Viewpoint: Prevention of Mother-to-Child Transmission of HIV and the Health-Related Millennium Development Goals: Time for a Public Health Approach

Journal Article
  • Erik J. Schouten
  • Andres Jahn
  • Dalitso Midiani
  • Simon D. Makombe
  • Austin Mnthambala
  • Zengani Chirwa
  • Anthony D. Harries
  • Joep J. van Oosterhout
  • Tarek Meguid
  • Anne Ben-Smith
  • Rony Zachariah
  • Lutgarde Lynen
  • Maria Zolfo
  • Wim Van Damme
  • Charles F. Gilks
  • Rifat Atun
  • Mary Shawa
  • Frank Chimbwandira
The Lancet
378 (July 16, 2011): 282-84. doi:10.1016/S0140-6736(10)62303-3.

The WHO 2010 guidelines specify that a CD4 cell count is crucial to decisions about the eligibility of HIV-infected pregnant women for lifelong antiretroviral treatment (ART). In Malawi, however, access to CD4 cell count analysis is minimal. Thus, to make this test a prerequisite for increasing the coverage of prevention of mother-to-child transmission services and early access to ART would hinder rapid expansion in countries with heavily constrained health systems. Malawi, therefore, proposes a strategy that does not rely solely on CD4 cell counts but is based on the WHO guidelines and the public health approach outlined in the current Ministry of Health ART guidelines. We propose to offer all HIV-infected pregnant women lifelong ART. This approach is not completely new, but rather is a more feasible alternative to WHO's proposed option B, which we call option B+.