Mentor Mothers Play Important Role in New Option B+ Guidelines in Kenya

“Single dose Nevirapine was like a bicycle; Option B+ was like a motorcycle; and this new Option B+ is like a fuel efficient limousine which allows for longer travel giving mothers better health.” This was how mothers2mothers (m2m) Mentor Mother Team Leader Irene Awuor, in Nairobi, Kenya, recently described the progress of interventions to prevent mother-to-child transmission of HIV. Irene was speaking at one of two workshops that m2m Kenya organised, through the government’s Kenya Mentor Mother Program, targeting Country AIDS and STI (sexually transmitted infections) Control Officers (CASCOs) on the role that Mentor Mothers can play in the successful implementation of Option B+ in Kenya.

In June 2013, the World Health Organization (WHO) released updated guidelines on anti-retroviral use for pregnant and breastfeeding HIV-positive mothers known as Option B+. The new guidelines recommend that any woman in this category be started on ART (anti-retroviral therapy) for life, regardless of her CD4 count, which measures the stage of the HIV infection. A year later, Kenya’s Ministry of Health officially took the new guidance on board and adopted Option B+, which is currently being rolled out nationally. Previously, Kenya was implementing Option B+, which recommended that pregnant HIV-positive women get initiated on lifelong care only if their CD4 count were considered below the recommended levels.
WHO acknowledges that client adherence, retention, and the strained health workforce are critical challenges that need to be addressed for the successful implementation of Option B+. Early findings on the rollout of Option B+ in Malawi indicate that women are significantly less likely to start taking their medications or continue with their treatment after their babies are out of danger from HIV infection, than HIV-positive women who start treatment for their own health.
In response, m2m – led by the National AIDS and STI Control Program (NASCOP) – is supporting a process to review and develop resource materials to help clients understand and adhere to Option B+. Furthermore, all of the Mentor Mothers at m2m Kenya’s model sites were taken through an adherence training package last year. Training Mentor Mothers on adherence education relieves some of the pressure on the already strained health workforce in Kenya. The enhanced role of Mentor Mothers should translate into improved client retention and adherence, including for women who are on anti-retroviral drugs for life through Option B+.
During the two workshops – one which was held in Kisumu and the other in Nairobi – two Mentor Mothers shared their personal experiences as well as the role they can play in the future of Option B+. They talked about how the education and support that Mentor Mothers provide are essential in helping women stay on treatment for the rest of their lives, especially after they have given birth and stopped breastfeeding, and their babies are no longer at risk of being infected with HIV. Mentor Mothers also actively track their clients’ progress, and follow up with those that miss key medical appointments and contact them to make sure they return for treatment.
“For eMTCT (elimination of mother-to-child transmission) to succeed, Mentor Mothers are the way to go,” said Dr. Lenai, one of the CASCOs present at the workshop.