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The impact of Option B+ on mother‐to‐child transmission of HIV in Africa: A systematic review
Author(s) -
Maingi Mildred,
Stark Aliza Hannah,
IronSegev Sharon
Publication year - 2022
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13756
Subject(s) - breastfeeding , tanzania , medicine , antiretroviral therapy , transmission (telecommunications) , inclusion (mineral) , human immunodeficiency virus (hiv) , developing country , population , environmental health , pediatrics , family medicine , geography , viral load , economic growth , gender studies , engineering , environmental planning , sociology , electrical engineering , economics
Objective In 2015, the WHO released new guidelines to reduce mother‐to‐child transmission (MTCT) of HIV. The recommendations, known as Option B+, included initiation of lifelong highly active antiretroviral therapy regardless of CD4 count for all HIV‐positive pregnant and breastfeeding mothers. For infants, exclusive breastfeeding for 6 months and antiviral therapy were sanctioned. Targets of <5% transmission in breastfeeding populations and <2% in non‐breastfeeding populations were set. This review evaluated the impact of Option B+ on MTCT in African countries. Methods Using the PRISMA guidelines, a systematic search of PubMed and Google Scholar databases was conducted to identify relevant studies published between 2015 and 2021. All studies meeting inclusion criteria were evaluated. Results Of the 687 references screened, 22 studies from 11 countries (Cameroon, Ethiopia, Lesotho, Malawi, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe) met inclusion criteria. Six studies reported MTCT rates of <2%, 16 studies reported rates of 2–5% and two studies (Uganda and Zambia) reported 6% or more. Rates varied within the same study at different time points postpartum and amongst studies from the same country. Overall, reported MTCT rates appear to be close to WHO targets. However, diverse study designs, selection bias, extensive loss to follow‐up and undocumented adherence rates to Option B+ protocols may significantly underestimate MTCT rates of HIV in Africa. Conclusions Standardised protocols for impact evaluation must be established to provide evidenced‐based data on the efficacy of Option B+ in Africa.