Our “Treatment for Life” series show how Option B+ is providing more options to HIV-positive mothers, their children, and the health workers who are implementing the guidelines.
Option B+ is the recommendation by the World Health Organization (WHO) to health providers in HIV-affected countries to initiate all HIV-positive pregnant and breastfeeding women on antiretroviral therapy (ART) for life. The guidelines also call for expanded pediatric treatment, including immediate initiation of ART for all HIV-positive children younger than five.
Previous prevention of mother-to-child HIV transmission (PMTCT) guidelines recommended varying treatment regimens for HIV-positive pregnant and lactating women depending on their HIV viral load levels and did not include a recommendation to remain on treatment for life. The potential benefits of Option B+ include its ease to prescribe (it’s a simpler treatment formula than previously recommended regimens); limited or no treatment interruptions (minimizing issues of drug resistance and ensuring reduced transmission risk in all future pregnancies), and treatment as prevention in serodiscordant relationships (reducing risks of transmission to an uninfected sexual partner).
“Option B+ demonstrates the continuing evolution of the global HIV/AIDS response,” said Charles Lyons, EGPAF’s president, after release of the WHO’s programmatic update in April 2012. “As we combat this epidemic, we must expand our treatment and prevention efforts to meet as many HIV-positive people as possible.”
Option B+ requires strengthening health systems and increasing the capacity of low-resource countries to provide all of its citizens with prevention and treatment services. That investment will bring compounded benefits in many areas of health care. Over the past three years, EGPAF has worked to achieve this investment in its supported countries. Throughout the rest of April 2015, we will be bringing you stories of how Option B+ is changing lives in the countries that EGPAF supports.
Option B+ Improves Care for Mother-Baby Pairs in EGPAF-Supported Settings
To kick off this series, we spoke to Mary Pat Kieffer, EGPAF’s senior director of technical leadership development. Kieffer has been carefully monitoring the roll-out of Option B+ across sub-Saharan Africa and India, assessing the benefits and the challenges.
“Overall, the 2013-14 rapid scale-up of Option B+ has had significant impact on PMTCT programs and on their outcomes,” said Kieffer. “The programs have evolved to include HIV treatment services as an integral part of maternal and child health services, both in antenatal care and maternity settings, and in some places, in postnatal settings. This has greatly improved access to lifesaving ART and led to reduced morbidity and mortality among HIV-positive women.
“Most importantly, for those women who have remained on ART throughout the risk period for HIV transmission to the infant, the rates of infant infection have dropped to extremely low levels. Many countries are reporting that the percentage of HIV-exposed infants diagnosed with HIV in the first two months of life has dropped to 1-3%. This is a huge change from a few years ago when these rates were between 7-10%.”
“The continuation of ART throughout the breastfeeding period has, for the first time, allowed a huge advance in prevention of HIV transmission through breast milk,” continued Kieffer. “This change has allowed HIV-positive mothers to safely breastfeed their infants, providing critical nutrition to their growing infants.”
Kieffer said that one challenge of implementing Option B+ is that a significant proportion of women stop ART during the first three months, reversing the benefit of treatment. This is why health system strengthening remains a key element of EGPAF’s support of Option B+.
“Mother-baby pairs who receive care across different settings are difficult to track and monitor, and access to good quality care is limited at lower level facilities in countries with fewer resources,” says Kieffer. “EGPAF continues to lead efforts across its 14 countries of program implementation to strengthen health care provision, monitoring and evaluation. The scale up of Option B+ is an important step in finally eliminating pediatric AIDS.”