Integrating Antiretroviral Therapy Into MNCH: Antenatal and Postpartum Care in the Option B+ Era

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: HIV/AIDS is the leading cause of death among women of reproductive age globally. Pregnant or postpartum women living with HIV have an estimated eight times greater risk of maternal mortality than HIV-negative women. While maternal deaths have decreased globally, countries with high HIV prevalence have seen smaller declines. While most deaths in HIV-infected pregnant and postpartum women are due to non-obstetric infections such as pneumonia, tuberculosis, and meningitis, they also face three times the risk of puerperal sepsis; some studies suggest they are also at higher risk of obstetric hemorrhage. The expansion of prevention of mother to child transmission (PMTCT) services has reduced new pediatric infections by half since 2001, but 240,000 infants were infected in 2013.

Methodology: This presentation will provide an update on the epidemiology and the natural history of HIV in pregnancy. Participants will be oriented to the 2013 WHO antiretroviral therapy (ART) guidelines which call for all HIV-infected pregnant and breastfeeding women to be initiated on lifelong ART, regardless of their CD4 count or clinical stage (Option B+).

Results: Malawi and Uganda were the first countries to adopt Option B+. Most African countries have now adopted it. Under Option B+ nurses and midwives typically initiate ART in MNCH, rather than referring to HIV clinic. Option B+ has resulted in a massive increase in initiation of maternal ART, but retention in care is a challenge, especially postpartum.

Conclusion: HIV in pregnancy is an important risk factor for maternal mortality. The current approach to prevent HIV-related maternal deaths and eliminate mother to child transmission of HIV, Option B+, requires effective integration of ART into the MNCH setting, with proactive efforts to support adherence and retention in care.