Format

Send to

Choose Destination
J Acquir Immune Defic Syndr. 2017 Apr 15;74(5):517-522. doi: 10.1097/QAI.0000000000001273.

Exploring the Experiences of Women and Health Care Workers in the Context of PMTCT Option B Plus in Malawi.

Author information

1
*Medical and Research Department, Dignitas International, Zomba, Malawi; †Chancellor College, University of Malawi, Zomba, Malawi; ‡The University of North Carolina Project, Lilongwe, Malawi; §The Lighthouse Trust, Lilongwe, Malawi; ‖mothers2mothers, Lilongwe, Malawi; ¶Management Sciences for Health, Lilongwe, Malawi; #College of Medicine, University of Malawi, Blantyre, Malawi; and **Ministry of Health, Lilongwe, Malawi.

Abstract

INTRODUCTION:

Malawi has embarked on a "test-and-treat" approach to prevent mother-to-child transmission (PMTCT) of HIV, known as "Option B+," offering all HIV-infected pregnant and breastfeeding women lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage. A cross-sectional qualitative study was conducted to explore early experiences surrounding "Option B+" for patients and health care workers (HCWs) in Malawi.

METHODS:

Study participants were purposively selected across 6 health facilities in 3 regional health zones in Malawi. Semi-structured interviews were conducted with women enrolled in "Option B+" (n = 24), and focus group discussions were conducted with HCWs providing Option B+ services (n = 6 groups of 8 HCWs). Data were analyzed using a qualitative thematic coding framework.

RESULTS:

Patients and HCWs identified the lack of male involvement as a barrier to retention in care and expressed concerns at the rapidity of the test-and-treat process, which makes it difficult for patients to "digest" a positive diagnosis before starting ART. Fear regarding the breach of privacy and confidentiality were also identified as contributing to loss to follow-up of women initiated under the Option B+. Disclosure remains a difficult process within families and couples. Lifelong ART was also perceived as an opportunity to plan future pregnancies.

CONCLUSIONS:

As "Option B+" continues to be rolled out, novel interventions to support and retain women into care must be implemented. These include providing space, time, and support to accept a diagnosis before starting ART, engaging partners and families, and addressing the need for peer support and confidentiality.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02005835.

PMID:
28045712
PMCID:
PMC5340586
DOI:
10.1097/QAI.0000000000001273
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wolters Kluwer Icon for PubMed Central
Loading ...
Support Center