A FUTURE

WITHOUT HIV

A young mother gets HIV-tested during a postnatal consultation

at Sainte Bernadette Health Centre in Lubumbashi.
Crdit : Benoit Almeras-Martino / UNICEF, 2014.

Introducing Option B+ to
prevent Mother-To-Child
Transmission in Katanga

Uni te d N atio n s C h ild ren s Fu n d Demo cratic Re publ i c of t he Congo

CONTEXT
Although HIV / AIDS prevalence
appears to be relatively moderate
in the Democratic Republic of
Congo 1, knowledge of motherto-child (MTCT) HIV transmission
is limited 2, reflecting the lack of
structures having the capacity to
conduct the prevention of MTCT
through appropriate care. 3.

(eMTCT) in 2017, with the support of

UNICEF.

Screening rate is very low: about

8 congolese citizens out of 10 do
not know their serological status,
according to the Demographics and
Health Survey conducted in 2013 by
UNICEF and its partners.

Since September 2013, a pilot project

aims at rolling out Option B+ in
several Katanga Health Zones, with
the support of UNICEF. Katanga was
chosen due to its greater exposure
to HIV/AIDS (the provinces main
commercial roads are oriented
towards Southern Africa) and
suspected risky behaviors around its
mining sites.

In 2012, ten years after the official

start of Prevention of MotherTo-Child Transmission of HIV
(PMTCT) activities, the
government launched
a national plan for
the Elimination of
Mother-To-Child
Transmission of HIV
Option B+ combines three molecules
in a single tablet - facilitating treatment
continuity for the HIV-positive patients
2

1,2% HIV prevalence rate DHS 2013

26% of congolese women aged 15-49 have knowledge of
PMTCT EDS 2013
3
26,2% is covered with PMTCT care according to the PNLS
(National Plan to Fight Against AIDS)
1
2

The plan was launched coincidentally

with new recommendations from the
World Health Organization calling
for the transition from Option A to
Option B+ to improve the PMTCT in
developing countries.

The pilot project is implemented

through the Optimizing HIV
Treatment Access Among Pregnant
Women (OHTA). UNICEF leads this
initiative in 4 African countries,
thanks to Norway and Sweden
funding 4.
4

DRC, Malawi, Uganda and Ivory Coast are concerned.

A F U T URE WITH OUT HIV In tro d u cin g Op tio n B+ to p reven t Mo t he r -To-Chi l d Tra ns m i s s i on i n Ka ta nga

DESIGN:
HOW IT WORKS

In developing its eMTCT strategy in 2012, the Congolese Ministry of Health has decided to
adopt a Test / Treat approach. The transition towards Option B+ is expected to be one of its
key elements.

SCREENING
People attending antenatal
consultation 1 are encouraged to
have a better knowledge of their
serological status. If they are
interested, they have a personal
interview with a health professional
and accept or refuse to be tested.
The screening takes about ten
minutes - if the result is positive,
the patient is immediately put under
antiretroviral treatment.
Children born from HIV-positive
mothers are tested using dried blood
spot (DBS) at 6, 9 and 18-months.
HIV-positive children are immediately
placed under antiretroviral therapy.
ANTIRETROVIRAL TREATMENT
Option B+ antiretroviral treatment
combines three molecules in one pill,
which has to be taken every day as
soon as the patients HIV status is
1
Free HIV tests are also offered during postnatal care and
preschool consultation,

discovered.
Unlike Option A 2 and Option B,
Option B+ does not necessitate
testing the number of CD4 cells of
the patient - thus accelerating the
initiation of antiretroviral treatment.
STORAGE AND PROVISION
OF ANTIRETROVIRAL TREATMENT
Antiretroviral drugs are stored at a
Regional Distribution Center.
Stock of antiretroviral treatment is
distributed on a quarterly basis to the
participating health facilities based on
their expected monthly consumption.
PATIENTS ACCOMPANIMENT
In each Health Center, nurses in
charge of Maternal and Child Health
and peer-educators monitor patients
compliance to the treatment.
Patients participate in support
groups, which allows them to learn
tips on how to use the antiretroviral
2

treatment; to share their personal

experience related to the disease;
and the difficulties they encounter in
everyday life.
If patients participation is considered
as being too low, peer educators and
community volunteers conduct home
visits.
PATIENTS MONITORING
Every health structure involved
monitors the number of tested
persons; the number of HIV+
diagnosed persons; and eventually,
the number of persons who
effectively comply with the
antiretroviral therapy.
Data gathered is synthetized and
shared with the various health
subdivisions in order to evaluate
Option B+ implementation;
continuity of the antiretroviral
treatment of HIV-positive patients;
and possible MTCT cases.

