Acceptability of lifelong treatment (Option B+) among HIV-positive pregnant and lactating women in Selected Sites in Malawi
Background: In 2011, Malawi implemented Option B+, a policy recommending lifelong maternal antiretroviral (ARV) treatment for prevention of mother-to-child HIV transmission (PMTCT), irrespective of clinical staging or CD4 count. This study seeks to explore the acceptability of Option B+ and the barriers and facilitators that affect a woman''s decision to initiate lifelong antiretroviral therapy (ART).
Methods: Data were collected using convenience sampling from two rural sites and two urban sites in the districts of Dedza, Mchinji and Lilongwe between September-December 2013. Eighteen in-depth interviews (IDIs) and 4 focus-group discussions (FGDs) were conducted with pregnant women, 21 IDIs and 8 FGDs with lactating women and 4 FGDs with health care workers (HCWs). Eligible pregnant and lactating women were ≥18 years old, HIV-positive, on ART ≥1 month and with a child ≤18 months for lactating women. HCWs identified and referred eligible participants to data collectors. Eligible HCWs worked in the ANC/ART for ≥6 months and were referred by the head nurse to study data collectors. All study participants provided written informed consent. Audio recordings from the FGD/ IDIs were transcribed into English. Data were coded and analyzed using MAXqda.
Results: Women reported difficulty around learning their HIV status and initiating ART on the same day. They were overwhelmed with the information, needed time to think about ART initiation and wanted to first discuss with their partners before committing to lifelong treatment. Disclosure had both a positive and negative effect. Those who disclosed discussed being supported by the partner/family and those who did not disclose discussed challenges with initiating and adhering to ART. HCWs reported women taking the medication home and waiting to initiate until they felt ready. According to the women, knowing other women who had a positive experience with Option B+ made it easier to initiate. All groups emphasized a strong need for increased community sensitization about Option B+.
Conclusions: In order to maximize the impact of Option B+, it is important to address challenges faced by women starting on lifelong therapy. Methods (e.g., psychosocial support at results disclosure) need to be developed to strengthen initiation and adherence of Option B+.
L. Katirayi1, H. Namadingo2, E. Bobrow1, A. Yemaneberhan2, M. Phiri2, S. White2, F. Chimbwandira3, N. Buono2, K. Molland4, T. Tylleskar4, A. Ahimbisibwe2
1Elizabeth Glaser Pediatric AIDS Foundation, Research, Washington, United States, 2Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi, 3Ministry of Health Malawi, Lilongwe, Malawi, 4University of Bergen, Center for International Health, Bergen, Norway