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

Abstract

Introduction Malawi has embarked on a ‘test-and-treat’ approach to prevent mother-to-child transmission of HIV (PMTCT), known as ‘Option B+’, offering all HIV-infected pregnant and breastfeeding women lifelong antiretroviral treatment (ART) regardless of CD4-count or clinical stage. We conducted a cross-sectional qualitative study to explore early experiences surrounding ‘Option B+’ for patients and health care workers (HCWs) in Malawi. Methods Study participants were purposively selected across six health facilities in three 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 analysed 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 initated 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.

Perceptions of mothers and healthcare professionals to contributors and preventions of loss-to-follow-up and child mortality at the PMTCT program after option B + guideline implementation in northwest Ethiopia

“…This also compounded the struggle with stigma and discrimination as some women would choose to protect their relationships through leverage of husbands' absence at Antenatal care and cultural practices that would raise ag in mothers do not breastfeed the child. Similar results were reported elsewhere (38) as their main nding in Malawi and Uganda populations and in Malawi (41). Poverty as a barrier reported here has also been reported by other studies as lack of funds to travel for Antenatal care (37,40).…”

“…Stigma and discrimination is reported as a major barrier across studies and countries and it was reported as a major issue by the participants including internalized stigma (35,37,38,40,41). Despite, information on HIV be widely available through all media, this study con rmed that stigma and discrimination are still a major issue in HIV in Ethiopia and in other African states stigma (35,37,38,40,41)). Unlike ndings from Schechter et al (40) stigma in Amhara region is not largely internalized but rather from the community and sometimes health care professionals.…”

A secondary analysis of retention across the PMTCT cascade in selected countries: Rwanda, Malawi, Kenya, and Swaziland

“…However, very early on, some women identified as HIV-positive in pregnancy and instructed to start ART for life were reluctant and rather than refuse treatment, disposed of the ARVs (based on anecdotal stories from implementing partners' observations). A recent presentation suggested that stigma, confidentiality, privacy, and the method of initiating ART continue to challenge PMTCT services in Malawi (Cataldo et al 2013).…”

Social concerns related to HIV status disclosure and participation in the prevention of mother-to-child transmission of HIV care among pregnant women in Kenya

“…PMTCT care as well as ART to prevent sexual transmission, condom use, and voluntary male medical circumcision are successful strategies for HIV prevention in low and middle-income countries [2,3,12]. However, qualitative evidence from sub-Saharan Africa (SSA) and Asia has shown that concerns about unintentional HIV status disclosure and HIV related stigma are barriers to participate in PMTCT care among pregnant women [13][14][15][16][17][18]. Qualitative studies have also identified other important barriers to HIV status disclosure including concerns about separation or divorce [19][20][21][22][23], conflicts with a partner [19,21], intimate partner violence (IPV) [19][20][21]23] and stigma in the family or community [20,23].…”