Women's preferences regarding infant or maternal antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV during breastfeeding and their views on Option B+ in Dar es Salaam, Tanzania.
BACKGROUND
The WHO 2010 guidelines for prevention of mother-to-child transmission (PMTCT) of HIV recommended prophylactic antiretroviral treatment (ART) either for infants (Option A) or mothers (Option B) during breastfeeding for pregnant women with a CD4 count of >350 cell/µL in low-income countries. In 2012, WHO proposed that all HIV-infected pregnant women should receive triple ART for life (B+) irrespective of CD4 count. Tanzania has recently switched from Option A to B+, with a few centers practicing B. However, more information on the real-life feasibility of these options is needed. This qualitative study explored women's preferences for Option A vs B and their views on Option B+ in Dar es Salaam, Tanzania.


METHODS
We conducted four focus group discussions with a total of 27 pregnant women with unknown HIV status, attending reproductive and child health clinics, and 31 in-depth interviews among HIV-infected pregnant and post-delivery women, 17 of whom were also asked about B+.


RESULTS
Most participants were in favor of Option B compared to A. The main reasons for choosing Option B were: HIV-associated stigma, fear of drug side-effects on infants and difficult logistics for postnatal drug adherence. Some of the women asked about B+ favored it as they agreed that they would eventually need ART for their own survival. Some were against B+ anticipating loss of motivation after protecting the child, fearing drug side-effects and not feeling ready to embark on lifelong medication. Some were undecided.


CONCLUSIONS
Option B was preferred. Since Tanzania has recently adopted Option B+, women with CD4 counts of >350 cell/µL should be counseled about the possibility to "opt-out" from ART after cessation of breastfeeding. Drug safety and benefits, economic concerns and available resources for laboratory monitoring and evaluation should be addressed during B+ implementation to enhance long-term feasibility and effectiveness.
Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania ; Swedish Institute for Communicable Disease Control, Solna, Sweden and Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
Matilda
M
Ngarina
Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Edith A M
EA
Tarimo
Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania ; Department of Public Health Sciences, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Helga
H
Naburi
Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Charles
C
Kilewo
Management and Development for Health, Dar es Salaam, Tanzania.
Mary
M
Mwanyika-Sando
Management and Development for Health, Dar es Salaam, Tanzania.
Guerino
G
Chalamilla
Swedish Institute for Communicable Disease Control, Solna, Sweden and Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
Gunnel
G
Biberfeld
Department of Public Health Sciences, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Anna Mia
AM
Ekstrom
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001942:Breast Feeding / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D054884:Host-Pathogen Interactions / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007407:Interviews as Topic; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control* / Q000523:psychology / Q000821:virology; D034121:Reproductive Health Services / Q000706:statistics & numerical data; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
D044966:Anti-Retroviral Agents