TITLE:
Outcome Evaluation of Early Implementation of Option B+ in Cameroon: A Prospective Cohort Observational Survey in the Northwest and Southwest Regions
AUTHORS:
Pius Tih Muffih, Edouard Katayi Tshimwanga, Andrew Abutu, Lem Edith Abongwa, Jacques Chirac Awa, Pascal Nji Atanga, Felix Desembuin, Eveline Mboh Khan, Kuni Esther Bonje, Nshom Emmanuel, Ebeny Francois Temgbait Chimoun, Thomas Welty, Gladys Tayong Fosah, Jennifer Lim, Dana Duncan, Leah Petit, Gilbert Tene, Jembia Mosoko, Omotayo Bolu
KEYWORDS:
Option B+, Implementation Research, Prevention of Mother to Child HIV Transmission, HIV Exposed Infants
JOURNAL NAME:
World Journal of AIDS,
Vol.8 No.3,
September
21,
2018
ABSTRACT: Background: Mother
to child transmission (MTCT) of HIV constitutes a major source of new pediatric
infections in Cameroon. Objective: The aim of this implementation research
was to assess outcomes and effectiveness of providing life-long antiretroviral therapy
(ART) for HIV-positive pregnant and breastfeeding women (Option B+). Methods: From October 2013 to July 2014, HIV-positive pregnant and breastfeeding women, not
on antiretroviral (ARV) prophylaxis and ART, were recruited from 22 purposefully
selected health facilities in the Northwest and Southwest regions for a prospective,
observational cohort evaluation. Option B+ was offered to participants and outcome
indicators were measured. Results: Out of 680 women eligible for this assessment,
669 (98%) were initiated on Option B+. Retention-in-care was 90% (95% CI, 87.85 - 92.61) and 79% (95% CI, 75.20 - 81.88), and loss to follow
up (LTFU) was 7% (95% CI: 4.95 - 8.90) and 15% (95% CI: 12.06 - 17.56) at 6 and 12 months respectively.
Maternal mortality at 12 months after ART initiation was 2% (13). As of March 2015,
538 HIV exposed infants (HEIs) were enrolled and received postpartum nevirapine
prophylaxis within 72 hours of birth and 84% (454) were on cotrimoxazole at 6 to
8 weeks. By 8 weeks of age, 498 (93%) infants had HIV DNA PCR test with 486 (97.6%)
negative and 12 (2.4%) positive. Conclusion: In Cameroon, successful implementation
of Option B+ increased retention-in-care to 79% at one year for pregnant and breastfeeding
women and reduced MTCT rate below 5% for HEIs at 8 weeks of age. Long term retention,
maternal and infant mortality and final MTCT rate after cessation of breastfeeding
require further evaluation.