Dignitas International’s researchers enthusiastically participated in the 20th International AIDS Conference in Melbourne last week with both oral and poster presentations. Research topics presented by our team ranged from the pharmacokinetics of anti-tuberculosis drugs to understanding the transition to adulthood for HIV+ adolescents, but our main focus at this year’s conference was targeted on the elimination of mother-to-child transmission of HIV in Malawi’s Option B+ era. (For a full summary of our participation at AIDS2014, click here.
A critical component of our frontline medical care, Dignitas has been working closely with the Malawi Ministry of Health to implement a groundbreaking HIV program known as Option B+, designed to improve maternal health and eliminate mother-to-child transmission of HIV. The Option B+ program employs a ‘test and treat’ strategy to ensure all pregnant women and breastfeeding mothers are offered HIV testing and all those who test positive are offered immediate access to lifelong antiretroviral therapy, regardless of the stage of their disease. Malawi was the first country to roll out this program, which began in November 2011. Since then, the World Health Organization has endorsed Option B+ and several countries including the Democratic Republic of Congo, Haiti, Lesotho, Rwanda, Uganda and Zimbabwe have adopted the strategy.
Program results to date have shown a dramatic increase in the number of mothers initiated on treatment but there are challenges. At the conference, our Medical and Research Dr. Joep van Oosterhout presented an oral abstract related to the performance of different Option B+ “models of care” used for starting lifelong antiretroviral therapy for pregnant women in Malawi. Results from our recently completed Models of Care study showed that 20% of pregnant women that started HIV treatment at an antenatal clinic but were then transferred to an HIV clinic for follow-up stopped treatment within six months. Better results were found when pregnant women were started and followed on treatment at the same clinic until delivery. Furthermore, results from our PURE formative study indicate that both patients and health workers have concerns with the immediacy of the Option B+ strategy by which patients are tested and started on treatment within a few hours or a few days, leaving little time for patients to ‘digest’ a positive diagnosis and discuss treatment options with their families. There may also be an opportunity to better engage male partners into the program while addressing the need for privacy and confidentiality. The next step is patient-level research to explore which models of care are most successful in encouraging women to get tested and, if positive, stay on lifelong treatment and care.
Dignitas is working on a number of research studies related to the implementation of Option B+ in Malawi. Our partners include the Malawi Ministry of Health (through the Department of HIV and AIDS), the U.S. Centers for Disease Control and Prevention, Management Sciences for Health, the International Union Against Tuberculosis and Lung Disease, the MRC-UK Clinical Trials Unit/Lablite Project and the PURE Malawi Consortium [including Lighthouse Trust, University of North Carolina-Malawi Project, University of Malawi’s College of Medicine and Chancellor College, Malaria Alert Centre, mothers2mothers and the Karonga Prevention Study].
With Option B+, the Malawi Ministry of Health has taken a bold approach to eliminating mother-to-child HIV transmission. As Option B+ continues to be rolled out across Malawi and other sub-Saharan African countries, finding the optimal model of care will be paramount to the success of the program, which holds the promise of an AIDS-free generation. Along with our partners, Dignitas will continue to conduct vital research to determine the effects of Option B+ throughout the cascade of Prevention of Mother-to-Child Transmission services. Research around the Option B+ strategy will provide a roadmap for Malawi and for other countries in the region. For press coverage on our oral presentation at AIDS2014, click here.