Table 3 Advantages of Option B+ in Malawi

Simple to implement

One tablet a day of TDF + 3TC + EFV for the woman with NVP infant prophylaxis for 6 weeks. Reinforces the nationwide message that ART is taken for life; procurement and distribution needs for the country made easier compared with having Option A or Option B.

Reduced vertical transmission from mother to child

For current pregnancy ART offers protection from time of administration and is continued in breast feeding period. For future pregnancies, ART offers protection from time of conception.

Avoids stop-start ART

Interrupted ART has risks for increased morbidity and mortality.

Improved maternal health and survival

Post-partum women in Zimbabwe with CD4 count > 350 cells/mm³ have an elevated risk of death six times higher than non-infected women [40].

Reduced sexual transmission of HIV to discordant couples

HIV-infected persons on ART have significantly reduced risk of HIV transmission through sexual intercourse to non-infected partners even at high CD4 cell counts [41].

Reduced risk of tuberculosis

ART reduces the risk of tuberculosis in people living with HIV, even at high CD4 cell counts [42].

Treats hepatitis B infection

Tenofovir and lamivudine are active against hepatitis B virus, and about 15 % of people living with HIV in Malawi are also infected with hepatitis B.