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‘Option B+’ program in Malawi increased access to ART for women
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ATLANTA — Malawi’s expansion of its antiretroviral therapy public health initiative to include a test-and-treat program for all HIV-positive pregnant or breast-feeding women regardless of their CD4 count and clinical status — referred to as “Option B+” — rapidly increased access to efficacious antiretroviral therapy treatments, researchers reported here.
“Option B+ has increased the number of HIV-infected pregnant and breast-feeding women accessing antiretroviral treatment by 820% in the first 18 months of implementation,” study researcher Beth Tippett Barr, DrPH, the CDC’s biomedical HIV prevention adviser, told Infectious Disease in Children.
The 2009 revised WHO guidelines for preventing mother-to-child transmission (PMTC) of HIV made CD4 count testing a prerequisite for PMTC. However, Malawi health officials implemented Option B+ to include all HIV-positive women who are pregnant or breast-feeding, which removed barriers to ART access, according to Tippett Barr.
Beth Tippett Barr
Between March and September 2012, the total number of women receiving antiretroviral drugs during pregnancy increased to 19,735 from 13,910 in January to June 2011 — the 6-month period before Option B+ was implemented. In March 2012, 100% of pregnant women with HIV who received antiretroviral treatment were prescribed ART vs. the 6 months before Option B+, when only 2,398 (17%) received ART. From July to September 2012, 87% of all known pregnant women with HIV received antiretroviral drugs. Among those women, 31% were previously receiving ART when entering antenatal care.
During the same time period, 25% of women initiating ART under Option B+ were breast-feeding. According to the researchers, 83% of women who enrolled in Option B+ between July and December 2011 were retained in the treatment at 6 months, which was comparable to the entire ART cohort initiated between April and June of the same year, when the 12-month ART retention was 80%.
“Option B+ women have continued on treatment at a rate comparable to other adult ART patients receiving antiretroviral treatment,” Tippett Bar said.
According to the CDC, Malawi was the first country to initiate Option B+, but other countries have since developed similar policies, including Rwanda, Uganda and Haiti.
For more information:
Barr BT. #82. Presented at: 20th Conference on Retroviruses and Opportunistic Infections; March 3-6, 2013; Atlanta.
CDC. MMWR. 2013;62:141-156.
Disclosure: Tippett Barr reports no relevant financial disclosures.
Perspective
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Elizabeth Connick, MD
The introduction of Option B+ into Malawi as well as other African countries is very exciting. By treating pregnant women, infections in the children of these women and their sexual partners will be reduced. Furthermore, ensuring the mothers' health will allow them to care for their families. It is obvious that this will impact the HIV epidemic, although the question is to what extent. It will be very important to document how much Option B+ reduces AIDS-related morbidity and mortality in these countries, in order to inform future interventions in the HIV epidemic.
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