Effectiveness of option B+ towards elimination of mother to child transmission of HIV: A retrospective cohort study of 6 selected facilities in Lusaka,Zambia

Abstract

Most countries in sub-Saharan Africa are encouraged to adopt WHO recommended Option B+, but there is a general fear that the evidence for its effectiveness has not been demonstrated in different settings. Option B+ is an intervention that ensures administering of life-long HIV treatment to HIV infected pregnant women regardless of their CD4 count. Zambia for example, still has a generalized HIV epidemic and thus programs that focus on reducing mother to child transmission of HIV ought to have clear evidence of the effectiveness of new interventions so as to correctly focus interventions. The main objective of the study was to compare the number of HIV infant infections between options A, B and B+ cohorts at six (6) weeks in selected facilities of Lusaka district in Zambia.

Using a retrospective cohort research design, clinical records of HIV+ positive women and their infants drawn from 6 public health facilities of Lusaka were analyzed. A two-step analysis was used. The first step involved a bi-variate analysis in order to generate the average percentages of children who tested positive at 6 weeks with the help of the mother’s background characteristic. In addition the relationship between attrition and PMTCT options (Options A, B and B+) was analyzed. The second approach, logistic and multinomial regression were used to measure the effect of independent variables on the dependent variable of positivity of children at 6 weeks. The study findings showed that both options A and B+ recorded 6% infant infections whereas option B at 13%, recorded the most infections. In assessing attrition levels, Option A recorded the least deaths at 21% compared to 39% in option B and 37% in option B+. Option B+ recorded 39.6% transfer outs compared to 24.7% in option B and 30.9% in option A. Antiretroviral treatment (ART) and other effective interventions for the prevention of mother-to-child transmission (PMTCT) can reduce this risk to below 5% (WHO, 2014). Therefore, option B+ results from the study at 6% infant infections show that the initiative has potential of reducing the HIV burden in Zambia and thereby contributing favorably to the HIV free generation dream. Support activities that ensure less attrition are critical in ensuring successful implementation of prevention interventions so as to reduce transmission of HIV in the target population.