Awareness and perceived fairness of option B+ in Malawi: a population‐level perspective

Abstract

Introduction: Policies for rationing antiretroviral therapy (ART) have been subject to on-going ethical debates. Introduced in Malawi in 2011, Option B+ prioritized HIV-positive pregnant women for lifelong ART regardless of the underlying state of their immune system, shifting the logic of allocation away from medical eligibility. Despite the rapid expansion of this policy, we know little about how it has been understood and interpreted by the people it affects. Methods: We assessed awareness and perceived fairness of the prioritization system for ART among a population-based sample of young women (n = 1440) and their partners (n = 574) in southern Malawi. We use a card-sort technique to elicit understandings of who gets ART under Option B+ and who should be prioritized, and we compare perceptions to actual ART policy using sequence analysis and optimal matching. We then use ordered logistic regression to identify the factors associated with policy awareness. Results: In 2015, only 30.7% of women and 21.1% of male partners understood how ART was being distributed. There was widespread confusion around whether otherwise healthy HIV-positive pregnant women could access ART under Option B + . Nonetheless, more young adults thought that the fairest policy should prioritize such women than believed the actual policy did. Women who were older, more educated or had recently engaged with the health system through antenatal care or ART had more accurate understandings of Option B + . Among men, policy awareness was lower, and was patterned only by education. Conclusions: Although most respondents were unaware that Option B+ afforded ART access to healthy-pregnant women, Malawians support the prioritization of pregnant women. Countries adopting Option B+ or other new ART policies such as universal test-and-treat should communicate the policies and their rationales to the public – such transparency would be more consistent with a fair and ethical process and could additionally serve to clarify confusion and enhance retention.​​

<p>Level of Knowledge About Prevention of Mother-to-Child Transmission of HIV Option B+ and Associated Factors Among ANC Clients in Kombolcha Town, South Wollo Amhara Regional State, Ethiopia, 2017</p>

“…The current study finding was higher than the finding of studies done in Gahanna (25%), Tanzania (35.2%), South Africa (23.1%), and Uganda (30.1%) [9][10][11]22 and lower than the studies done in Malawi (68%). 8 This variation of findings across various studies might be due to cross-cultural limitations of diagnostic tools and reporting biases, differences in socio-economic environments. However, this study finding was comparable to studies done in Hadyia and Mekelle town which reported pregnant women knowledge of PMTCT B + were 59.9% and 56.7%, respectively.…”

“…This finding was agreed with reports of WHO 2014 and Malawi. 1,8 The possible explanation may be that employment leads to adequate knowledge of PMTCT B + option in a number of ways. When women become unemployed, it is a stressful event that affects their self-esteem.…”

“…A study done in Malawi shows that knowledge about PMTCT option B+ was low. 8 Similarly, the finding of studies done in Gahanna, Tanzania, and Uganda indicated that only 25%, 35.2% and 30.1% pregnant women had adequate knowledge about PMTCT B+ options respectively. [9][10][11] According to a study done in Hadiya, 94.6% of participants supposed that HIV infected pregnant women can transmit HIV to her fetus.…”

An Assessment of the Social, Cultural, and Economical Barriers to Option B&amp;#43; Retention and Their Solutions in Malawi: A Review

“…Findings from the survey suggested that those who stopped ART did so due to their extensive distance from the clinic, having limited transportation, HIV disclosure status, limited education concerning why they were receiving treatment, and others [18] [19] [20]. Pertaining to Option B+ education, a study by Yeatman et al 2017 showed that only 30.7% of women and 21.1% of male partners understood how ART was distributed, and most respondents were unaware that healthy pregnant women were included in Option B+ [21].…”

Tsogolo la Thanzi: A Longitudinal Study of Young Adults Living in Malawi's HIV Epidemic

“…Key findings have centered on the changing HIV treatment context (Yeatman et al. ; Yeatman and Trinitapoli ), fertility preferences (Trinitapoli and Yeatman ; Yeatman, Sennott, and Culpepper ; Yeatman and Sennott ; Sennott and Yeatman ; Trinitapoli and Yeatman ), education and literacy (Smith‐Greenaway ; Frye ), young‐adult relationships (Frye and Trinitapoli ), and family dynamics (Bachan ; Trinitapoli, Yeatman, and Fledderjohann ). A publication list for TLT is available at https://scholar.google.com/citations?user=OFx9oPIAAAAJ&hl=en.…”