title: Lessons learned from early implementation of option B+: the Elizabeth Glaser Pediatric AIDS Foundation experience in 11 African countries.
abstract: BACKGROUND
  "Option B+" is a World Health Organization-recommended approach to prevent mother-to-child HIV transmission whereby all HIV-positive pregnant and lactating women initiate lifelong antiretroviral therapy (ART). This review of early Option B+ implementation experience is intended to inform Ministries of Health and others involved in implementing Option B+.
  
  
  METHODS
  This implementation science study analyzed data from 11 African countries supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to describe early experience implementing Option B+. Data are from 4 sources: (1) national guidelines for prevention of mother-to-child HIV transmission and Option B+ implementation plans, (2) aggregated service delivery data between January 2013 and March 2014 from EGPAF-supported sites, (3) field visits to Option B+ implementation sites, and (4) relevant EGPAF research, quality improvement, and evaluation studies.
  
  
  RESULTS
  Rapid adoption of Option B+ led to large increases in percentage of HIV-positive pregnant women accessing ART in antenatal care. By the end of 2013, most programs reached at least 50% of HIV-positive women in antenatal care with ART, even in countries using a phased approach to implementation. Scaling up Option B+ through integrating ART in maternal and child health settings has required expansion of the workforce, and task shifting to allow nurse-led ART initiation has created staffing pressure on lower-level cadres for counseling and community follow-up. Complex data collection needs may be impairing data quality.
  
  
  CONCLUSIONS
  Early experiences with Option B+ implementation demonstrate promise. Continued program evaluation is needed, as is specific attention to counseling and support around initiation of lifetime ART in the context of pregnancy and lactation.
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC.
authors.forename: Mary Pat
authors.initials: MP
authors.lastname: Kieffer
authors.forename: Meghan
authors.initials: M
authors.lastname: Mattingly
authors.forename: Anja
authors.initials: A
authors.lastname: Giphart
authors.forename: Roland
authors.initials: R
authors.lastname: van de Ven
authors.forename: Caspian
authors.initials: C
authors.lastname: Chouraya
authors.forename: Moses
authors.initials: M
authors.lastname: Walakira
authors.forename: Alexandre
authors.initials: A
authors.lastname: Boon
authors.forename: Silvia
authors.initials: S
authors.lastname: Mikusova
authors.forename: R J
authors.initials: RJ
authors.lastname: Simonds
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000635:transmission*; D000349:Africa; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D005260:Female; D005582:Foundations / Q000458:organization & administration*; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D015397:Program Evaluation; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents