Facilitators and barriers to retention in care under universal antiretroviral therapy (Option B+) for the Prevention of Mother to Child Transmission of HIV (PMTCT): A narrative review

Background Mother to child transmission (MTCT) is the most significant sources of Human Immune Deficiency Virus (HIV) in children. The risk of HIV transmission from the mother to the child, during pregnancy, birthing and breastfeeding, ranges from 15 to 45% (World Health Organisation [WHO] 2018), but with prevention of mother to child transmission (PMTCT) services the risk of transmission can be reduced to 5% (WHO, 2017). In 2011, Malawi became the first country to use Option B+ in 2011 which later became the WHO recommendation for the prevention of mother to child transmission of HIV (PMTCT) in Low and Middle-income countries (WHO, 2013). With Option B+, all HIV positive pregnant and lactating women are initiated on lifelong antiretroviral therapy (ART) regardless of their clinical and immunological status (WHO, 2013). Furthermore, all babies born or lactating from such mothers are said to be HIV exposed and are enrolled in an early infant diagnosis (EID) programme where they are followed up until they are two years old. Some of the reasons for adopting these recommendations were to increase access to ART, reduce MTCT, prolong the life and sustain the health of the mother, and reduce HIV transmission to the spouse or sexual partner. Evidence suggests that the use of ART by pregnant and lactating mothers prevents MTCT and improves maternal health (Shapiro et al., 2010; Granich et al., 2010). This is true because ARTs suppress HIV viral replication thereby drastically lowering the HIV viral load in infected persons stopping the progression of HIV disease; consequently, HIV becomes untransmissible (Bunnell et al., 2006, Granich et al., 2010. Following the adoption of Option B+, there was substantial progress in pregnant mothers receiving ART. The UNAIDS (2017a), reported that 80% of pregnant mothers living with HIV were on ART in 2017, compared with 51% who had access in 2010. Furthermore, results from the implementation of Option B+ accounted for a significant reduction of MTCT (Haas et al., 2017; Miller, ...