Treatment for Life, Part 3: “This Policy Brings Life to the Next Generation”

As we pulled onto the grounds of the Presbyterian Secondary School in Kumba, Cameroon, we were greeted by a cappella voices of women rehearsing hymns in a building off the main road. I had come to Kumba, a mercantile hub in the southwest, to observe the technical assistance officers of Cameroon Baptist Convention Health Services (CBCHS), a partner of the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). Under threat of the daily afternoon downpour, we quickly made our way to the main building, which was packed with more than 50 health workers. They had assembled for a three-day Option B+ workshop, facilitated by CBCHS.

Option B+ is the name of World Health Organization (WHO) guidelines that were proposed in 2012 as a path to containing the HIV epidemic. Under these guidelines, a pregnant or breastfeeding woman who tests positive for HIV is enrolled in antiretroviral medication for life. This not only ensures her own health, but it can nearly eliminate the possibility that she transmits the virus to her child during pregnancy, birth, or breastfeeding.

Until 2013, health facilities in Cameroon limited their prevention of mother-to-child transmission of HIV (PMTCT) treatment programs to pregnant and breastfeeding women with high viral loads—those at greatest risk. But after the WHO announcement, the Cameroon Ministry of Health launched universal lifelong treatment for all pregnant and breastfeeding women at pilot sites, with support from partner groups like CBCHS. Now, having seen success at those facilities, Philip Mbamulu Nkemontoh, M.D., the district medical officer for Kumba is supervising a scale-up of Option B+ in his district.

The health workers assembled at the school are being trained to join the front lines of lifelong treatment at all 30 of the health facilities around Kumba. The HIV prevalence rate is 8%, in southwest Cameroon, meaning that nearly everyone knows a family member or close friend who is living with HIV or has died from an AIDS-related illness—so Dr. Nkemontoh expects a big impact.

“With Option B+ coming in, people are very positive,” Dr. Nkemontoh told me, as sheets of rain fell behind us. “People are seeing that they can do the things that will allow them to live with HIV and also raise their children.”

“It has been horrifying to see people who are HIV-positive feel like they are at the end of the road,” Dr. Nkemontoh continued. “Most often a Cameroonian will want to have a child. But when someone discovers that they are HIV-positive, they think that their life has ended because they think that they cannot have children—or that if they do, the child will be HIV-positive and die.

“And to a Cameroonian, if you don’t have a child, you do not live on. There is no legacy.

“But with Option B+, a patient can drop her viral load so that in most situations it is possible for an HIV-positive mother to give birth to a child who does not have HIV. This policy brings life to the next generation.”

Dr. Nkemontoh acknowledged that while the benefits are clear, Option B+ presents challenges for this economically struggling nation. He cites worries about supply stock-outs and staff shortages. But through partnerships with CBCHS, EGPAF, and others, he maintains confidence. 

A public health physician and father of five, Dr. Nkemontoh explained his dedication to reaching more mothers with prevention and treatment: “When you have children, and you are working in the area of HIV, you can say, ‘this could be my child,’ and you tend to be more committed.”

With a hearty handshake, Dr. Nkemontoh then hurried off to attend to the pressing health concerns of the more than one-quarter million people he serves. The rain was trickling to a stop, and the joyous voices had started again, enhancing the air of hope for mothers, children, and families around Kumba who will soon see the lifelong benefits of Option B+.

Read, "Treatment for Life, Part 2: Option B+: Working Toward a Generation Free of HIV," here. 

Read "Treatment for Life, Part 1: Option B+ Gives Mothers and Children Options," here.