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The case for Option B and Optional B+: Ensuring that South Africa’s commitment to eliminating mother-to-child transmission of HIV becomes a reality

D Besada, G Van Cutsem, E Goemaere, N Ford, H Bygrave, S Lynch
Southern African Journal of HIV Medicine | Vol 13, No 4 | a112 | DOI: https://doi.org/10.4102/sajhivmed.v13i4.112 | © 2012 D Besada, G Van Cutsem, E Goemaere, N Ford, H Bygrave, S Lynch | This work is licensed under CC Attribution 4.0
Submitted: 15 December 2012 | Published: 04 October 2012

About the author(s)

D Besada, Médecins Sans Frontières, Cape Town, South Africa
G Van Cutsem, Centre for Infectious Disease Epidemiology and Research, University of Cape Town, and Médecins Sans Frontières, Cape Town, South Africa
E Goemaere, Centre for Infectious Disease Epidemiology and Research, University of Cape Town, and Médecins Sans Frontières, Cape Town, South Africa
N Ford, Centre for Infectious Disease Epidemiology and Research, University of Cape Town, and Médecins Sans Frontières, Geneva, Switzerland
H Bygrave, Médecins Sans Frontières, London, United Kingdom
S Lynch, Médecins Sans Frontières Access Campaign, New York, United States

Abstract

In a previous issue of the Southern African Journal of HIV Medicine, Pillay and Black summarised the trade-offs of the safety of efavirenz use in pregnancy (Pillay P, Black V. Safety, strength and simplicity of efavirenz in pregnancy. Southern African Journal of HIV Medicine 2012;13(1):28-33.). Highlighting the benefits of the World Health Organization’s proposed options for the prevention of mother-to-child transmission (PMTCT) of HIV, the authors argued that the South African government should adopt Option B as national PMTCT policy and pilot projects implementing Option B+ as a means of assessing the individual- and population-level effect of the intervention. We echo this call and further propose that the option to remain on lifelong antiretroviral therapy, effectively adopting PMTCT Option B+, be offered to pregnant women following the cessation of breastfeeding, for their own health, following the provision of counselling on associated benefits and risks. Here we highlight the benefits of Options B and B+.

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