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PLoS One. 2014 Jan 22;9(1):e85310. doi: 10.1371/journal.pone.0085310. eCollection 2014.

Women's preferences regarding infant or maternal antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV during breastfeeding and their views on Option B+ in Dar es Salaam, Tanzania.

Author information

1
Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania ; Swedish Institute for Communicable Disease Control, Solna, Sweden and Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
2
Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
3
Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania ; Department of Public Health Sciences, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
4
Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
5
Management and Development for Health, Dar es Salaam, Tanzania.
6
Swedish Institute for Communicable Disease Control, Solna, Sweden and Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
7
Department of Public Health Sciences, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.

Abstract

BACKGROUND:

The WHO 2010 guidelines for prevention of mother-to-child transmission (PMTCT) of HIV recommended prophylactic antiretroviral treatment (ART) either for infants (Option A) or mothers (Option B) during breastfeeding for pregnant women with a CD4 count of >350 cell/µL in low-income countries. In 2012, WHO proposed that all HIV-infected pregnant women should receive triple ART for life (B+) irrespective of CD4 count. Tanzania has recently switched from Option A to B+, with a few centers practicing B. However, more information on the real-life feasibility of these options is needed. This qualitative study explored women's preferences for Option A vs B and their views on Option B+ in Dar es Salaam, Tanzania.

METHODS:

We conducted four focus group discussions with a total of 27 pregnant women with unknown HIV status, attending reproductive and child health clinics, and 31 in-depth interviews among HIV-infected pregnant and post-delivery women, 17 of whom were also asked about B+.

RESULTS:

Most participants were in favor of Option B compared to A. The main reasons for choosing Option B were: HIV-associated stigma, fear of drug side-effects on infants and difficult logistics for postnatal drug adherence. Some of the women asked about B+ favored it as they agreed that they would eventually need ART for their own survival. Some were against B+ anticipating loss of motivation after protecting the child, fearing drug side-effects and not feeling ready to embark on lifelong medication. Some were undecided.

CONCLUSION:

Option B was preferred. Since Tanzania has recently adopted Option B+, women with CD4 counts of >350 cell/µL should be counseled about the possibility to "opt-out" from ART after cessation of breastfeeding. Drug safety and benefits, economic concerns and available resources for laboratory monitoring and evaluation should be addressed during B+ implementation to enhance long-term feasibility and effectiveness.

PMID:
24465532
PMCID:
PMC3899007
DOI:
10.1371/journal.pone.0085310
[Indexed for MEDLINE]
Free PMC Article

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