Favoured by DRC since 2010 due to its lower cost.

Uni te d N atio n s C h ild ren s Fu n d Demo cratic Re publ i c of t he Congo

HIV SCREENING, FIRST STEP TO PREVENT MOTHER-TO-CHILD TRANSMISSION

If the result is negative, then it means you and your baby are both
OK. If the result is inconclusive, we should set another appointment
to test you again. If the result is positive, then the health centre will
provide you with antiretroviral therapy but you still have a choice:
do you want to take the test?
Inside Sainte-Bernadette Health Centres small interview room,
tension rose slightly, as
Safi initially came to the Health Centre to immunize her sixth child.
During the consultation, she was offered counselling about HIV/
Aids prevention. She accepted it... and now she has to decide if she
wants to know her own serological status. Its obviously not an easy
decision. Yet Safi overcomes her initial embarrassment.
She nods, whispers an almost inaudible Ndio 1, thus agreeing to take
the test. Her choice is far from being surprising. Nine women2 out of
ten accept to take the test before or after giving birth.
On the opposite side of the table, Leon Mulimbi, one of SainteBernadette lab technicians, put on latex gloves, unwraps the single
use test and cleans the tip of Safis middle finger.
1
2

Yes in kiswahili.
among women attending the health structures during their pregnancy.

With mechanical precision, Leon stings the finger, gets a drop of

blood to put on the single use test. Well know the result in 5 to 10
minutes you can wait outside.
When Safi comes back to the room, it almost feels as if centuries
have passed. Her angst seems so strong that you can almost feel it
so its not hard to imagine Safis relief when Leon announces that
the test turned negative.
Today your test turned negative. Neither your baby nor you have
HIV, and thats very good news. That also means you have to remain
cautious so you dont get infected. Else you will put your health and
your future childrens health at risk. You should also talk to your
husband so he gets tested he should know his serological status
too.

In the Democratic Republic of the Congo, 78% of women and 84% of

men never took HIV-tests, according to the 2013 Demographics and
Health Survey.
Between October 2013 and August 2014, 47595 women were
counselled and tested in the six health zones targeted by UNICEF
within the Option B+ implementation project.

A F U T URE WITH OUT HIV In tro d u cin g Op tio n B+ to p reven t Mo t he r -To-Chi l d Tra ns m i s s i on i n Ka ta nga

DELIVER: WHAT HAS BEEN ACHIEVED

I n o rd er to harmoni ze Opti on B +
i m p l e mentat ion, U N ICEF 1 ) c a r r i e d ou t a
m a p p i ng of t he PM TCT i nte rve nti ons l e d
i n Ka tanga; 2) an d a c ti ve l y supporte d
t h e rev italizat ion of the M a te r na l ,
N e o n a tal and Chi l d H e a l th ( M N CH)
Wo r k i ng G roup to c oordi na te future
i n t e r ve nt ions of the va r i ous sta ke hol d e rs
i n vo l ved 1 .
Wi t h the s upport of UN ICEF, Opti on B+
h a s b een int rodu c e d i n si x he a l th zon e s 2 .
To d a t e, 106 hea l th fa c i l i ti e s i n si x a re a s
ta rg e t ed ef f ect ive l y provi de PM TCT
c a re 3 t hus improvi ng the popul a ti on s
c ove ra ge.
Be fo re implementi ng Opti on B+ , 26
fo c u s groups and si x c ommuni ty for um s
we re conduct ed i n si x he a l th zone s
in o rd e r to ident i fy l oc a l probl e ms
a n d s olut ions ne e de d to i nc re a se HIV
p reve nt ion and sc re e ni ng.
In o rd er to facili ta te the tra nsi ti on to
O p t i o n B+, 169 he a l thc a re provi de rs
we re t rained on the i nte gra ti on of this
P MTCT new approa c h sta nda rds.
29 7 h ealt hcare provi de rs i n PM TCTre a d y healt h faci l i ti e s we re tra i ne d
PNLS, PNSR, PEPFAR, PARSS, GAVI are among the MNCH Working Group members
2
Option B+ has been extended to additional 8 health zones
3
Compared to 57 health facilities

