The government of Uganda has launched the UN World Health Organization's (WHO) "Option B+" to boost the prevention of mother-to-child HIV transmission (PMTCT).
Uganda currently uses a PMTCT system similar to WHO's Option A, which involves single-dose antiretroviral (ARV) drugs for the mother - if her CD4 count, a measure of immune strength, is over 350 - from the 14th week, as well as ARVs during labour, delivery and one week post-partum. Pregnant women with CD4 counts below 350 are advised to start taking ARVs for their own health.
Option B - which WHO introduced alongside Option A in 2010 - involves triple therapy ARVs from the 14th week of pregnancy until one week after breastfeeding has ended, which can be up to one year.
In April, WHO added Option B+ to its repertoire; it involves providing the same triple ARV drugs to all HIV-infected pregnant women beginning in the antenatal clinic setting, and continuing this therapy for the rest of their lives. Some of the benefits of the new option include PMTCT for future pregnancies, protection of a woman's HIV-negative sexual partner from infection, and enabling continuity in ARV regimens, which reduces the chances of resistance.
Launching the plan on 12 September in the capital, Kampala, patron of the Uganda Paediatric Association First Lady Janet Museveni said Option B+ would go a long way in reducing the estimated 20,000-25,000 mother-to-child HIV infections that occur in Uganda annually.
"We have to unite all various resources to fight this enemy. We are ringing the bell for all of us to rise up and fight.... We call for the end of paediatric HIV in Uganda," she said. "We should keep in mind the [UN] Millennium Development Goals... we should not get to 2015 when our HIV prevalence rates are up."
Option B+ was pioneered by Malawi in 2010; Swaziland has also expressed its intention to use the strategy, which Dr Scott Kellerman, global technical lead on HIV for Management Sciences for Health, a non-profit organization dedicated to improving health systems, recently called a "game-changer and one of the most exciting developments in decreasing vertical transmission and paediatric HIV in recent years".
The US president's Emergency Plan for AIDS Relief (PEPFAR) has funded the purchase of 25,000 packs of drugs for mother and baby under Option B+; Health Ministry officials say each mother-baby care package will cost about US$315.
"We welcome the policy shift. Not only will pregnant women receive the most effective care and treatment available, their unborn babies will also receive the most effective prophylaxis to prevent transmission of HIV during pregnancy, birth and breastfeeding," Dan Travis, public affairs officer for the US Mission Uganda, told IRIN/PlusNews by email. "Furthermore, the policy will protect any discordant male partner and the administration of Option B+ will be easier on the clinical staff and health system.
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"In addition to the base funding for PMTCT, a further $25 million has been allocated to support Uganda to eliminate mother-to-child transmission," he added. "We will continue to work with the government of Uganda, all development partners and national stakeholders to ensure funding for Option B+."
Godfrey Esiru, the national PMTCT coordinator at the Ministry of Health, said the national roll-out would be carried out in phases due to financial challenges, infrastructure and the country's ongoing public health human resources’ shortage - just 56 percent of the health worker positions in Uganda's public sector are filled, while only 36 percent of the country's public health facilities offer comprehensive PMTCT services.
The roll-out will start in the districts that registered the highest HIV prevalence in a recent AIDS Indicator Survey - Kampala, Wakiso, Rakai, Mayuge, Kayunga, Mubende, Masaka, Kalangala, Nakasongola, Butambala and Gomba.
Senior government officials acknowledged that the roll-out would be tough, but said Uganda had to succeed if it was to turn around a worsening epidemic.
"We are at crossroads as a country. HIV has been a burden to this country's people and development," David Kihumuro Apuuli, director-general of the Uganda AIDS Commission (UAC), told IRIN/PlusNews. "We are going to sit down in the next two or three weeks to plan on how to mobilize funding, resources, human resource and infrastructure to achieve the target of up to 90 percent coverage of Option B+."
Experts warned the government against slack implementation of the programme and over-dependence on donor funds. Activists have previously accused the government of failing in its paediatric HIV programmes - just 26 percent of them have access to HIV treatment, compared to 55 percent of adults.
"If we implement this programme half-heartedly, we shall not succeed in the elimination of mother-to-child transmission of HIV. The government has to come forward and take charge of the responsibility of the health of its citizens," Philippa Musoke, the principal investigator for paediatric infection disease at the Makerere University-Johns Hopkins University Clinical Research Site in Kampala.
"I appeal to the government to invest more money in HIV prevention, treatment and care. It's not going to be cheap. We thank Americans but we can't continue to rely on them," said Musa Bungudu, the outgoing UNAIDS country representative, told IRIN/PlusNews.