July 2013

Implementing Option B+ in Lesotho

Created by:

Appolinaire Tiam





Last month, the World Health Organization (WHO) launched new, consolidated HIV/AIDS treatment and prevention guidelines, which include recommendations for lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and breastfeeding women (referred to in previous guidelines as Option B+) in order to reduce mother-to-child transmission rates. Learn more about how the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) helped support the country in its effort to adopt Option B+ earlier this year—ahead of the official WHO guidelines launch.

At 23 percent, Lesotho’s overall HIV prevalence is among the highest in the world. Out of a population of 1.89 million, 320,000 people are living with HIV, including 41,000 children. Each year, approximately 15,000 HIV-positive women deliver children, which – in the absence of any intervention to prevent vertical (mother-to-child) transmission of HIV – would result in an estimated 5,900 new pediatric HIV infections per year. In order to help combat this epidemic and boost prevention of mother-to-child transmission (PMTCT) services, the Lesotho Ministry of Health (MOH), with assistance from the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) began using Option B+ in April 2013, about two months before the World Health Organization (WHO)’s new guidelines were officially launched at the International AIDS Society Conference.

Planning for the new program began in May 2012, a year before Option B+ was implemented.  The Lesotho MOH decided to move to Option B+ in order to improve maternal health while providing maximum protection against mother-to- child HIV transmission.

In preparation for the shift and in support of Lesotho’s MOH, EGPAF led the process of reviewing and revising the national PMTCT guidelines and related training materials. In addition, between January and March 2013, EGPAF trained 423 health care workers on Option B+. In April 2013, EGPAF piloted the Option B+ site readiness assessment tool at seven facilities in Lesotho.

The MOH also built a community mobilization component into the national roll-out plan, both to share information about Option B+ with local communities  and to encourage adherence. The MOH briefed civil society and mass media outlets on the change in guidelines while EGPAF and other partners helped develop behavior change and education communication materials for television and radio, in addition to creating posters and brochures. The group also developed strategies, such as village health workers’ community linkage tools, to help community health workers strengthen referrals between the community and health facilities in order to support improved treatment retention among HIV-positive women. With EGPAF support, the revised national PMTCT guidelines were finalized, printed, and disseminated to all health facilities.

Implementation of Option B+ officially began on April 1, 2013. In the first month alone, more than 1,000 HIV-positive pregnant or lactating women were initiated on Option B+. In some communities, the communications campaign effectively generated demand for Option B+–pregnant women visiting health facilities on April 1 were requesting “treatment for life.”

As with implementing any new health programs, the teams faced several challenges, including human resource constraints, insufficient infrastructure, inadequate laboratory services, and problems getting integral commodities (e.g., HIV test kits).

Despite the obstacles, Lesotho’s move to initiate all HIV-positive pregnant and breastfeeding women on lifelong ART, regardless of CD4 count, is a strong step toward the goal of virtual elimination of new pediatric infections in the country. The implementation of these new guidelines has been efficient and effective, thanks to the collaborative work of in-country partners and pre-implementation efforts.

Read our Lesotho country profile page to learn more our work there, and check out a blog post by Dr. Christian Pitter, Senior Director of Global Technical Policy and Partnerships, to learn more about the new WHO guidelines.

To learn more about our work in Lesotho, click here.

Appolinaire Tiam is Country Director and acting Technical/Clinical Director for the Foundation, based in Lesotho.