Immediate lifelong highly active antiretroviral therapy for all pregnant women with HIV: The counselling conundrum

Many countries are contemplating introducing immediate lifelong highly active antiretroviral therapy (HAART) for all women diagnosed with HIV during pregnancy (“Option B+”).

A prospective cohort study was carried out comprising 100 women attending Naivasha Hospital, Kenya, who had been diagnosed with HIV during their current pregnancy. Attrition along the pathway to HAART, and associations with registration at an HIV clinic were assessed. 19 of these women and eight of their health service providers were interviewed to better understand women’s experiences and care-seeking behaviours. 30 HIV testing sessions were observed.

The uptake of services along the pathway to HAART was low. Women who felt that they had enough information to decide whether or not to be tested for HIV were 3.6 times more likely to register at an HIV clinic within three months than women who did felt insufficiently informed in this regard. Most women were unprepared for the test itself and for a positive test result, and described needing time to accept their HIV diagnosis.

To maximize the potential benefits of Option B+, linkage into HAART services following an HIV diagnosis in pregnancy-related services must be improved. A range of innovative approaches to counselling should be introduced and rigorously tested.