program for the prevention of mother-to-child transmission of HIV (PMTCT).

• Currently there are an estimated 10 - 12,000 people taking ARVs in Malawi, almost all of them adults. This number is expected to increase to 80,000 by the end of 2005 due to an influx of $41 million in Global Fund money over two years.

The new Malawi pediatric HIV clinic will be attached to the Kamuzu Central Hospital (KCH), a government referral hospital for the central region of Malawi. KCH also serves as the main teaching hospital for the adjacent Malawi College of Health Sciences.

Sources: UNAIDS, UNICEF, Malawi MOH, Malawi National AIDS Commission (NAC), WHO

Program Update

The Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence (COE) was officially opened on 2 November 2006 within the grounds of Kamuzu Central Hospital (KCH) in Lilongwe. The COE serves as the outpatient pediatric HIV clinic for KCH and a pediatric referral centre for the nation. It is managed by a trust registered in Malawi, the Baylor College of Medicine Children's Foundation-Malawi (BCM-CF). Its mandate in Malawi as per a Memorandum of Understanding signed in 2005 with the Ministry of Health (MoH) is to assist the MoH to scale up pediatric HIV care nationally.

The Baylor College of Medicine Children's Foundation-Malawi (BCM-CF) essentially functions on five program levels:

1. Direct patient care, mentoring and training health care professionals at the COE;
2. Direct patient care and mentoring at ARV clinics in the district hospitals and health centers within Lilongwe district;
3. Direct patient care, mentoring, training and supervision at ARV clinics in the district hospitals and health centers throughout the central region;
4. Direct patient care, mentoring, training and supervision at ARV clinics in the district hospitals and health centers in the southern and northern regions;
5. Participation in national level policy activities.

HIV Prevention and early diagnosis
In 2007, the COE began offering pediatric HIV counseling and testing services on-site and at Kamuzu Central Hospital (KCH) pediatric ward in partnership with the Lighthouse Trust and introduced routine counseling and testing (RCT) at the KCH pediatric ward. Daily pre-test group counseling of all newly admitted patients is followed by an opt-out testing strategy. This strategy enables clinical relevance of testing results by strengthening both inpatient and outpatient linkages to COE pediatric HIV care and treatment services offered from within the hospital and in the COE. The counselors served nearly 3000 patients during 2007 resulting in the notable increase in the proportion of new enrolled patients at the COE who are from inpatient care (pediatric ward) from 16% to 30%. The Ministry of Health early infant diagnosis pilot project that was implemented nationally with KCH as one of the sites has contributed to the early HIV diagnosis in infants through the dried blood spot (DBS) testing.

Patient care, treatment, and support
Since the COE was opened in November 2006, there has been a continuous increase in the number of newly registered patients; the monthly average of new patients enrolled into care has grown from 30 to over 100 within 2 years. Daily clinic attendance currently ranges from 70 and 100 patients. The number of patients ever initiated on ART has continued to grow steadily to over 1500 by end of August 2008, of whom 1127 were actively in care. At the end of August 2008 the caseload of patients actively enrolled in care had reached 2161 patients, of whom 111 were adults. The adults are parents of some of the pediatric patients who had been enrolled into care through the family clinic after meeting the enrolment eligibility criteria. Patients and caregivers are provided counselling, guidance and in rare cases financial assistance by a complement of COE staff comprising of clinicians, nurses, counsellors and social workers. Presently, the more pertinent issues for our patients and caregivers include HIV/AIDS disclosure, adherence to medications, nutritional counselling, child neglect, and child abuse. Efforts to retain our patients in care and on treatment include patient follow-up via phone, home visits to track defaulters (those who miss clinic appointments), home assessment, documentation, and reporting.

Training, outreach, and mentorship
The training and outreach mentorship program was launched in October 2006 with the aim of increasing competency among health care providers in providing pediatric HIV care services and increasing our patients' and caregivers' self-efficacy to address issues pertaining to pediatric HIV as well as general health education. The program strategy complements traditional didactic training with a series of site-specific, practical in-clinic sessions to ensure implementation of knowledge learned during didactic sessions and underpin best practices in the provision of pediatric HIV care and treatment services and scale up enrollment of children and infants at health facilities nationally. The four key components of the training are: core one-day didactic training, follow-up site visits (4-8), clinical attachments at the COE for health care providers from public and Christian Health Association of Malawi (CHAM) facilities, and follow up site mentorship or at least 6 months.

To date the program has trained 1200 health care professionals in eighteen of Malawi's twenty-four districts. These health care providers include HIV counseling and testing (HCT) counselors, nurses, doctors, clinical officers, ART clerks and others, all of whom are now participating in the national scale up of pediatric HIV care mostly within MoH and Christian Health Association of Malawi (CHAM) facilities.

Teen Club
The COE has enrolled over 300 pediatric and adolescent patients aged 10 - 19 years who have been disclosed to (i.e. know their HIV status). The Teen Club meets monthly on a Saturday with an adolescent HIV clinic in the morning following by social and educational activities in the afternoon; about 80 children are usually in attendance. Teen Club provides both clinical care and psycho-social support that is crucial to the development of the children that enables them to remain healthy and grow into productive and responsible adults. The children enjoy participating in arts and craft, sports, music, dance and drama, songs, story telling, drama, games and group discussions, through which they have gained knowledge on growth and development, adherence, stigma, gender issues, and how to be good citizens. Some of these teenagers are also been involved in photography through "Picturing Hope", a project that is financed by Abbott Fund which provides an opportunity to 70 teenagers to own a camera and learn how to use it. The children narrate stories and create their own biography through the photos they take. We are working on producing a curriculum which can be shared with other youth groups nationally. In February 2008, the teens participated in Camp Hope Malawi; this annual event is funded in part by the AIDS Foundation Houston through BIPAI, and organized in collaboration with the Children in the Wilderness program.

M&E and Research
Operational research is part and parcel of all aspects of the programme with a view to generate timely and relevant data to inform service delivery. We have built into our program a sound monitoring and evaluation (M&E) component at all levels of our program in order to generate objectively verifiable information on performance. The feedback from the M&E and operational research activities helps us to assure provision of quality comprehensive pediatric HIV care as we continue expanding the program nationally to improve access.