Fundamental concerns of women living with HIV around the implementation of Option B+

Abstract

IntroductionIn 2011, the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping Their Mothers Alive was launched to scale up efforts to comprehensively end vertical HIV transmission and support mothers living with HIV in remaining healthy. Amidst excitement around using treatment as prevention, Malawi's Ministry of Health conceived Option B+, a strategy used to prevent vertical transmission by initiating all pregnant and breastfeeding women living with HIV on lifelong antiretroviral therapy, irrespective of CD4 count. In 2013, for programmatic and operational reasons, the WHO officially recommended Option B+ to countries with generalized epidemics, limited access to CD4 testing, limited partner testing, long breastfeeding duration or high fertility rates.DiscussionWhile acknowledging the opportunity to increase treatment access globally and its potential, this commentary reviews the concerns of women living with HIV about human rights, community-based support and other barriers to service uptake and retention in the Option B+ context. Option B+ intensifies many of the pre-existing challenges of HIV prevention and treatment programmes. As women seek comprehensive services to prevent vertical transmission, they can experience various human rights violations, including lack of informed consent, involuntary or coercive HIV testing, limited treatment options, termination of pregnancy or coerced sterilization and pressure to start treatment. Yet, peer and community support strategies can promote treatment readiness, uptake, adherence and lifelong retention in care; reduce stigma and discrimination; and mitigate potential violence stemming from HIV disclosure. Ensuring available and accessible quality care, offering food support and improving linkages to care could increase service uptake and retention. With the heightened focus on interventions to reach pregnant and breastfeeding women living with HIV, a parallel increase in vigilance to secure their health and rights is critical.ConclusionThe authors conclude that real progress towards reducing vertical transmission and achieving viral load suppression can only be made by upholding the human rights of women living with HIV, investing in community-based responses, and ensuring universal access to quality healthcare. Only then will the opportunity of accessing lifelong treatment result in improving the health, dignity and lives of women living with HIV, their children and families.

Retention in care and reasons for discontinuation of lifelong antiretroviral therapy in a cohort of Cameroonian pregnant and breastfeeding HIV‐positive women initiating ‘Option B+’ in the South West Region

“…In Malawi, a 17% LTFU at 6 months after ART initiation was observed with a better retention in care in women who did not start ART on the same day of HIV diagnosis or who received focused counselling . In a commentary on women concerns about initiating Option B+, the authors argued that if women are not adequately prepared, they can experience various human right violations including lack of informed consent, involuntary or coercive HIV testing, limited treatment options, termination of pregnancy or coerced sterilisation and pressure to start treatment . In their recently updated guidelines, WHO suggests to make any effort to reduce the time between HIV diagnosis and ART initiation based on the assessment of the person's readiness to start.…”

Mobile Phone Communication for Improving Uptake of Antiretroviral Therapy in HIV-infected Pregnant Women: Review

“…Recently, most sub-Saharan Africa Ministry of Health introduced the option B+ which expands lifelong highly active antiretroviral therapy (HAART) to all HIV-infected pregnant women independent of CD4 cell count and clinical staging . In HIV-infected pregnant women, option B+ presents to increase treatment access globally and its potential in improving mothers' and babies' health, reduced stigma and opportunities to breastfeed (Matheson 2015). Option B+ has been adopted by several sub-Saharan countries (Schouten 2011; Republic of Zambia Ministry of Health 2013; Herlihy 2015).Then, the adequate measure should be taken in Sub-Sahara particularly, and in developing countries to strengthen option B+.…”

Awareness and perceived fairness of option B+ in Malawi: a population‐level perspective

“…Throughout the rapid expansion of Option B+, there have been relatively few voices of caution or critique. Nonetheless, some have raised ethical concerns including the risk of impinging upon access for immuno-compromised men and non-pregnant women, the top-down nature of a policy developed with little-to-no input from communities, and the speed with which it was adopted and spread absent evidence of improved PMTCT outcomes [27][28][29][30].…”