Option B+ improving outcomes
Continuing with the theme of anti-retroviral drugs this weekend, let us take a look at Option B+. Malawi can own this one! Western countries or international agencies like the World Health Organisation recommend most HIV initiatives and program innovations. Option B+ was a Malawian advancement. The Ministry of Health devised this approach with the support of Management Sciences for Health’s Basic Support for Institutionalising Child Survival (Basics) programme, funded by Usaid. In 2011, Option B+ was launched in Malawi, the approach enables pregnant and breastfeeding women who test positive for HIV to begin lifelong treatment. It goes beyond the standard prevention of mother to child transmission approaches, under Option B+ regardless of CD4 count, pregnant and breastfeeding women start anti-viral therapy and they continue with therapy for life.
Normal practice for prevention to mother transmission is for pregnant women with CD4 counts below 350 or at clinical stage 3 or 4 to begin lifelong treatment. For pregnant women who are not eligible for ART treatment i.e. their CD4 count is above 350, there are two options. Option A and Option B. Option A involves a taking a single drug (AZT) during pregnancy and additional ARVs during labour, delivery and immediately after birth for seven days. Option B involves taking three ARVs during pregnancy and breastfeeding. Both Option A and B include the infant also taking additional antiretroviral medication.
Option B+ (i.e. 5A– tenofovir/lamivudine/
Within 18 months of Malawi introducing Option B+, the number of HIV-infected pregnant women on ART increased by a staggering 700 percent. A cost effective analysis of Option B+ found that not only does it prevent infant infections, it improves the ten year survival of mothers more than four-fold compared to other Options. It greatly increases the number of maternal life years and is more cost effective compared to other Options. Option B+ is also advantageous in that it does not rely on access to CD4 testing equipment.
Other countries have adopted the approach – Rwanda, Uganda, and Haiti and the World Health Organisation has embraced Option B+ as a combined strategy for prevention of mother- to -child transmission and anti-retroviral therapy. Other countries such as South Africa are hesitant, stressing concerns over adherence and resistance in mothers who do not need treatment for their own health and recommending that countries should make individual decisions based on their HIV infection rates, resources, priorities and local evidence.
