title: Why Did I Stop? Barriers and Facilitators to Uptake and Adherence to ART in Option B+ HIV Care in Lilongwe, Malawi.
abstract: Causes for loss-to-follow-up, including early refusals of and stopping antiretroviral therapy (ART), in Malawi's Option B+ program are poorly understood. This study examines the main barriers and facilitators to uptake and adherence to ART under Option B+. In depth interviews were conducted with HIV-infected women who were pregnant or postpartum in Lilongwe, Malawi (N = 65). Study participants included women who refused ART initiation (N = 10), initiated ART and then stopped (N = 26), and those who initiated ART and remained on treatment (N = 29). The barriers to ART initiation were varied and included concerns about partner support, feeling healthy, and needing time to think. The main reasons for stopping ART included side effects and lack of partner support. A substantial number of women started ART after initially refusing or stopping ART. There were several facilitators for re-starting ART, including encouragement from community health workers, side effects subsiding, decline in health, change in partner, and fear of future sickness. Amongst those who remained on ART, desire to prevent transmission and improve health were the most influential facilitators. Reasons for refusing and stopping ART were varied. ART-related side effects and feeling healthy were common barriers to ART initiation and adherence. Providing consistent pre-ART counseling, early support for patients experiencing side effects, and targeted efforts to bring women who stop treatment back into care may improve long term health outcomes.
authors.affiliation: Baylor College of Medicine Department of Pediatrics, Section of Global Health and Retrovirology, Texas Children's Hospital, Houston, Texas, United States of America.|Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
authors.forename: Maria H
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Department of Sociology, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Amy
authors.initials: A
authors.lastname: Zhou
authors.affiliation: Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
authors.forename: Alick
authors.initials: A
authors.lastname: Mazenga
authors.affiliation: Baylor College of Medicine Department of Pediatrics, Section of Global Health and Retrovirology, Texas Children's Hospital, Houston, Texas, United States of America.|Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, Houston, Texas, United States of America.
authors.forename: Christine
authors.initials: C
authors.lastname: Markham
authors.affiliation: HIV Unit, Malawi Ministry of Health, Lilongwe, Malawi.
authors.forename: Gerald
authors.initials: G
authors.lastname: Zomba
authors.affiliation: Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
authors.forename: Katie
authors.initials: K
authors.lastname: Simon
authors.affiliation: Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kazembe
authors.affiliation: ICAP, Mailman School of Public Health and College of Physicians & Surgeons, Columbia University, New York, New York, United States of America.
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D055118:Medication Adherence / Q000523:psychology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology
chemical_list: D044966:Anti-Retroviral Agents