Is Option B+ the best choice?

Coutsoudis A, A Goga, C Desmond, P Barron, V Black, H Coovadia
Southern African Journal of HIV Medicine | Vol 14, No 1 | a94 | DOI: | © 2013 Coutsoudis A, A Goga, C Desmond, P Barron, V Black, H Coovadia | This work is licensed under CC Attribution 4.0
Submitted: 12 December 2013 | Published: 26 February 2013

About the author(s)

Coutsoudis A, Department of Paediatrics & Child Health, University KwaZulu-Natal, Durban, South Africa
A Goga, Medical Research Council, Pretoria, South Africa
C Desmond, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
P Barron, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
V Black, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
H Coovadia, MatCH, University of the Witwatersrand, Johannesburg, South Africa


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


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Crossref Citations

1. 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
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doi: 10.1111/tmi.12816