“We have heard it together”: a qualitative analysis of couple HIV testing and counselling recruitment in Malawi’s Option B+ programme

Abstract

Background: Encouraging HIV-infected pregnant women to recruit male partners for couple HIV testing and counseling (CHTC) is promoted by the World Health Organization, but remains challenging. Formal strategies for recruiting the male partners of pregnant women have not been explored within an Option B+ program. Our objective was to learn about experiences surrounding CHTC recruitment within a formal CHTC recruitment study. Methods: A randomized controlled trial comparing two CHTC recruitment strategies was conducted among HIV-infected pregnant women presenting to Bwaila Antenatal Unit in 2014. Women were randomized to receive an invitation to attend the clinic as a couple or this invitation plus clinic-led phone and community tracing. A qualitative study was conducted with a subset of participants to learn about recruitment. We describe experiences of a subset of HIV-infected pregnant women (N=20) and male partners (N=17). One-on-one In-depth interviews were audio-recorded, transcribed, translated, and coded using content analysis. Results: Nearly all women presented the invitation and disclosed their HIV-positive status to their partners on the day of HIV diagnosis, often to facilitate pill-taking. Men and women in both arms perceived the messages to be more compelling since they came from the clinic, rather than the woman herself. Couples who attended CHTC displayed greater care for one another and mutual support for HIV-related behaviors. Discussion: Facilitating CHTC with invitations and tracing can support CHTC uptake, as well as support for HIV-affected couples. In an Option B+ context inviting partners for CHTC can facilitate male involvement and have important benefits for families.

Understanding women's uptake and adherence in Option B+ for prevention of mother-to-child HIV transmission in Papua, Indonesia: A qualitative study

“…Our findings are consistent with previous research regarding the importance of post-test HIV counselling in helping women understand the disease and consequently promote participation in PMTCT programs [ 24 , 27 , 31 – 32 ]. Similar to a study in rural Tanzania, we found that PMTCT knowledge alone did not ensure women’s adherence to the program [ 33 ], which is in contrast to findings from Malawi and Uganda [ 34 ].…”

“I do all I can but I still fail them”: Health system barriers to providing Option B+ to pregnant and lactating women in Malawi

“…Results from other studies show that support from husbands and partners is crucial to the success of Option B+ [5,22,30,37,41]. Some studies have shown that couple HIV-test yields better acceptance and adherence to ART in pregnant and lactating women [17,37,42,43] similar to our findings. HCWs in our study described cases of women refusing or stopping treatment because their husband threatened to divorce them after they informed them of their HIV positive test result.…”

“…Changing that imbalance is crucial to eradicating HIV in the long-term, but in the short term, interventions that do not require upending existing power structures can be effective. Since men are more likely to follow directions from HCWs than from their wife [41,43], health authorities can give women notes that request their husband’s presence. [43,45] Or local chiefs can enact bylaws that require every man to escort their pregnant wife to ANC [44].…”

Understanding the influence of health systems on women’s experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa

“…'I know ART has come a long way, and it can be provided by a whole host of healthcare workers, but one still needs decent clinical care expertise … ' (International Implementing Partner, Uganda) (Doherty et al, 2017) Provider perspectives and the way in which they relayed health messages lead to mixed understandings of care and treatment that affected care engagement (Buregyeya et al, 2017; Chadambuka et al, 2018; Doherty et al, 2017;Elwell, 2016;Erekaha et al, 2018;Flax et al, 2017a;Helova et al, 2017;Katirayi, et al, 2016a;Masereka et al, 2019;McMahon et al, 2017;Phiri et al, 2018). Many studies reported how health workers emphasised the need for women to remain ART adherent in order to protect their unborn baby (Black et al, 2014;Buregyeya et al, 2017;Cataldo et al, 2018;Chadambuka et al, 2018;Clouse et al, 2014;Doherty et al, 2017;Flax et al, 2017a;Flax et al, 2017b;Gill et al, 2017;Gugsa et al, 2017;Helova et al, 2017;Katirayi, et al, 2016b;McLean et al, 2017;Mulamba et al, 2017;Nkhata et al, 2016;Phiri et al, 2018;Rosenberg et al, 2017;Sariah et al, 2019;Zhou, 2016). However, limited post-partum psychosocial counselling in many settings often led to faltering ART adherence, and loss-to-follow up (LTFU) beyond delivery.…”

“…(Mother with HIV, Malawi) (Zhou, 2016) The way in which health workers conveyed counselling messages affected women's experiences of care, including their ability to cope with stress, depression, low self-worth and experiences of stigmatisation (Erekaha et al, 2018;Flax et al, 2017a;Gill et al, 2017;Gugsa et al, 2017;Mamba & Hlongwana, 2018;McMahon et al, 2017;Sariah et al, 2019). Providers who presented HIV as a chronic, manageable condition often left women feeling more positive about their experiences with HIV services and more likely to adhere to ART (Black et al, 2014;Buregyeya et al, 2017;Chadambuka et al, 2018;Doherty et al, 2017;Elwell, 2016;Gill et al, 2017;Gugsa et al, 2017;Katirayi, et al, 2016a;Katirayi, et al, 2016b;Phiri et al, 2018;Rosenberg et al, 2017).…”