Lessons Learned From Option B+ in the Evolution toward "Test and Start" from Malawi, Cameroon, and the United Republic of Tanzania

Kalua, T., Tippett Barr, B.A., van Oosterhout, J.J., et al.

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.
June 7, 2017
Year of publication
Resource types
Journal and research articles
option B+, prevention of mother-to-child transmission (PMTCT), PMTCT, Malawi, Cameroon, Tanzania, Test and Start, antiretroviral therapy, ART, treatment, HIV prevention, pregnant women, key populations

Similar Resources

To understand the uptake of HIV services by adolescent women, the authors conducted a retrospective analysis of patient-level data (2011–2013) on services for antenatal care (ANC) and prevention of mother-to-child transmission (PMTCT) in 36 facilities in 5 districts in Zimbabwe.

This study aimed to evaluate the impact of clinic-based prevention of mother-to-child transmission (PMTCT) community support by trained lay health workers in addition to standard clinical care on PMTCT infant outcomes.

In 2013, Uganda updated its prevention of maternal-to-child transmission of HIV program to Option B+, which requires that all HIV-infected pregnant and breastfeeding women be started on lifelong antiretroviral therapy (ART) regardless of CD4 count…

This paper documents the development of the global and national monitoring and reporting systems for PMTCT and paediatric HIV care and treatment programmes, achievements and remaining challenges.

Many countries are working to reduce or eliminate mother-to-child transmission (MTCT) of HIV. Prevention efforts have been conceptualized as steps in a cascade but cascade completion rates during and after pregnancy are low.

Timely access to antiretroviral treatment (ART) is vital to ensuring safe motherhood and reducing vertical transmission. Treatment guidance and programming has changed dramatically in recent years.

An essential first step in caring for HIV-infected children is accurate and early diagnosis of HIV, early HIV testing, prompt return of results, and rapid initiation of treatment.

Universal antiretroviral therapy (ART) for all pregnant/ breastfeeding women living with HIV, known as prevention of mother-to-child transmission of HIV (PMTCT) Option B+ (PMTCTB+), is being scaled up in most countries in Sub-Saharan Africa.

Remarkable progress is being made on HIV treatment. Ahead of World AIDS Day, UNAIDS has launched a new report showing that access to treatment has risen significantly. In 2000, just 685 000 people living with HIV had access to antiretroviral therapy.

We conducted a retrospective study to investigate the effectiveness of an mHealth messaging intervention aiming to improve maternal health and HIV outcomes.