Initial programmatic implementation of WHO option B in Botswana associated with increased projected MTCT
Scott Dryden-Peterson1, Shahin Lockman, Rebecca Zash
1*Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA; †Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; ‡Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA; §Department of Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA; ‖Department of Biostatistics, Harvard School of Public Health, Boston, MA; ¶Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA; #Department of Pathology, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana; and **Department of HIV/AIDS Prevention and Care, Ministry of Health, Gaborone, Botswana.
Botswana
Area of Science:
- Public Health
- Infectious Diseases
- HIV/AIDS Research
Background:
- Botswana transitioned from WHO Option A to Option B for preventing mother-to-child HIV transmission (MTCT).
- This policy shift aimed to improve HIV outcomes for pregnant women and infants.
- Evaluating the impact of this transition is crucial for public health strategies.
Purpose of the Study:
- To evaluate the impact of Botswana's transition from Option A to Option B on projected MTCT risk.
- To identify factors associated with ART initiation under the new Option B protocol.
- To inform future strategies for optimizing MTCT prevention programs.
Main Methods:
- Retrospective review of 10,681 obstetric records from HIV-infected women across 6 maternity wards.
- Statistical analysis comparing ART uptake and projected MTCT rates between Option A and Option B.
- Calculation of adjusted odds ratios (aOR) with 95% confidence intervals to assess associations.
Main Results:
- Women under Option B were more likely to receive combination antiretroviral therapy (ART), aOR: 2.59.
- However, Option B was also associated with a higher likelihood of receiving no antenatal antiretrovirals, aOR: 2.10.
- Initial Option B implementation showed increased projected MTCT at 6 months (4.69%) compared to Option A (3.79%), P < 0.001.
Conclusions:
- The initial implementation of Option B in Botswana was associated with a higher projected MTCT risk.
- Barriers to rapid ART initiation within antenatal clinics need to be addressed for successful Option B/B+ implementation.
- Novel strategies are required to improve ART access and reduce MTCT rates effectively.