Time to get wonky: Learn about Option B+, an anti-HIV ‘treatment for life’

Erin Hohlfelder interviews Beth Tippett Barr, the CDC’s biomedical HIV prevention adviser in Malawi, who sheds light on Option B+, an approach that provides treatment for life for all HIV-positive pregnant women. 

Joyce Dixon and Tamanda at a Community Mobilization Event
Joyce Dixon and her daughter Tamanda are part of a PMTCT program in Malawi. Photo credit: The Clinton Foundation, Flickr

With Mother’s Day just around the corner in the US, the global health community often (rightfully) focuses on the tragedy of maternal mortality. But a number of other health issues also impact mothers around the world, including those who become pregnant while living with HIV.

Traditionally, to prevent transmission of HIV from mothers to their infants, HIV-positive pregnant women who are still fairly healthy are put on a short course of antiretroviral drugs that lasts from pregnancy until they have finished breastfeeding. But more recently, some countries have switched over to a treatment program called “Option B+,” an approach that provides treatment for life for all HIV-positive pregnant women as a way to provide continued protection for both the mother and her child.

To learn more about this issue, we spoke with Beth Tippett Barr, the CDC’s biomedical HIV prevention adviser in Malawi. In our conversation, she shares a message to US members of Congress, explains why more investments should be made toward Option B+, and explains why it’s a game changer.

Erin: What have prevention of mother-to-child (PMTCT) efforts to-date in Malawi looked like, and how has the introduction of Option B+ changed that picture?

Beth: Until 2011, Malawi had separate PMTCT and adult treatment programs.  There were many barriers to scaling up PMTCT, including a lack of access to CD4 counts testing, supply chain challenges, and very limited follow-up for infants exposed to HIV.  The Malawi Government’s introduction of Option B+ was a calculated decision designed to improve health outcomes by streamlining, simplifying and integrating health services, thus eliminating many of the barriers to PMTCT.

The implementation of Option B+ included rigorous training of clinical officers and nurses in the country, and rapid decentralization of ART services to all clinic sites. As a result, the HIV-positivity rate in exposed infants tested at 6 weeks of age has plummeted as low as 2 percent from a previous 31 percent.

How do you convince Ministers of Finance that Option B+ is a worthwhile investment?

Option B+ impacts many aspects of the HIV epidemic, not just vertical transmission from mother to child.  These benefits include provision of more effective treatment regimens for pregnant women, the reduction of mother-to-child transmission through early treatment access, reduced disease and death of those on treatment, and subsequently, fewer orphaned children.

When these benefits are combined, projections done by the PEPFAR-funded Futures Group and others have shown that we can achieve virtual elimination of mother-to-child-transmission in known HIV-positive pregnant women through implementation of Option B+.

Are there personal or human impact stories from the frontlines of PMTCT work in Malawi that stand out? What keeps you going through a long day or a tough week?

Through implementation of Option B+, Malawi has averted thousands of additional infant infections and deaths, which is extremely satisfying.

Also, knowing that HIV-infected pregnant women now have lifelong access to a simple and safe intervention for their own health and that of their children, and seeing the testimonials from women about the positive impact is very compelling. 

What also stands out to me is the enthusiasm with which health workers have taken on Option B+, regardless of the many personal and professional constraints they face.  Malawi has a severe human resource shortage, with vacancy rates at health facilities often exceeding 70 percent. Health care workers are underpaid, overworked, often posted to facilities away from their families, and frequently face stock-outs of the commodities needed to provide basic health care. Option B+ has helped them to experience real and visible successes, which is a great motivation and morale booster when working under such difficult circumstances.

What messages do US members of Congress need to hear about the work going on in Malawi?  What lessons are applicable for other African leaders?

There are two messages I’d like everyone to hear about the work in Malawi.  First, a simplified, integrated approach can work wonders for the scale-up of services and the impact on the health and productivity of a population. When donors and partners work collaboratively under strong host government leadership to implement an approach like this, much can be accomplished in a very short space of time.

Second, for the first time in the history of HIV, there is a glimpse of hope that we can virtually eliminate new HIV infections.  However, budget cuts directly threaten the gains in prevention that could be realized in the coming years through increasing early access to ART and VMMC.  Strong and sustained commitment, with investments focused on evidence-based interventions, is needed both globally and nationally in order to build upon the successes achieved thus far towards achieving an AIDS-free generation.

Thank you Beth for taking the time to talk to ONE! If you have any questions, please leave them in a comment below. 

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