MMWR Morb Mortal Wkly Rep. 2013 Mar 1;62(8):148-51.
Antiretroviral medications can reduce rates of mother-to-child transmission of human immunodeficiency virus (HIV) to less than 5%. However, in 2011, only 57% of HIV-infected pregnant women in low- and middle-income countries received a World Health Organization (WHO)-recommended regimen for prevention of mother-to-child transmission (PMTCT), and an estimated 300,000 infants acquired HIV infection from their mothers in sub-Saharan Africa; 15,700 (5.2%) of these infants were born in Malawi. An important barrier to PMTCT in Malawi is the limited laboratory capacity for CD4 cell count, which is recommended by WHO to determine which antiretroviral medications to start. In the third quarter of 2011, the Malawi Ministry of Health (MOH) implemented an innovative approach (called "Option B+"), in which all HIV-infected pregnant and breastfeeding women are eligible for lifelong antiretroviral therapy (ART) regardless of CD4 count. Since that time, several countries (including Rwanda, Uganda, and Haiti) have adopted the Option B+ policy, and WHO was prompted to release a technical update in April 2012 describing the advantages and challenges of this approach as well as the need to evaluate country experiences with Option B+. Using data collected through routine program supervision, this report is the first to summarize Malawi's experience implementing Option B+ under the direction of the MOH and supported by the Office of the Global AIDS Coordinator (OGAC) through the President's Emergency Plan for AIDS Relief (PEPFAR). In Malawi, the number of pregnant and breastfeeding women started on ART per quarter increased by 748%, from 1,257 in the second quarter of 2011 (before Option B+ implementation) to 10,663 in the third quarter of 2012 (1 year after implementation). Of the 2,949 women who started ART under Option B+ in the third quarter of 2011 and did not transfer care, 2,267 (77%) continue to receive ART at 12 months; this retention rate is similar to the rate for all adults in the national program. Option B+ is an important innovation that could accelerate progress in Malawi and other countries toward the goal of eliminating mother-to-child transmission of HIV worldwide.
抗逆转录病毒药物可将艾滋病毒（HIV）母婴传播率降低到 5%以下。然而，2011 年，中低收入国家只有 57%的 HIV 感染孕妇接受了世界卫生组织（WHO）推荐的预防母婴传播方案，估计撒哈拉以南非洲有 30 万婴儿从母亲那里感染了 HIV；其中 15700 名（5.2%）婴儿出生于马拉维。马拉维实施预防母婴传播方案的一个重要障碍是 CD4 细胞计数的实验室能力有限，WHO 建议使用 CD4 细胞计数来确定启动哪些抗逆转录病毒药物。2011 年第三季度，马拉维卫生部（MOH）实施了一项创新方法（称为“B+方案”），所有感染 HIV 的孕妇和哺乳期妇女无论 CD4 计数如何，均有资格接受终身抗逆转录病毒治疗（ART）。从那时起，几个国家（包括卢旺达、乌干达和海地）采用了 B+方案，世界卫生组织于 2012 年 4 月发布了一份技术更新，描述了这种方法的优势和挑战，以及评估 B+方案在各国经验的必要性。本报告使用通过常规方案监督收集的数据，首次总结了马拉维在卫生部的指导下、在全球艾滋病协调办公室（OGAC）通过总统艾滋病紧急救援计划（PEPFAR）的支持下实施 B+方案的经验。在马拉维，每季度开始接受抗逆转录病毒治疗的孕妇和哺乳期妇女人数增加了 748%，从 2011 年第二季度的 1257 人（在 B+方案实施前）增加到 2012 年第三季度的 10663 人（实施后 1 年）。在 2011 年第三季度开始接受 B+方案治疗且未转院的 2949 名妇女中，2267 名（77%）在 12 个月时继续接受 ART；这一保留率与国家方案中所有成年人的保留率相似。B+方案是一项重要创新，可加速马拉维和其他国家在全球消除母婴传播 HIV 方面取得进展。
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