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Option B+ has enabled Malawi to make significant progress towards 90-90-90
Roger Pebody, 2016-02-27 13:10:00
In four years Malawi’s treatment cascade for pregnant women has been transformed so that the proportion of HIV-positive women who are diagnosed has gone from 49% to 80% and the proportion who are virally suppressed has jumped from 2% to 48%, the Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston heard this week.
The country’s creation and implementation of an Option B+ programme for pregnant women shows what can be achieved by a ‘treat all’ programme and the kind of health system reforms needed to deliver UNAIDS’ 90-90-90 targets, Andreas Jahn of the Malawian Ministry of Health told delegates.
Option B+ was first conceived and implemented in Malawi and offers antiretroviral therapy to all HIV-positive pregnant women, regardless of CD4 cell count or disease stage, with the intention that therapy will be continued after the pregnancy ends. It was designed to be a simple approach to implement in the context of extremely limited resources.
Since Malawi introduced Option B+ in 2011, the benefits of early initiation of antiretroviral therapy (ART) have become better understood and the World Health Organization now recommends that all people living with HIV are offered ART, regardless of CD4 cell count.
In the first half of 2011 – just before Option B+ was introduced – the coverage of ART was “abysmal”, Jahn said. Of all pregnant women living with HIV, an estimated 49% were diagnosed, 3% were receiving treatment, 2% were still in care after a year and 2% were virally suppressed.
Just four years later, in the first half of 2015, 80% of women living with HIV were diagnosed, 78% were receiving treatment, 60% were still in care after a year and 48% were virally suppressed.
If current trends continue, Malawi may be able to achieve 90-90-90 by the year 2020.
Option B+ is also preventing mother to child transmission. A presentation earlier in the week showed that in those women who had already begun ART before their current pregnancy (just under half of the sample), the transmission rate was 1.4% – comparable to that in many developed countries. Across the whole sample it was 4.1%.
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