In the last days the province of Gaza in Mozambique was the seat of the first course in the country for the implementation of the option B+ of the WHO for the prevention of the mother to child transmission (PMTCT) of HIV. The course was organized by the DREAM program in cooperation with the Ministry of Health of Mozambique (MISAU).

Following the agreement signed in July 2011 between the DREAM program and MISAU, the joint effort continues, to achieve the goal of zero new infections, especially related to the transmission from mother to child, operating in public hospitals in all provinces of the country.

After the province of Maputo with the Health Center of Matola 2, which was the first integrated DREAM-MISAU center, it is the turn of the Province of Gaza. But this time a new goal was added: the implementation of the Option B + of the WHO within the vertical prevention programs.

In fact, in April 2012 WHO published an update that adds a third option (option B+) to the existing guidelines for the prevention of the transmission of HIV in pregnant women who do not have the criteria to initiate the lifelong therapy. Next to the Option A (zidovudine during pregnancy, NVP at delivery and double therapy up to a week after delivery, with administration of NVP to the child for the entire duration of breastfeeding) the option B (triple therapy for women during pregnancy and until the end of breastfeeding) a third option is shown: the option B+: administration of a lifelong triple therapy to all HIV-positive pregnant women.

This option would present numerous advantages: simplify the PMTCT programs, avoiding the CD4 count to distinguish the women who need lifelong treatment from those who undergo treatment just for the vertical prevention; prevent the sexual transmission in discordant couples; bring benefits for the health of mothers avoiding the risk associated with constant interruptions and resume of the therapy, in particular in those regions with high fertility rate.

There is therefore a clear need to implement this option in contexts such as those of sub-Saharan Africa.

The course was held in the district of Bilene from February 11 to 15, in the Health Center of the town of Macia. The district has a population of more than 165.000 inhabitants. In the province of Gaza, HIV prevalence among adults is 25.1%, among pregnant women 33%. (2009 data, UNAIDS Country Progress Report 2012).

25 health workers of the health Center of Macia attended the course: clinicians, nurses, laboratory and pharmaceutical technicians. The teaching staff (doctors, nurses, activists, computer technicians of the DREAM program) gave lectures on the diagnosis and treatment of the HIV/AIDS and the opportunistic infections, on nutritional supplementation, breastfeeding and retention to lifelong treatment programs. Moreover, among other things, the DREAM program computer for the management of the HIV-positive patient was shown.

A session was devoted to the presentation of the DREAM model and the results of the adherence to the therapy and the retention in the program among pregnant women followed in different centers throughout the country.

Training days have been greeted with great enthusiasm and led to a first immediate result: the triple therapy was started in all pregnant women regardless of the CD4 count, levels of viral load or clinical stage. The positive results achieved since 2002 in the country by the DREAM program (more than 11.000 HIV-positive pregnancies followed by more than 10.000 children born healthy from the vertical prevention program) encouraged the participants of the course, showing how it is possible to repeat this model, administrating the triple therapy to all HIV-positive pregnant women.

The training will be repeated shortly in another health center of the province of Gaza, in Chiqumbane. It will then be possible for thousands of HIV-positive pregnant women to have access to the five health centers in the Province that operate according to the DREAM model.