title: Fundamental concerns of women living with HIV around the implementation of Option B+.
abstract: BACKGROUND
  In 2011, the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping Their Mothers Alive was launched to scale up efforts to comprehensively end vertical HIV transmission and support mothers living with HIV in remaining healthy. Amidst excitement around using treatment as prevention, Malawi's Ministry of Health conceived Option B+, a strategy used to prevent vertical transmission by initiating all pregnant and breastfeeding women living with HIV on lifelong antiretroviral therapy, irrespective of CD4 count. In 2013, for programmatic and operational reasons, the WHO officially recommended Option B+ to countries with generalized epidemics, limited access to CD4 testing, limited partner testing, long breastfeeding duration or high fertility rates.
  
  
  CONCLUSIONS
  While acknowledging the opportunity to increase treatment access globally and its potential, this commentary reviews the concerns of women living with HIV about human rights, community-based support and other barriers to service uptake and retention in the Option B+ context. Option B+ intensifies many of the pre-existing challenges of HIV prevention and treatment programmes. As women seek comprehensive services to prevent vertical transmission, they can experience various human rights violations, including lack of informed consent, involuntary or coercive HIV testing, limited treatment options, termination of pregnancy or coerced sterilization and pressure to start treatment. Yet, peer and community support strategies can promote treatment readiness, uptake, adherence and lifelong retention in care; reduce stigma and discrimination; and mitigate potential violence stemming from HIV disclosure. Ensuring available and accessible quality care, offering food support and improving linkages to care could increase service uptake and retention. With the heightened focus on interventions to reach pregnant and breastfeeding women living with HIV, a parallel increase in vigilance to secure their health and rights is critical.
  
  
  CONCLUSIONS
  The authors conclude that real progress towards reducing vertical transmission and achieving viral load suppression can only be made by upholding the human rights of women living with HIV, investing in community-based responses, and ensuring universal access to quality healthcare. Only then will the opportunity of accessing lifelong treatment result in improving the health, dignity and lives of women living with HIV, their children and families.
authors.affiliation: International Community of Women Living with HIV (ICW), Nairobi, Kenya.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Matheson
authors.affiliation: Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands.
authors.forename: Suzette
authors.initials: S
authors.lastname: Moses-Burton
authors.affiliation: Global Network of People Living with HIV (GNP+), Brooklyn, NY, USA; amyhsiehesq@gmail.com.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Hsieh
authors.affiliation: International Community of Women Living with HIV (ICW), Harare, Zimbabwe.
authors.forename: Sophie
authors.initials: S
authors.lastname: Dilmitis
authors.affiliation: International Community of Women Living with HIV (ICW), Kampala, Uganda.
authors.forename: Margaret
authors.initials: M
authors.lastname: Happy
authors.affiliation: International Community of Women Living with HIV (ICW), Lusaka, Zambia.|Network of Zambian People Living with HIV (NZP+), Lusaka, Zambia.
authors.forename: Eunice
authors.initials: E
authors.lastname: Sinyemu
authors.affiliation: International Community of Women Living with HIV (ICW), Washington, DC, USA.
authors.forename: Sophie O
authors.initials: SO
authors.lastname: Brion
authors.affiliation: Global Network of People Living with HIV (GNP+), Brighton, UK.
authors.forename: Aditi
authors.initials: A
authors.lastname: Sharma
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D003068:Coercion; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi; D011247:Pregnancy; D012111:Residence Characteristics; D014754:Violence; D014933:Women's Rights
keywords: PMTCT; adherence; eMTCT; implementation science; qualitative research; retention; vertical transmission