to a d a p t th e i r k n ow l e d g e to th e
re q u i re m e n ts of O p ti o n B +.
T h e 6 h e a l th zo n e s
m a n a g e m e n t te a m s we re
tra i n e d a t th e n ew g u i d e l i n e s
re g a rd i n g th e tra n si ti o n
towa rd s O p ti o n B +.
I n eve r y h e a l th zo n e s, 8 0
c o m m u n i ty sta ke h o l d e rs ( 2 0
Co m m u n i ty re l ays, 2 0 p e e r e d u c a to rs, 4 0 h e a l th p e rso n n e l )
we re tra i n e d a t PMTCT c a re u n d e r
O p ti o n B + sta n d a rd s, i n o rd e r to
fa c i l i ta te se n si ti za ti o n a n d p a ti e n ts
a c c o m p a n i m e n t.
Fro m O c to b e r 2 01 3 to Au g u st 2 01 4,
4 7 , 5 9 5 wo m e n we re c o u n se l e d a n d
sc re e n e d 4 . 11 9 0 we re te ste d p o si ti ve to
H I V.
1 2 2 5 H I V- p o si ti ve wo m e n we re p u t
o n a n ti re trovi ra l th e ra py fo l l ow i n g t h e
O p ti o n B + p ro to c o l . O n a sa m p l e of
61 8 H I V- p o si ti ve wo m e n , 4 6 3 h ave b e e n
c o n ti n u i n g th e i r tre a tm e n t fo r m o re t h a n
6 m o n th s ( 7 5 % re te n ti o n ra te ) .

I N T E RV I E W
Albertine is a HIV-positive mother of
three who lives in Lubumbashi since
2010.
I took the test in 2008. I lived in
Mwene Ditu (Kasa Oriental) at the
time. I had several miscarriages over
a short time span and so the doctor
asked me to take a HIV test.
Thus I learnt I was HIV-positive. My
husband took the test. He also had HIV. We
didnt accept our serological status at first. We
decided not to follow our treatment.
We then moved to Lubumbashi. Our status was
deteriorating and we attended the health center
more and more over time.
At the health center, we met people who actually
cared for us, loved us and gave us advices.
The nurses convinced us to get back to the
antiretroviral treatment. We quickly noticed that
our health was improving. We take the pill every
evening with my husband. We support each other.
We had our third child in 2013. Thanks to God
and the treatment, he was born without HIV. We
were so happy when we learned that yet we are
still afraid about testing his two brothers.
My only wish for the future is that my children
grow up as responsible persons, attached to their
lives.

4
pendantduring antenatal consultation, preschool consultation or
after giving birth.

Uni te d N atio n s C h ild ren s Fu n d Demo cratic Re publ i c of t he Congo

DISCOVER: WHAT IS WORKING

LOCAL AUTHORITIES INVOLVEMENT
Every activity is conducted with the approval and participation of
local political, administrative and health authorities. Option B+
deployment and coordination is carried o ut by the Provincial Health
Division and the National Programme for the Fight against AIDS
(PNLS).

submit monthly reports to the health zones, which synthesize the

data gathered for the health authorities information.

COORDINATED ACTIVITIES
Following UNICEFs mapping of PMTCT a ctivities and the
reactivation of MNCH Working Group, stakeholders activities are
conducted jointly in order to enhance their consistency; and to
effecti vely respond to the health authorities priorities.

IMPROVED CONTINUITY OF TREATMENT

Continuity of treatment for HIV-positive women was eased 1) by
the availability of antiretroviral drugs; 2) by the increased coverage
of PMTCT-ready health facilities; 3) and by the community-based
organizations better sensitization and accompaniment efforts.

HIV SCREENING AMONG PREGNANT WOMEN

Almost every pregnant woman agrees to be tested, if they attend
the health facilities during their pregnancy. Women can be tested
during the prenatal, postnatal and pre-sc hool consultations, thus
increasing HIV-testing opportunities.

COLLABORATION BETWEEN COMMUNITIES AND HEALTH FACILITIES

Community stakeholders play a central part within the health
facilities. Peer-educators conduct the monitoring and support of
HIV-positive patients within health facilities. Community relays
perform monthly visits to households in order to promote PMTCT
services and care provided by the health facilities.

BETTER ORGANIZATION OF HEALTH FACILITIES

Monitoring of HIV-positive patients is properly done. Health facilities

ARV SUPPLY AND STOCK MANAGEMENT

Option B+ facilitated ARV storage and stock management within
health facilities.

P E E R - E D U C AT O R S , E N C O U R A G I N G R O L E M O D E L S
I became a peer educator so I could help seropositive
persons improving their health just like I did. I work
within the Health Center, I schedule the patients
appointments.
I get in touch with patients directly when I
notice that they dont attend the appointments
I made. I try to convince them to continue the
treatment for their own sake. My best argument is
my own state: Im the living proof that antiretroviral
treatment works. Look at me, Im in perfect shape!

