[afro-nets] AIDS 2012: MSH Supports Growing International Acceptance of Option B+

["Management Sciences for Health" <communications@msh.org>]

MSH Supports Growing International Acceptance of Option B+, Encourages Country Adoption,
Further Research

View online:
http://www.msh.org/news-bureau/msh-supports-growing-international-acceptance-of-option-b.cfm

As the international community gathered for the XIX International AIDS Conference last week, HIV & AIDS experts and key organizations voiced their  support for a new approach to preventing mother-to-child transmission of  HIV: Option B+, which calls for antiretroviral therapy (ART) for all HIV-positive pregnant women for life, regardless of CD4 levels.

The government of Malawi, with the support of MSH, adapted the World  Health Organization (WHO) guidelines on preventing mother-to-child  transmission, to the needs of Malawi.
Unable to quickly and accurately ensure results from CD4 counts on  HIV-positive women, and struggling to adjust treatment regimens given high fertility rates and frequent pregnancies, Malawi elected to  combine ART with PMTCT in a new approach they dubbed Option B+ which  offers lifelong treatment to all HIV-positive pregnant women, regardless  of their CD4 levels. The Malawi Ministry of Health devised this  approach with support of MSH's Basic Support for Institutionalizing  Child Survival (BASICS) program, funded by USAID.

Dr. Erik Schouten of MSH and colleagues described the bold, new approach in a Lancet article in July, 2011. 

Option B+ puts women and children first, and, as Schouten and  colleagues argue, will likely be cost-effective for countries, like Malawi, in the long-term.

In April, 2012, the World Health Organization (WHO) released a programmatic update on "Use of ARVs for Treating Pregnant Women and Preventing HIV Infection in Infants". In the executive summary, the WHO said:

"Now a new, third option (Option B+) proposes further evolution-not only  providing the same triple ARV drugs to all HIV-infected pregnant women  beginning in the antenatal clinic setting but also continuing this  therapy for all of these women for life.
Important advantages of Option  B+ include: further simplification of regimen and service delivery and  harmonization with ART programmes, protection against mother-to-child  transmission in future pregnancies, a continuing prevention benefit  against sexual transmission to serodiscordant partners, and avoiding  stopping and starting of ARV drugs. While these benefits need to be  evaluated in programme settings, and  systems and support requirements  need careful consideration, this is an appropriate time for countries to  start assessing their situation and experience to make optimal  programmatic choices."

Since July 2011, MSH has helped train a cadre of 3,366 health  workers in Malawi.
Within the first year of implementation in Malawi, the number of HIV-positive pregnant women starting ARV treatment has  increased six-fold from 1,200 per quarter prior to implementation, to  7,200 in the quarter ending in June 2012. MSH is currently working on a  cost-benefit analysis, and is studying the efficacy and challenges of Option B+ scale up for preventing vertical transmission in Malawi.

Now others are following Malawi's lead, particularly in light of Ambassador Eric Goosby's and UNAIDS' Michel Sidibé's call for eliminating pediatric HIV by 2015. Earlier this year, Uganda announced its intention to adopt  Option B+; UNICEF began a thorough review of the approach; and other  countries have expressed a strong interest in moving toward including  Option B+ in their strategies for decreasing vertical HIV transmission.

Throughout the XIX International AIDS Conference researchers and  global health leaders touted the benefits of Option B+, and discussed  the potential for combining ART and PMTCT in other countries.

At a  satellite session on Sunday, July 22, leaders from UNICEF, the  International AIDS Society (IAS) and MSH discussed Option B+ for  preventing vertical transmission.
Dr. Chewe Luo, Senior Programme Advisor  at UNICEF, discussed the topic in depth during her plenary speech on  July 25. And in the closing words of the conference,two rapporteurs  gave a hat-tip to Option B+, displaying early data from Malawi, provided  by Schouten.

"Option B+ is a game-changer and one of the most exciting  developments in decreasing vertical transmission and pediatric HIV in  recent years. In short, it calls for  treating the mother, preventing  vertical transmission to the child, and continuing to treat the mother.  It offers the promise of much reduced vertical transmission rates while  simultaneously decreasing maternal morbidity and mortality from HIV,"  says Dr. Scott Kellerman, MSH's global technical lead on HIV & AIDS.

MSH is thrilled that the global momentum toward Option B+ is building.

Option B+ may not be right for every country or every  situation, but in Malawi -- and likely in many more countries -- Option B+  will prove efficacious and cost-effective in not only protecting  babies, but also in treating HIV-positive women.

MSH is proud to have  been a part of the inception of this idea and looks forward to working  with our broad network of HIV & AIDS programs throughout sub-Saharan Africa and the world, using our technical capacity and research ability to investigate the operational issues that need to be addressed and  understood for optimal implementation and scale-up of this approach.

Learn more about Option B+:

* The  Lancet: Prevention of mother-to-child transmission of HIV and the health-related Millennium Development Goals: time for a public health approach
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2962303-3/fulltext

* The WHO Executive Summary, 2012 April 
http://www.who.int/hiv/PMTCT_update.pdf (PDF)

* PMTCT and 5th Birthdays: Not Without the Mothers
http://blog.msh.org/2012/05/31/not-without-the-mothers/

** More from MSH at AIDS 2012 **
http://conferences.msh.org/aids2012/

For additional information or to arrange for a press interview, please contact Barbara Ayotte, Director of Strategic Communications, at 617.852.6011 or communications@msh.org. 

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