Twenty-two year-old Retsepile, who lives in Mafeteng, Lesotho, with her husband and son, gave birth to her first child six months ago. During her first prenatal visit, at three months, Retsepile tested negative for HIV. Three months later, at her next visit, she was retested and this time the test came back positive.
“I didn’t believe it at first,” says Retsepile, who was devastated to learn her status. “But I was told that this is something that happened and I have to take medication for the sake of the child. I got the pills that day.”
In 2013, Lesotho’s Ministry of Health, with technical assistance from the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and other partners, rolled out Option B+ to optimize prevention of mother-to-child transmission of HIV (PMTCT). The aim of these new national treatment guidelines was to access all HIV-positive pregnant and breastfeeding women with lifelong treatment.
An added benefit of Option B+ is that it requires a much simpler dosing formula than past World Health Organization (WHO) recommendations. “With [the 2010 WHO guidelines], it was a bit complicated for these women to understand,” says Matau Lebese, the EGPAF nurse in charge of PMTCT and MCH integration at Mafeteng Hospital. “But now with everyone on ART, it is a bit easier because you know that everybody is enrolled…Even all of [the women], now they understand.”
As Matau points out, Option B+ is the best way to protect women through multiple pregnancies. Under the previous guidelines, mothers with low CD4 counts would stop treatment at the end of the breastfeeding period, only to start again at the beginning of a new pregnancy. “Maybe there were issues of drug resistance,” says Matau. “But now with this option you don’t need to start and stop over and over again.”
Lesotho is only the second country to implement Option B+ nationwide all at once – a huge task in a resource-limited country with difficult terrain. As a co-chair of Lesotho’s PMTCT technical working group, EGPAF played a large role in the transition, providing technical assistance to the Ministry of Health to create new guidelines, translating those guidelines into training materials, and rolling out the training materials at health facilities nationwide. EGPAF helped to implement these guidelines in all supported health facilities through the Strengthening Clinical Services Project (SCS) project, which was funded by United States Agency for International Development (USAID) from 2010-2015.
EGPAF-Lesotho country director Appolinaire Tiam, M.D. explains that unlike other countries that have struggled in their attempts to roll out Option B+, Lesotho did extensive preparation to ensure a successful transition.
“Option B+ increases the amount of drugs that you need. But the country did a good forecasting of the amount of drugs that were needed,” says Dr. Tiam. “They procured drugs for two years ahead. Since we started Option B+ there has not been stock-out of medicines [in Lesotho].”
Retsepile’s son, Boitumelo, is now a six-month-old, healthy baby who was born HIV-negative. As long as she continues her treatment, any future children Retsepile may have will also be protected from mother-to-child HIV transmission during pregnancy and breastfeeding. It is through the continued implementation of innovative programs such as Option B+ that we will end pediatric AIDS.
Lesotho is on their way to doing just that.