Lessons Learned From Option B+ in the Evolution toward "Test and Start" from Malawi, Cameroon, and the United Republic of Tanzania
Option B+ for prevention of mother-to-child transmission (PMTCT) specifies treating all HIV-positive women with antiretroviral therapy (ART) regardless of CD4 count. This simplified approach enhances countries' capacity to reach national HIV targets and contribute to the global 90-90-90 goals. This article reviewed the progress of Malawi's adoption of Option B+ for PMTCT and briefly described its implementation in Cameroon and Tanzania. Option B+ was developed in Malawi in response to numerous systemic barriers to the rapid scale-up of ART and PMTCT services. Operationalizing Option B+ required several critical considerations, including integrating ART and PMTCT programs, developing systems for following up mother–baby pairs, reducing systemic barriers to rapidly increase access to ART, building consensus with stakeholders, and securing funding for the new program. The authors detailed several lessons that could be of interest to countries adopting the approach of treating all HIV-positive pregnant women, as follows:
- Comprehensive change requires effective government leadership and coordination.
- ART services and commodities should be decentralized for broader access.
- National clinical guidelines must accommodate health system limitations.
- Regular monitoring and validation of program data support rapid program improvements.