Mother-to-child transmission of HIV is the most common source of HIV infection in children. In 2010, it was estimated that 20% of all children born in sub-Saharan Africa were exposed to HIV, resulting in 130,000 infections.
In 2011, Malawi introduced a public health approach to improve the effectiveness of its Prevention of Mother-to-Child Transmission (PMTCT) program by offering all HIV-infected pregnant and breastfeeding women lifelong antiretroviral therapy (ART) regardless of clinical stage or CD4 count. The strategy, called Option B+, has since been adopted by several other countries in the region and was included in the 2013 updated World Health Organization guidelines. Option B+ is expected to have benefits for HIV+ women, their HIV-exposed infants, and their HIV-uninfected partners. However, these benefits hinge on early initiation of PMTCT, good adherence, and long-term retention in care.
Through a three-arm cluster randomized control trial, the PURE study will evaluate whether the Option B+ standard of care with the addition of either clinic- or community-based peer support will improve the likelihood of mothers and families starting and remaining in PMTCT care.