Option B+ in Vietnam
On an autumn day in 2014 in the mountainous province of Yen Bai, Vietnam, an expectant mother, Yên, 27, was admitted to the Obstetric Department of Yen Bai Provincial General Hospital with pain she attributed to premature labor. “Yesterday she was still smiling and happily talking about her baby” said her mother, who accompanied her to the hospital. “I don’t know what happened.”
After being admitted, Yen tested positive for HIV, and was immediately transferred to an emergency care facility. There, Dr. Thuy Cao, CHAI’s HIV clinical specialist in Vietnam, was mentoring local doctors that day as a part of routine mentoring program on HIV/AIDS care and treatment. Yen was notified of her HIV status, provided with proper counseling, and initiated on triple antiretroviral therapy (ART). Hers was the first case in Yen Bai province in which lifelong ART was administered to an HIV-positive pregnant women, without delay to access her clinical eligibility or CD4, in adherence to a policy known as Option B+. Option B+ is the most aggressive and comprehensive prevention of mother-to-child transmission of HIV (PMTCT) regimen because it recommends that a pregnant, HIV-positive woman receive immediate and lifelong triple formulation ART treatment regardless of her CD4 count to protect herself and minimize the risk that the virus is transmitted to her infant.
Yen’s husband, Loc, who was traveling for work in Hanoi when she was in the hospital, was shocked to hear what had happened. “When I heard the news, I felt like a person who was drowning,” he later said. “But after receiving advice and support from Dr. Ha, [a doctor in the Infectious Diseases Department of Yen Bai Provincial General Hospital] it felt like I had something strong to hold onto. Still, I had many worries.” The medical team caring for Yen contacted Loc and advised him to take an HIV test in Hanoi, which turned out to also be positive.
Ten days later, their baby boy was born, named Son. Five weeks after the delivery, the family brought the child to Yen Bai Provincial General Hospital for an early infant diagnosis (EID) test. The team and family once again held their breath until they got the EID test results back three weeks later. The result was negative.
“When I heard the news that my son’s HIV test was negative, I could not believe it was true. I was indescribably happy,” said Yen. “I hope my son will lead a healthy life.”
Now, Yen and Loc remain in the Yen Bai HIV care and treatment program, and are maintaining good health by taking their treatments every day as required.
This work in Yen Bai follows the Vietnam Authority of HIV/AIDS Control’s (VAAC) approval to pilot early testing and treatment, including Option B+ for HIV-positive pregnant women, in a number provinces including Yen Bai. CHAI and other partners partnered to help the VAAC make the decision to implement Option B+. Under VAAC’s leadership, CHAI led a national EID evaluation, which provided significant evidence to justify implementing Option B+ and improving exposed infant management and provider-initiated testing and counseling (PITC) services. CHAI also helped the VAAC and other national and provincial partners to provide related mentoring and training support to healthcare workers on HIV/AIDS care and treatment, supply chain, laboratory systems, PMTCT, nutrition, and TB prevention.
Due to the successes in Yen Bai and in other provinces, early testing and treatment for key populations including pregnant women is now in the new national guidelines. About 40 percent of HIV-positive pregnant women nationally now receive this Option B+ standard. CHAI continues to support the government to further scale up access to Option B+ and early testing and treatment.
For more information, please contact Thu Nguyen – Program Manager, Clinton Health Access Initiative, Inc. (CHAI): firstname.lastname@example.org