Mother and children, Salima, Malawi, April 2011

Malawi leads the developing world as the first to propose an approach to prevention of mother to child transmission (PMTCT) of HIV that addresses the health of the mother. Recently my MSH colleague Erik Schouten and his colleagues in Malawi wrote a commentary in the Lancet about Malawi’s innovative, public health approach to PMTCT. Malawi calls its model “B+” because it complements the World Health Organization’s (WHO) B option, whereby a mother’s CD4 cell count, a measure of the volume of HIV circulating in her blood, determines her eligibility for lifelong antiretroviral therapy (ART).

I’d like to call attention to an important set of articles in the recent HIV/AIDS themed issue of The Lancet. Erik Schouten of Malawi Basic Support for Institutionalizing Child Survival (BASICS) has published a commentary (free registration required) about Malawi’s push to be the first country to implement a “B+” approach to reducing mother to child transmission.

Yesterday the results of HIV Prevention Trials Network (HPTN) 052, a clinical trial funded by the National Institutes for Health, offered definitive proof of what we have long suspected---that treating HIV infected persons substantially reduces the risk of transmitting HIV to uninfected persons.

This is FANTASTIC news and offers very convincing evidence that, at least for heterosexual discordant couples (the study was not able to enroll significant numbers of gay men), if the infected person is on ART, the uninfected partner is protected. And more broadly, it offers significant evidence that treatment is indeed highly effective in preventing transmission of HIV. This can reasonably be described as a “game changer” with respect to how we think about HIV prevention, care, and treatment. We used to talk about “treatment as prevention,” but now we can say “treatment IS prevention.”

Read the UNAIDS report here.


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