The government of Uganda has adopted the UN World Health Organization’s (WHO) “Option B+” to boost the prevention of mother-to-child HIV transmission (PMTCT).
Uganda currently uses a PMTCT system, which involves single-dose antiretroviral (ARV) drugs for the mother – if her CD4 count, a measure of immune strength, is over 350 – from the 14th week, as well as ARVs during labour, delivery and one week post-partum. Pregnant women with CD4 counts below 350 are advised to start taking ARVs for their own health.
Option B – which WHO introduced alongside Option A in 2010 – involves triple therapy ARVs from the 14th week of pregnancy until one week after breastfeeding has ended, which can be up to one year.
In April, WHO added Option B+ to its repertoire; it involves providing the same triple ARV drugs to all HIV-infected pregnant women beginning in the antenatal clinic setting, and continuing this therapy for the rest of their lives. Some of the benefits of the new option include PMTCT for future pregnancies, protection of a woman’s HIV-negative sexual partner from infection, and enabling continuity in ARV regimens, which reduces the chances of resistance.
The patron of the Uganda Paediatric Association First Lady Janet Museveni said Option B+ would go a long way in reducing the estimated 20,000-25,000 mother-to-child HIV infections that occur in Uganda annually during the launch in September 2012.
“We have to unite all various resources to fight this enemy. We are ringing the bell for all of us to rise up and fight…. We call for the end of paediatric HIV in Uganda,” she said. “We should keep in mind the [UN] Millennium Development Goals… we should not get to 2015 when our HIV prevalence rates are up.”
Option B+ was pioneered by Malawi in 2010; Swaziland has also expressed its intention to use the strategy, which Dr Scott Kellerman, global technical lead on HIV for Management Sciences for Health, a non-profit organization dedicated to improving health systems, which is of late called a “game-changer and one of the most exciting developments in decreasing vertical transmission and paediatric HIV in recent years”.
The US president’s Emergency Plan for AIDS Relief (PEPFAR) has funded the purchase of 25,000 packs of drugs for mother and baby under Option B+; Health Ministry officials say each mother-baby care package will cost about US$315.
“We welcome the policy shift. Not only will pregnant women receive the most effective care and treatment available, their unborn babies will also receive the most effective prophylaxis to prevent transmission of HIV during pregnancy, birth and breastfeeding,” Dan Travis, public affairs officer for the US Mission Uganda, told our reporters. “Furthermore, the policy will protect any discordant male partner and the administration of Option B+ will be easier on the clinical staff and health system.
“In addition to the base funding for PMTCT, a further $25 million has been allocated to support Uganda to eliminate mother-to-child transmission,” he added. “We will continue to work with the government of Uganda, all development partners and national stakeholders to ensure funding for Option B+.” .