Exploring the Experiences of Women and Health Care Workers in the Context of PMTCT Option B Plus in Malawi.
Exploring the Experiences of Women and Health Care Workers in the Context of PMTCT Option B Plus in Malawi.
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DOI：
10.1097/qai.0000000000001273
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发表时间：
2017-04-15
期刊：
影响因子：
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通讯作者：
PURE Malawi Consortium
中科院分区：
文献类型：
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作者：
Cataldo F;Chiwaula L;Nkhata M;van Lettow M;Kasende F;Rosenberg NE;Tweya H;Sampathkumar V;Hosseinipour M;Schouten E;Kapito-Tembo A;Eliya M;Chimbwandira F;Phiri S;PURE Malawi Consortium
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. 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. 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. 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.
