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J Acquir Immune Defic Syndr. 2015 Mar 1;68(3):245-9. doi: 10.1097/QAI.0000000000000482.

Initial programmatic implementation of WHO option B in Botswana associated with increased projected MTCT.

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  • 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 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.

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