Is Option B+ the best choice?

Southern African Journal of HIV Medicine

Field Value
Title Is Option B+ the best choice?
Creator A, Coutsoudis Goga, A Desmond, C Barron, P Black, V Coovadia, H
Description This article is reprinted from The Lancet, with permission from Elsevier: Coutsodis A, Goga A, Desmond C, Barron P, Black V, Coovadia H. Is Option B+ the best choice? Lancet 2013;381(9863):269-271. [http://dx/]

The success of prevention of mother-to-child transmission (PMTCT) programmes (Options A and B) in middle-income countries, together with clinical trial data on antiretroviral (ARV) treatment as prophylaxis, has emboldened UN agencies to aggressively promote lifelong ARVs for PMTCT (Option B+). Unsubstantiated claims submit that Option B+ is cost-effective at population-level, will protect HIV-negative male partners, improve maternal and infant health, and increase ARV coverage. We provide counterfactual arguments about the ethics, medical safety, programme feasibility and economic benefits of Option B+. Option B+ offers no advantage to PMTCT and there are social hazards associated with privileging pregnant woman for treatment over men and non-pregnant women, especially with the absence of data to suggest that discordant relationships are more frequent among pregnant women or that they contribute disproportionately to the horizontal HIV transmission. The benefits and safety of long-term ARVs – including adherence and resistance – in mothers who do not need treatment for their own health, need to be considered, as well as, crucially, health service costs. The assumption that a decrease in efficiency caused by inappropriate targeting is compensated for by lower recruitment costs, is untested. Lives could be saved instead with appropriately targeted interventions. Countries should make individual decisions based on their HIV epidemiology, resources, priorities and local evidence.

S Afr J HIV Med 2013;14(1):8-10. DOI:10.7196/SAJHIVMED.898
Publisher AOSIS
Date 2013-02-26
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion —
Format text/html application/pdf
Identifier 10.4102/sajhivmed.v14i1.94
Source Southern African Journal of HIV Medicine; Vol 14, No 1 (2013); 8-10 2078-6751 1608-9693
Language eng
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Rights Copyright (c) 2013 Coutsoudis A, A Goga, C Desmond, P Barron, V Black, H Coovadia