The Option B+ Approach to HIV/AIDS Prevention


PMTCT B+HIV/AIDS has been the number one hindrance to development in the small southern African country of Swaziland. With one in four adults and over 40 percent of pregnant women living with the virus, Swaziland bears the world’s highest HIV/AIDS prevalence rate. In an effort to contain the epidemic, Doctors Without Borders (MSF) is now piloting the ‘preventing mother-to-child transmission, option B+’ (PMTCT B+) approach in Swaziland’s Shiselweni region.

PMTCT B+ means that all HIV-positive pregnant and breastfeeding women are put on a course of antiretroviral (ARV) drugs as soon as their status is diagnosed, and continue to receive the drugs for life. It is an important step in the fight against HIV/AIDS considering there is a 25 to 40 percent risk a baby will become infected without treatment. MSF launched this innovative four year pilot project in February 2013 in partnership with the local Ministry of Health. So far 200 women have participated, with the ultimate goal of reaching 2,000 by 2017.


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In most resource-poor settings, women with CD4 counts under 500 cells/mm3 only receive ARVs while pregnant and breastfeeding (option B). With the option B+ approach, all women receive lifelong ARV treatment, irrespective of their CD4 count or clinical stage. This approach not only prevents mother-to-child transmission, it also protects the mother’s health, and transmission to any babies or HIV-negative partners she may have in the future.

One major obstacle to success is the resistance to HIV testing in the target region. In 2012, only an estimated 35,000 Shiselweni residents were tested out of a population of 210,000. Fear and social stigma prevent women from getting tested or disclosing their status and, in response, MSF has turned to community leaders and traditional healers for support.

The pilot project will be evaluated based on its impact on overall health and HIV transmission rates, the experience of patients and health practitioners, and the financial cost. According to Elias Pavlopoulos, MSF’s head of mission to Swaziland, MSF hopes to act as a catalyst for change and shape national health policy to ensure the PMTCT B+ approach is implemented nationwide.

As a final push to try and meet HIV MDG targets by 2015, last year the Government of Swaziland also launched a national strategic framework for the Elimination of new HIV Infections among Children by 2015 and Keeping Their Mothers Alive with support from the UN and WHO. Combined, these PMTCT program efforts are a critical step towards an HIV-free generation in Swaziland.

Check out MSF’s Swaziland Born HIV-free website for further project information and videos.


Courtney Mollenhauer

Courtney Mollenhauer

Courtney is a writer and development professional based in Toronto, Canada.

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