Session 19 - Swaziland, HIV, & Option B+

Question 1

how is HIV determined

Answer 1

determined by CD4 cell count
CD4 count of less than 200 = HIV+ person has AIDS

Question 2

what are CD4 cells

Answer 2

t cells; immune cells that signal the onset of infection so the body could defend against it

Question 3

treatment as prevention

Answer 3

prioritized treatment of HIV positive pregnant & breastfeeding women as a means of prevention of mother-to-child transmission of HIV
- use of antiretroviral medication to prevent HIV transmission

Question 4

benefits of prioritizing Option B+

Answer 4

starts HIV+ women on an antiretroviral treatment after being screened positive, regardless of their immune system
- reduces risk of HIV transmission from mother to child in current & future pregnancies
- protects HIV- partners
- allows HIV+ mothers to live longer
- reduce transmission & save lives by improving mother & infant health

Question 5

ethical issues associated with prioritizing Option B+

Answer 5

is it right to treat a non pregnant woman because they had been pregnant in the past, while a never pregnant woman with the same or worse HIV status went without treatment
- should Swaziland prioritize pregnant women if drug shortages mean infected non-pregnant men & women are left behind
- could divert the resources from more sick people to healthier HIV+ pregnant women

Question 6

main factors contributing to the Swaziland HIV case study

Answer 6

highest HIV rate in the world
- 39% of pregnant women were HIV+
- several billion dollars from international organizations to the African region

Question 7

main outcomes of the Swaziland HIV case study

Answer 7

option B+
- women receives regardless of CD4 count, triple ARVs starting as soon as diagnosed, continued for life
- infant receives daily NVP or AZT from birth through age 4-6 weeks regardless of infant feeding method
- Swaziland Ministry of Health approves 2 pilots of Option B+ in December 2012
- 2013- findings from pilots appear promising
- end of 2014- SNAP initiates a phased nationwide Option B+ rollout

Question 8

different stakeholders to promote Option B+ in Swaziland

Answer 8

Swaziland Ministry of Health (MOH)
Columbia University Center on Global Health (ICAP)
World Health Organization (WHO)
International donors
Doctors, nurses
Pregnant women & their families
Community members