Option B+: Hope for HIV-Infected Pregnant Women, HIV-Free Newborns in Uganda
When Rose Chebet was five months pregnant with twins, she visited Kapchorwa Hospital in Eastern Uganda for a routine antenatal visit. She was devastated to learn that she was HIV positive and she feared her twins would not survive. Health workers referred Chebet, a first-time mother, to an antiretroviral therapy (ART) clinic where she began taking medication.
Four months later, Chebet gave birth to two healthy boys, Chekwech and Chesuro. Said Chebet, 22:
I was given strict instructions on how to feed and look after them.
The boys were immediately put on antiretroviral (ARV) prophylaxis. When both the mother and child are treated with ARVs, the risk of transmitting the virus during pregnancy, labor, delivery, or breastfeeding is reduced from 15 to 45 percent to just over 1 percent.
At six weeks old, Chekwech and Chesuro tested HIV negative.
Prevention of mother-to-child transmission (PMTCT) of HIV is one of the key activities supported by the Strengthening TB and HIV & AIDS Responses in Eastern Uganda (STAR-E) project. STAR-E, a US Agency for International Development (USAID) project, is funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) and implemented by a Management Sciences for Health (MSH)-led consortium of international and Ugandan partners.
The project (2009–2016) provides technical and other assistance to 12 districts of Eastern Uganda, including support to 154 district health facilities to provide comprehensive and quality HIV and TB services. STAR-E’s efforts have greatly reduced mother-to-child transmission in the Eastern Region, with the rate dropping from about 9 percent in 2012 to 6 percent in 2015.
In 2012, Uganda became the second country in Africa to formally adopt Option B+ for PMTCT as a national strategy to provide for lifelong ART for all pregnant HIV-infected women regardless of gestational age and CD4 cell count. Option B+ was first pioneered in Malawi, with support from MSH. STAR-E has trained and mentored more than 1,000 facility-based health workers to provide Option B+ at all 154 project-supported health facilities.
In addition to training health workers, STAR-E has also trained linkage facilitators to follow up with HIV-infected mothers and others to ensure they continue treatment. Linkage facilitator Helen Chelengat routinely follows up with Chebet to make sure that she keeps health care appointments and takes her medicine at home. Chelengat also gives Chebet and her husband guidance on feeding practices for their children to ensure good nutrition.
Currently, Chebet is seven months pregnant and is optimistic that her third child will be HIV free. Her husband, who is HIV negative, is supportive:
We hope to have two more children and then stop.
Chebet is grateful to staff at Kapchorwa Hospital for their support and encourages other mothers to seek early treatment. She said:
I am very happy to have healthy children.
More about Option B+
Option B+, a strategy for PMTCT, provides lifelong ART for all pregnant HIV-infected women regardless of gestational age and CD4 cell count. CD4 count is a measure of CD4 cells per cubic millimeter of blood. HIV attacks CD4 cells, which play a major role in protecting the body from infection. The Malawi Ministry of Health devised Option B+ with support from MSH’s Basic Support for Institutionalizing Child Survival (BASICS) program, funded by USAID. Option B+ was fully adopted by the World Health Organization (WHO) in 2013 (PDF).