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NPR Blog Examines Debate Over Option B+ HIV Prevention Strategy

NPR’s “Shots” blog examines the debate over Option B+, a strategy to prevent mother-to-child HIV transmission that “aims to put every pregnant woman with HIV on triple-drug treatment and keep her on it for the rest of her life — even if the virus has not yet damaged her immune system to the point where she needs medications to preserve her own health.” A report published Friday in the Centers for Disease Control and Prevention’s (CDC) “Morbidity and Mortality Weekly Report” shows “that when Malawi … made a big push to implement Option B+, the payoff was impressive: a sevenfold increase in the number of pregnant and breastfeeding women starting anti-HIV treatment in only a year,” according to the blog. CDC Director Thomas Frieden “estimates Option B+ prevented 7,000 infants from getting HIV from their mothers in its first year of operation,” and “[h]e predicts Option B+ will have ripple effects that benefit families and communities by sharply reducing transmission of HIV from women to their uninfected partners,” the blog notes.

“But not everyone is convinced,” “Shots” writes. Hoosen Coovadia, a leading South African HIV researcher, “tells ‘Shots’ that he had ‘a gut reaction’ against Option B+ last July ‘because of the way it was presented’ at the International AIDS Conference in Washington, D.C.,” the blog notes, adding he said, “Almost everyone spoke about B+ as though it was going to change the direction of the AIDS epidemic. But it didn’t look to me that there had been adequate consultation. This was a pet program of the U.S. government.” The blog continues, “Recently he coauthored a sharply worded commentary in the Lancet calling Option B+ ‘extreme,’” and “Shots” notes the authors wrote, “A switch now would be dangerous, ignoring severe ethical, safety, feasibility and economic concerns.” The blog adds, “Coovadia calls for more study of Option B+ before implementing it aggressively. More data will be forthcoming. Rwanda and Haiti have already adopted the strategy, and seven other sub-Saharan countries are actively implementing it or preparing to” (Knox, 2/28).