One-Year Outcomes of Women Started on Antiretroviral Therapy during Pregnancy before and after the Implementation of Option B+ in Malawi: A Retrospective Chart Review from Three Facilities

Abstract

Objective To compare one-year outcomes of women started on antiretroviral therapy (ART) during pregnancy in the pre-Option B+ era to those in the Option B+ era. Methods A retrospective chart review was performed at three sites in Malawi. Women were included in the ‘pre-Option B+’ cohort if they started ART during pregnancy for a CD4 count < 350 cells/mm3 or WHO 3/4 condition and in the ‘Option B+’ cohort if they started ART during pregnancy regardless of CD4 count or clinical stage. One-year outcomes were compared using Fisher's exact and ANOVA F-tests. Results A higher proportion of women in the pre-Option B+ cohort started ART at WHO stage 3/4 (11.9% versus 1.1%, P < 0.001), switched ART regimens (5.9% versus 0%, P = 0.002), or died in the first year after starting treatment (3.9% versus .5%, P = 0.05). While more women in the Option B+ cohort had poor adherence or defaulted, these differences were not significant. Conclusions At our study sites, the transition to Option B+ has been associated with ART initiation in women with less advanced HIV infection, improved medication tolerability, and lower mortality. Further research is needed to better understand outcomes of Option B+.

Nurses and midwives’ perceptions of option B+ treatment protocol for the prevention of mother-to-child transmission of HIV in Lubumbashi, Democratic Republic of Congo

“…In addition, the introduced PMTCT interventions have been effective in preventing infection in newborns, as other researchers have previously demonstrated [14]. Like other researchers [15], we found providers believed that antiretroviral combination therapy led to dramatic improvements in the survival of women living with HIV.…”

Levels of adherence and factors associated with adherence to option B+ prevention of mother-to-child transmission among pregnant and lactating mothers in selected government health facilities of South Wollo Zone, Amhara Region, northeast Ethiopia, 2016

“…Very few studies have shown this relationship, but a study carried out among Malawian women described that feeling pressure to initiate ART immediately at the time of HIV diagnosis with little or no support in health-related decision-making was significantly associated with poor adherence [22,23]. …”

Effectiveness of Lifelong ART (Option B+) in the Prevention of Mother-to-Child Transmission of HIV Programme in Zambia: Observations Based on Routinely Collected Health Data

“…There is substantial body of literature from elsewhere on the effectiveness of the PMTCT programme in reducing transmission from mother to child, but data from Africa about the operational effectiveness of Option B+ in the PMTCT are sparse (17,(19)(20)(21)(22)(23)(24)(25)(26)(27). Particularly in Zambia the effectiveness of option B+ has not been evaluated, as far as we are aware, thereby raising concerns on its effectiveness in the elimination of MTCT.…”