Evaluating the implementation of prevention of mother-to-child transmission of HIV in Mwanza district hospital, Malawi.

Globally, mother-to-child transmission (MTCT) of HIV significantly contributes to paediatric HIV infections. Effective prevention of mother-to-child transmission (PMTCT) programs aim to achieve the World Health Organization's target of less than 5% transmission rates. This study evaluated the implementation of PMTCT services in Mwanza district, Malawi, focusing on antiretroviral therapy (ART) adherence and key implementation challenges. This was a retrospective study which analysed data from HIV-positive pregnant women and exposed infants enrolled in the PMTCT program (June 2020-June 2022). Logistic regression and bivariate analyses assessed factors influencing MTCT rates. Further, qualitative data from structured interviews with health workers identified implementation barriers. The MTCT rate in Mwanza was 1.7%, below Malawi's national average of 6%. ART defaulting significantly raised MTCT risk (5.56%) versus consistent adherence (0.6%; = 9.6521, = 0.002). Logistic regression indicated mothers defaulting ART had nine-fold greater odds of MTCT (OR = 9.134, 95% CI: 1.72-48.43). Key challenges included loss to follow-up, shortage of resources, insufficient healthcare worker training, and other socioeconomic factors affecting adherence. Improving ART adherence and addressing socioeconomic and systemic barriers are crucial to reducing MTCT. Enhanced training, adequate resource allocation, and most importantly, targeted adherence interventions are recommended to strengthen PMTCT program effectiveness in Malawi.