title: Initial programmatic implementation of WHO option B in Botswana associated with increased projected MTCT.
abstract: : Botswana was one of the first African countries to transition from WHO Option A to Option B for prevention of mother-to-child HIV transmission (MTCT). We evaluated the impact of this transition on projected MTCT risk through review of 10,681 obstetric records of HIV-infected women delivering at 6 maternity wards. Compared with Option A, women receiving antenatal care under Option B were more likely to receive combination antiretroviral therapy (ART), adjusted odds ratio (aOR): 2.59 (95% confidence interval: 2.25 to 2.98), but they were also more likely to receive no antenatal antiretrovirals, aOR: 2.10 (95% confidence interval: 1.74 to 2.53). Consequently, initial implementation of Option B was associated with increased projected MTCT at 6 months of age, 3.79% under Option A and 4.69% under Option B (P < 0.001). Successful implementation of Option B or B+ may require that ART can be initiated within antenatal clinics, and novel strategies to remove barriers to rapid ART initiation.
authors.affiliation: *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.
authors.forename: Scott
authors.initials: S
authors.lastname: Dryden-Peterson
authors.forename: Shahin
authors.initials: S
authors.lastname: Lockman
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zash
authors.forename: Quonhong
authors.initials: Q
authors.lastname: Lei
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Chen
authors.forename: Sajini
authors.initials: S
authors.lastname: Souda
authors.forename: Chipo
authors.initials: C
authors.lastname: Petlo
authors.forename: Eldah
authors.initials: E
authors.lastname: Dintwa
authors.forename: Refeletswe
authors.initials: R
authors.lastname: Lebelonyane
authors.forename: Mompati
authors.initials: M
authors.lastname: Mmalane
authors.forename: Roger L
authors.initials: RL
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001902:Botswana; D015331:Cohort Studies; D004363:Drug Utilization; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*
chemical_list: D044966:Anti-Retroviral Agents