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Table 3 Advantages of Option B+ in Malawi

From: Act local, think global: how the Malawi experience of scaling up antiretroviral treatment has informed global policy

Advantage Explanation
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.
  1. ART antiretroviral therapy, HIV human immunodeficiency virus, TB tuberculosis, TDF tenofovir, 3TC lamivudine, EFV efavirenz, NVP nevirapine