BETHESDA, Md., March 12, 2013 /PRNewswire/ -- Providing life-long
antiretroviral treatment to HIV-infected pregnant women not only
prevents HIV infections in infants, but also improves the 10-year
survival rate in mothers, saving more than 250,000 maternal life years
and reducing the likelihood that children born to these mothers will
become orphans, a study published today in the journal PLOS ONE found.
Transmission of HIV during pregnancy, labor, delivery or
breastfeeding is the main mode of HIV infection in children. An
estimated 390,000 children worldwide acquired HIV from their mothers in
2010, with more than 90 percent of these new infections occurring in
sub-Saharan Africa. Malawi, a low-income country of 15 million people,
is one of the countries with the highest number of HIV-infected pregnant
women.
The study from Abt Associates' Dr. Carlos Avila and colleagues
examined how the Ministry of Health in Malawi is implementing a new
program termed Option B+, in which all pregnant women who test HIV
positive are placed on antiretroviral therapy (ART) for life, regardless
of their CD4 count or clinical stage.
They looked at whether the program represents a cost-effective policy
option for treating HIV-infected pregnant women and for preventing
mother-to-child transmission, as compared with World Health Organization
guidelines (Option A and B) to prevent mother-to-child transmission of
HIV. Those guidelines recommend antiretroviral therapy for women with
CD4 counts at or lower than 350 cells per microliter, which presents a
major restriction in areas where lab resources are scarce. Under WHO
Option A, the mother receives antiretrovirals at three different stages
of pregnancy and then for a week after childbirth. Under WHO Option B,
the mother takes a triple antiretroviral regimen at 14 weeks, and
continues taking this treatment until the child is born. Antiretrovirals
are suspended after delivery, or one week after all infant exposure to
breast milk has ended. The infants receive antiretroviral prophylaxis.
Researchers used data from Malawi to simulate the progression of HIV
among a group of HIV-infected pregnant women who received preventive and
antiretroviral therapy, and estimated the number of pediatric
infections averted and maternal life years gained over a 10-year period.
They found that providing lifelong antiretroviral treatment to all
mothers would improve 10-year survival in mothers more than four-fold,
saving more than 250,000 maternal life years, as compared to mothers
receiving other treatment options, which saved 153,000 and 172,000 life
years respectively. In addition, providing ARTs for all HIV-infected
pregnant women could save $455 U.S. per life year gained.
"Although providing these drugs may cost more in the short term, it
will save many lives, prevent future infant infections and reduce the
chances that a child will become an orphan in the long term," said
Avila, a senior health economist at Abt. "This study takes into account
the realities of providing antiretrovirals in rural Africa, where lab
facilities are scarce and requirements to start treatment based on CD4
counts are a major impediment to mothers getting the treatment they
need."
The researchers also note that simplifying drug regimen options may
improve adherence to therapy and can help overcome some of the
individual, organizational and societal barriers to achieving high
coverage levels of prophylaxis and treatment.
For the full paper, please visit: http://dx.plos.org/10.1371/journal.pone.0057778
About Abt Associates Abt Associates is a mission-driven, global
leader in research and program implementation in the fields of health,
social and environmental policy, and international development. Known
for its rigorous approach to solving complex challenges, Abt Associates
is regularly ranked as one of the top 20 global research firms and one
of the top 40 international development innovators. The company has
multiple offices in the U.S. and program offices in nearly 40 countries.
www.abtassociates.com
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