Is Option B+ the best choice?
This article is reprinted from The Lancet, with permission from Elsevier: Coutsodis A, Goga A, Desmond C, Barron P, Black V, Coovadia H. Is Option B+ the best choice? Lancet 2013;381(9863):269-271. [http://dx/doi.org/10.1016/S0140-6736(12)61807-8] The success of prevention of mother-to-child tran...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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AOSIS
2013-02-01
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| Series: | Southern African Journal of HIV Medicine |
| Online Access: | https://sajhivmed.org.za/index.php/hivmed/article/view/94 |
| _version_ | 1818538916998807552 |
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| author | Coutsoudis A A Goga C Desmond P Barron V Black H Coovadia |
| author_facet | Coutsoudis A A Goga C Desmond P Barron V Black H Coovadia |
| author_sort | Coutsoudis A |
| collection | DOAJ |
| description | This article is reprinted from The Lancet, with permission from Elsevier: Coutsodis A, Goga A, Desmond C, Barron P, Black V, Coovadia H. Is Option B+ the best choice? Lancet 2013;381(9863):269-271. [http://dx/doi.org/10.1016/S0140-6736(12)61807-8]
The success of prevention of mother-to-child transmission (PMTCT) programmes (Options A and B) in middle-income countries, together with clinical trial data on antiretroviral (ARV) treatment as prophylaxis, has emboldened UN agencies to aggressively promote lifelong ARVs for PMTCT (Option B+). Unsubstantiated claims submit that Option B+ is cost-effective at population-level, will protect HIV-negative male partners, improve maternal and infant health, and increase ARV coverage. We provide counterfactual arguments about the ethics, medical safety, programme feasibility and economic benefits of Option B+. Option B+ offers no advantage to PMTCT and there are social hazards associated with privileging pregnant woman for treatment over men and non-pregnant women, especially with the absence of data to suggest that discordant relationships are more frequent among pregnant women or that they contribute disproportionately to the horizontal HIV transmission. The benefits and safety of long-term ARVs – including adherence and resistance – in mothers who do not need treatment for their own health, need to be considered, as well as, crucially, health service costs. The assumption that a decrease in efficiency caused by inappropriate targeting is compensated for by lower recruitment costs, is untested. Lives could be saved instead with appropriately targeted interventions. Countries should make individual decisions based on their HIV epidemiology, resources, priorities and local evidence.
S Afr J HIV Med 2013;14(1):8-10. DOI:10.7196/SAJHIVMED.898 |
| first_indexed | 2024-12-11T21:35:10Z |
| format | Article |
| id | doaj.art-9a92f31e162a406c91360f396ff12d07 |
| institution | Directory Open Access Journal |
| issn | 1608-9693 2078-6751 |
| language | English |
| last_indexed | 2024-12-11T21:35:10Z |
| publishDate | 2013-02-01 |
| publisher | AOSIS |
| record_format | Article |
| series | Southern African Journal of HIV Medicine |
| spelling | doaj.art-9a92f31e162a406c91360f396ff12d072022-12-22T00:50:02ZengAOSISSouthern African Journal of HIV Medicine1608-96932078-67512013-02-0114181010.4102/sajhivmed.v14i1.9494Is Option B+ the best choice?Coutsoudis A0A Goga1C Desmond2P Barron3V Black4H Coovadia5Department of Paediatrics & Child Health, University KwaZulu-Natal, DurbanMedical Research Council, PretoriaSchool of Clinical Medicine, University of the Witwatersrand, JohannesburgSchool of Public Health, University of the Witwatersrand, JohannesburgWits Reproductive Health and HIV Institute, University of the Witwatersrand, JohannesburgMatCH, University of the Witwatersrand, JohannesburgThis article is reprinted from The Lancet, with permission from Elsevier: Coutsodis A, Goga A, Desmond C, Barron P, Black V, Coovadia H. Is Option B+ the best choice? Lancet 2013;381(9863):269-271. [http://dx/doi.org/10.1016/S0140-6736(12)61807-8] The success of prevention of mother-to-child transmission (PMTCT) programmes (Options A and B) in middle-income countries, together with clinical trial data on antiretroviral (ARV) treatment as prophylaxis, has emboldened UN agencies to aggressively promote lifelong ARVs for PMTCT (Option B+). Unsubstantiated claims submit that Option B+ is cost-effective at population-level, will protect HIV-negative male partners, improve maternal and infant health, and increase ARV coverage. We provide counterfactual arguments about the ethics, medical safety, programme feasibility and economic benefits of Option B+. Option B+ offers no advantage to PMTCT and there are social hazards associated with privileging pregnant woman for treatment over men and non-pregnant women, especially with the absence of data to suggest that discordant relationships are more frequent among pregnant women or that they contribute disproportionately to the horizontal HIV transmission. The benefits and safety of long-term ARVs – including adherence and resistance – in mothers who do not need treatment for their own health, need to be considered, as well as, crucially, health service costs. The assumption that a decrease in efficiency caused by inappropriate targeting is compensated for by lower recruitment costs, is untested. Lives could be saved instead with appropriately targeted interventions. Countries should make individual decisions based on their HIV epidemiology, resources, priorities and local evidence. S Afr J HIV Med 2013;14(1):8-10. DOI:10.7196/SAJHIVMED.898https://sajhivmed.org.za/index.php/hivmed/article/view/94 |
| spellingShingle | Coutsoudis A A Goga C Desmond P Barron V Black H Coovadia Is Option B+ the best choice? Southern African Journal of HIV Medicine |
| title | Is Option B+ the best choice? |
| title_full | Is Option B+ the best choice? |
| title_fullStr | Is Option B+ the best choice? |
| title_full_unstemmed | Is Option B+ the best choice? |
| title_short | Is Option B+ the best choice? |
| title_sort | is option b the best choice |
| url | https://sajhivmed.org.za/index.php/hivmed/article/view/94 |
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