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

Cataldo, Fabian; Chiwaula, Levison; Nkhata, Misheck; van Lettow, Monique; Kasende, Florence; Rosenberg, Nora E.; Tweya, Hannock; Sampathkumar, Veena; Hosseinipour, Mina; Schouten, Erik; Kapito-Tembo, Atupele; Eliya, Michael; Chimbwandira, Frank; Phiri, Sam

Abstract

ntroduction: 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.

Citation

Cataldo, F., Chiwaula, L., Nkhata, M., van Lettow, M., Kasende, F., Rosenberg, N. E., …Phiri, S. (2017). Exploring the Experiences of Women and Health Care Workers in the Context of PMTCT Option B Plus in Malawi. Journal of Acquired Immune Deficiency Syndromes, 74(5), 517-522. https://doi.org/10.1097/qai.0000000000001273

• Journal Article Type: Article
• Acceptance Date: Nov 21, 2016
• Online Publication Date: Apr 15, 2017
• Publication Date: Apr 15, 2017
• Deposit Date: Mar 20, 2018
• Publicly Available Date: Jul 12, 2018
• Journal: Journal of Acquired Immune Deficiency Syndromes
• Print ISSN: 1525-4135
• Electronic ISSN: 1944-7884
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 74
• Issue: 5
• Pages: 517-522
• DOI: https://doi.org/10.1097/qai.0000000000001273
• Public URL: https://durham-repository.worktribe.com/output/1337146