Initial programmatic implementation of WHO option B in Botswana associated with increased projected MTCT
Dryden-Peterson, S.; Lockman, S.; Zash, R.; Lei, Q.; Chen, J.Y.; Souda, S.; Petlo, C.; Dintwa, E.; Lebelonyane, R.; Mmalane, M.; Shapiro, R.L.
Journal of Acquired Immune Deficiency Syndromes 68(3): 245-249
2015
ISSN/ISBN: 1525-4135 PMID: 25501611 DOI: 10.1097/qai.0000000000000482Document Number: 626894
: 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.