Cataldo, Fabian and Chiwaula, Levison and Nkhata, Misheck and van Lettow, Monique and Kasende, Florence and Rosenberg, Nora E. and Tweya, Hannock and Sampathkumar, Veena and Hosseinipour, Mina and Schouten, Erik and Kapito-Tembo, Atupele and Eliya, Michael and Chimbwandira, Frank and Phiri, Sam (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 : JAIDS., 74 (5). pp. 517-522.
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.
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|Publisher Web site:||https://doi.org/10.1097/QAI.0000000000001273|
|Publisher statement:||© 2016 The Author(s). Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative CommonsAttribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.|
|Date accepted:||21 November 2016|
|Date deposited:||12 July 2018|
|Date of first online publication:||15 April 2017|
|Date first made open access:||No date available|
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