About 160,000 new HIV infections among children aged 0–14 occurred in 2016, dramatically declining from 300,000 in 2010. Progress in reducing mother-to-child transmission of HIV has been dramatic since the introduction in 2011 of the ‘Global Plan towards the Elimination of New HIV Infections among Children, and Keeping their Mothers Alive’, largely because of increased access to PMTCT-related services and increased number of pregnant women living with HIV being initiated on lifelong antiretroviral medicines [1]. But it has not been fast enough to reach the 2020 targets set by UNAIDS and partners as part of the Super-Fast-Track Framework to end AIDS. Acceleration of treatment for all pregnant and breastfeeding women living with HIV is still needed to achieve elimination of new infections among children and halve HIV-related deaths among pregnant women and new mothers [1].
Under WHO’s 2010 PMTCT ARV guidance, countries had the option to choose between two prophylaxis regimens for pregnant women living with HIV with CD4 greater than 350cells/mm3. Option A and Option B. Under Option A, women received antenatal and intrapartum antiretroviral prophylaxis along with an antiretroviral postpartum “tail” regimen to reduce risk of drug resistance, while infants receive postpartum antiretroviral prophylaxis throughout the duration of breastfeeding [2].
Option B, on the other hand, has a simpler clinical flow in which all pregnant and lactating women with HIV initially are offered ART – beginning in the antenatal period and continuing throughout the duration of breastfeeding. At the end of breastfeeding those women who do not yet require ART for their own health would discontinue the prophylaxis and continue to monitor their CD4 count, eventually re-starting ART when the CD4 falls below 350cells/mm3. Along with these two options a third approach is now being used, Option B+, in which all pregnant women living with HIV are offered life-long ART, regardless of their CD4 count [2].
To achieve the goal of elimination of mother to child transmission (eMTCT), in 2013, the Zambian government accepted the immediate operationalization of Option B+ [3]. This is done with the understanding that all HIV positive women are to be initiated on antiretroviral therapy (ART) for life. Antiretroviral therapy offers women the best chance of preventing mother to child transmission, however, not all HIV positive women are willing to accept ART for life.
Katirayi et al. [4] found that women reported difficulty around learning their HIV status and initiating ART on the same day. They needed time to think about ART initiation and wanted to first discuss with their partners before committing to lifelong treatment. A study conducted in Zimbabwe found that pregnant and lactating women find it easy to accept lifelong therapy because it is similar to taking medication for diabetes or birth control [5].
Other studies have identified attitudes towards lifelong treatment [6], knowledge of prevention of mother to child transmission [7], social demographic [8] and cultural characteristics [9] as factors that determine acceptability of Option B+. However, the impact of these factors may vary depending on the study setting and study population.
Overall, the evidence regarding how women’s experiences in PMTCT option B+ services affect their subsequent care-seeking behaviour remains sparse. This appears particularly true with regard to the uptake of both long-term HIV care and treatment for the woman’s own HIV infection and infant HIV testing and related services. However, women’s experiences of and perspectives on current and proposed interventions and how these influence subsequent care-seeking behaviour need to be better understood to ensure that an appropriate and acceptable package of services could be offered and that the virtual elimination of mother-to-child HIV transmission become an attainable goal [10].
A study on acceptability of Option B+ among HIV positive pregnant and breastfeeding women is of supreme value in understanding the factors that inhibit enrolment on lifelong ART. During the implementation of different regimens for PMTCT, the efficacy of a regimen is not the only important aspect to consider but the way in which the people accept it will determine how well or how poorly it will work.
Study findings on the acceptability of Option B+ among Zambian women are limited. This study was conducted to determine acceptability of Option B+ and associated factors among HIV positive women receiving antenatal and postnatal care services at UTH and Lusaka Urban City Clinics. The information generated may be used to aid policy makers and HIV care givers in improving programmes aimed at encouraging the uptake of ART for life among pregnant and breastfeeding women and improve maternal health.