Still, Malawi operated an independent prevention of mother-to-child transmission (PMTCT) program, which objectively lagged far behind the ART program. PMTCT in Malawi and many high-burden LMICs suffered poor patient enrollment, high attrition rates, and logistical inefficiencies despite increased resource allocations. Complex WHO guidelines made PMTCT much more challenging compared to the simplified regimens available in HICs. Acknowledging the realities of its failing PMTCT program and incorporating lessons from the relative success of the ART program, Malawi pioneered a pragmatic and progressive modification to the WHO guideline for PMTCT in 2010 by recommending voluntary lifelong HIV treatment for all HIV-positive pregnant and breastfeeding women as a means to prevent new infections in a high-fertility LMIC (Option B+). They integrated PMTCT into the ART program, integrated antenatal and ART data into a unified registry, and scaled up logistics and supply chain systems to allow access in remote communities. To address human resource needs, the new Option B+ PMTCT/ART program adopted task-shifting initiatives, which trained and allowed HSAs to perform testing and simple laboratory testing in antenatal clinics. Additionally, the Ministry of Health formulated new national HIV treatment guidelines to integrate all aspects of testing, treatment, counseling, and mental health services. This new regimen was highly successful, leading the WHO to recommend Malawi’s Option B+ in their subsequent guidelines.