Initial programmatic implementation of WHO option B in Botswana associated with increased projected MTCT.
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Author list: Dryden-Peterson S, Lockman S, Zash R, Lei Q, Chen JY, Souda S, Petlo C, Dintwa E, Lebelonyane R, Mmalane M, Shapiro RL
Publisher: Lippincott, Williams & Wilkins
Publication year: 2015
Journal: Journal of Acquired Immune Deficiency Syndromes (1525-4135)
Journal acronym: J Acquir Immune Defic Syndr
Volume number: 68
Issue number: 3
Start page: 245
End page: 9
Number of pages: -235
ISSN: 1525-4135
eISSN: 1944-7884
Languages: English-Great Britain (EN-GB)
Abstract
: Botswana was one of the first African countries to transition from WHO Option A to Option B for prevention of mother-to-child HIV transmission (MTCT). We evaluated the impact of this transition on projected MTCT risk through review of 10,681 obstetric records of HIV-infected women delivering at 6 maternity wards. Compared with Option A, women receiving antenatal care under Option B were more likely to receive combination antiretroviral therapy (ART), adjusted odds ratio (aOR): 2.59 (95% confidence interval: 2.25 to 2.98), but they were also more likely to receive no antenatal antiretrovirals, aOR: 2.10 (95% confidence interval: 1.74 to 2.53). Consequently, initial implementation of Option B was associated with increased projected MTCT at 6 months of age, 3.79% under Option A and 4.69% under Option B (P < 0.001). Successful implementation of Option B or B+ may require that ART can be initiated within antenatal clinics, and novel strategies to remove barriers to rapid ART initiation.
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