- Patient Binene, peer-educator.

6

When I learnt I was seropositive, everything fell apart

in my life. I got better when I received others
advice and this made me want to become a
peer-educator myself.
Every month, I run a support group with other
seropositive patients. With the help of the new
antiretroviral treatment, we can practically live and
work like anyone else.
I now want a better job. Id love to run my own
business and also, Id like to have two more children.

- Astrid Kabedi, peer-educator, mother of two.

A F U T URE WITH OUT HIV In tro d u cin g Op tio n B+ to p reven t Mo t he r -To-Chi l d Tra ns m i s s i on i n Ka ta nga

DREAM: VISION FOR THE FUTURE

T h e g overnment s ta rge t i s a l i gne d on U N A I D S T h re e Ze ro s
o b j e c t ive: Zero new H IV i nfe c ti ons. Ze ro d i sc r i m i n a ti o n . Ze ro
AI D S- relat ed dea ths.
O n a short -t erm pe rspe c ti ve, Opti on B+ w i l l b e exte n d e d to
2 0 6 Healt h Zone s i n 201 5 .
U N I C E F aims at c ontri buti ng to sc a l e u p O p ti o n B + to eve r y
h e a l t h zone of t h e c ountry ( 51 6 ) a nd i n c re a si n g th e n u m b e r of
PMTCT-ready hea l th fa c i l i ti e s.
U N I C E F als o plans the revi ta l i za ti on of l o c a l c o m m u n i ti e s
t h ro u g h a t ight en e d ne twor k of Comm u n i ty Re l ays a n d th e
c re a t i o n of Communi ty Ani ma ti on Cel l s ( CAC) i n eve r y
v i l l a g e.
B o t h meas ures woul d c ontr i bute to a ch i eve a b e tte r
se n si t izat ion on PM TCT a mong fa mi l i e s. T h e re a re two key
ta rg e ts of t his renewe d c ommi tme nt to c o m m u n i ty- b a se d H I V
p reve n t ion: ex pa ndi ng a nte na ta l c ons u l ta ti o n s a tte n d a n c e
a m o n g pregnant mothe rs; a nd i mprovi n g H I V sc re e n i n g a m o n g
men.
Wi t h i n t he healt h struc ture s, the ma i n c h a l l e n g e l i e s i n
t h e H IV-t es t ing of c hi l dre n i n the a bse n c e of d e c e n tra l i ze d
st r u c t ures able to a na l yse the D B S te sts re su l ts.
To s u p port t he f uture sc a l i ng- up of PMTCT a c ti vi ti e s, c a p a c i ty
b u i l d i n g of all s ta ke hol de rs i s a l so nee d e d a t eve r y ste p ( H I Vt e s t i n g , t reat men t, moni tor i ng a nd a c c o m p a n i m e n t of H I Vp o si t i ve pat ients) .

In Kisanga Health zone in Lubumbashi, the implementation of

Option B + resulted in many improvements in the management
and monitoring of HIV patients.

Nadine Muyungu, MD

Head of PMTCT division - Katanga Provincial Health Division

In my opinion Option B + is a simplification: it is

easier to prescribe the treatment, it is easier to store
the medicine, its easier to follow the treatment.
It is also a reason for hope because pregnant women
who take the treatment appropriately will not transmit
HIV to their children.

Benjamin Manika
HIV/PMTCT focal point - Kisanga Health Zone (Lubumbashi)

Since the project began, there has been an increase

in the use of PMTCT services. The increase in health
facilities involved is the key reason of this increase.
The other positive effect is that were able to do a
better monitoring of people living with HIV.

Lily Mwanya
PMTCT nurse - Mama Wa Huruma Health Centre (Lubumbashi)

Option B+ made treatment continuity easier

for patients. Their condition improved, they
sometimes wonder if they are really sick. I think
its necessary that we continue raising awareness
about HIV/Aids, especially among men who are
reluctant about getting tested.

The OHTA initiative is led in collaboration with the Fight Against AIDS
National Programme (PNLS) and is funded by the Norwegian Agency
for Development Cooperation (NORAD) and the Swedish International
Development Cooperation Agency (SIDA).

Noly T. and her son Tshilonda, at Sainte Bernadette Health Center

in Lubumbashi. Noly learnt her seropositivity during her pregnancy shes been following antiretroviral treatment ever since.
Crdit : Benoit Almeras-Martino / UNICEF, 2014.