In February 2013 in Swaziland, Médecins Sans Frontières began using an approach called
PMTCT B+ with HIV-positive pregnant and breastfeeding women.
The objective was to not only prevent the transmission of HIV from mothers to their
children, but also to keep these mothers healthy in a country where 40 per cent of pregnant
women are HIV-positive.
PMTCT stands for Prevention of Mother-To-Child Transmission, and the 'B+ option' is an approach
that aims to start a life-long antiretroviral (ARV) treatment immediately after a woman
is screened HIV-positive.
Without treatment, there is a 20-45 percent chance that a baby born to an HIV-infected
mother will become infected.
Expert patients are a key part of the fight against HIV in Swaziland.
One of their jobs is to visit clinics and communities and talk to pregnant women to
encourage them to get tested for HIV.
All expert patients are HIV-positive themselves, and are on treatment.
As patients, they can use their personal experiences when talking about the importance of HIV testing.
They can show how, with proper ARV treatment, people living with HIV/AIDS can live a long
and full life.
Whether the women are positive or negative, they receive initial counselling about HIV.
When they receive their results and if they are diagnosed with HIV, guidance is provided
so they can start their ARV treatment immediately, while they continue to receive counselling
to ensure the best possible adherence to a life-long ARV treatment.
The CD4 count is a measurement of the strength of a patient's immune system.
The lower the CD4 count the weaker the immune system.
Under previous approaches, a pregnant woman would only be put on ARV treatment when her
CD4 count has reached a threshold, or only for the sole duration of the pregnancy/breast
feeding period.
But with PMTCT B+ the HIV-positive mother is immediately put on ARVs for the rest of
her life, regardless of her CD4 count.
Today HIV remains incurable.
However, with early testing and appropriate ARV treatment, patients can live for decades.
A baby born to a positive mother is tested 6 weeks after birth to see whether the mother
has passed on the infection.
The baby is also automatically put on treatment.
Another HIV test is performed when the mother has stopped breastfeeding, to confirm the
HIV status of the baby.
The PMTCT B+ approach has a full range of benefits.
In the short term: - It prevents the transmission of the virus to the child.
- ARV treatment decreases the amount of the virus present in a person's body, known as
the viral load, hence reducing the risk of transmission to sexual partners.
In the medium term: - The transmission to any future babies by HIV-positive mothers
on treatment should be prevented.
- Mothers on treatment live longer.
- HIV-negative partners are protected from getting the virus.
Another important benefit is that women on ARV treatment are less likely to develop opportunistic
infections like tuberculosis since their immune system is less weakened.
These innovative approaches should help contribute to the vision of an HIV-free generation in
Swaziland.