Uganda has adopted a new policy called Option B+ for the elimination of mother to child transmission of HIV (EMTCT). According to the Ministry Of Health the new policy guidelines focus not only on eliminating HIV transmission mother to child, but also reducing mortality and morbidity among HIV positive women, and HIV exposed and infected infants. It was adopted from the WHO 2010 guidelines on use of ARVs in pregnant women irrespective of their CD4 count.
Option B+ has already been launched in some districts, prioritized according to HIV prevalence as well as prevention of mother to child transmission (PMTCT) population coverage. The national launch and campaign for EMTCT in Uganda was at Ntungamo District, Itojo Hospital grounds, under the theme ‘Stand Out, Participate, Protect and Have an HIV-Free Baby’.
The champion of this new intervention is the first lady of the Republic of Uganda Janet Museveni who advised couples to go together for HIV testing and for mothers to attend antenatal care four times and give birth in a health facility to guarantee that the baby is born HIV free.
According to the Minister of Health Christine Ondoa the results of the 2011 Uganda AIDS indicator survey indicate that 7.3 per cent of adults in Uganda are living with HIV and 0.6 per cent of children under age five are infected. About 1.3 million people are living with HIV, and an estimated 145,000 new infections are occurring each year. Of these, mother-to-child transmission contributes16,000 (11 per cent) of these new infections.
The Minister revealed that in 2012, 1.6 million pregnancies occurred and about 5.5 per cent of these expectant mothers were estimated to be living with HIV. This translated to 88,000 pregnant women whose babies were at risk of acquiring HIV. With an average transmission rate of 30 per cent, it was estimated that about 26,400 babies would get infected with HIV in 2012 alone through mother to child transmission without intervention. This explains the Ministry’s new effort through Option B+.
Option B+ differs from previous PMTCT policies in that all HIV pregnant women will be initiated on Option B+ irrespective of her CD4 count.
Members of People Living with HIV (PLHIV) Networks from Kigulu South Iganga District, shared experiences about their enrolment in previous PMTCT programmes (Option A and Option B) and welcomed the new guidelines under Option B+. Under previous programmes some of them still gave birth to HIV positive children and/or did not receive adequate information about PMTCT which resulted in poor adherence to treatment.
At the same time they noted that the Options A and B only sought to prevent the child from being infected, but now Option B+ will cater for the good health of the mother as well.
The challenge the participants foresaw in Option B+ was about adherence, because some mothers find it difficult to disclose their HIV sero status to their spouses and yet there is need for partner support to effectively promote Option B+. Therefore there is need for government to ensure that male involvement in PMTCT interventions are highly considered.
The Government’s elimination of mother to child transmission of HIV strategy involves reducing the risk of HIV transmission from an infected mother to her baby during pregnancy, labor, delivery and breastfeeding to less than 5 per cent nationally. It aims to reduce transmission of HIV from infected mothers to their children by 90 per cent by 2015.
In addition to reducing new infections in children, Option B+ offers some other benefits and these include:
• Promotion of antiretroviral treatment for life for all HIV positive pregnant women
• Reducing the number of orphans
• Reducing transmission of HIV to the negative spouse in a discordant relationship
• Improving adherence and treatment outcomes
• Contributing towards achievement of MDG3, 4, 5 and 6
EMTCT services are provided in all hospitals, all health Centers IVs, most health center IIIs and 15 percent of health center IIs (these health centers are based rural community facilities that even those on a low income can access freely).