title: Trends in ART Initiation among Men and Non-Pregnant/Non-Breastfeeding Women before and after Option B+ in Southern Malawi.
abstract: BACKGROUND
  Option B+ is promoted as a key component to eliminating vertical transmission of HIV; however, little is known about the policy's impact on non-targeted populations, such as men and non-pregnant/non-breastfeeding women. We compare ART uptake among non-targeted populations during pre/post Option B+ periods in Zomba District, Malawi.
  
  
  METHODS
  Individual-level ART registry data from 27 health facilities were digitized and new ART initiates were disaggregated by sex and type of initiate (Option B+ or not). Data were analyzed over the pre- (January 2009-June 2011) and post- (July 2011- December 2013) Option B+ periods.
  
  
  RESULTS
  After the implementation of Option B+, the total number of new female initiates increased significantly (quarterly median: 547 vs. 816; P = 0.001) and their median age decreased from 34 to 31 years (P = <0.001). Both changes were the result of the rapid and sustained uptake of ART among Option B+ clients. Post-policy, Option B+ clients represented 48% of all new female initiates while the number of females who initiated through CD4 or WHO staging criteria significantly decreased (quarterly median: 547 vs. 419; P = 0.005). The number and age of male initiates remained stable; however, the proportion of men among new initiates decreased (36% vs. 31%; P = <0.001).
  
  
  CONCLUSIONS
  Option B+ shifted the profile of first-time initiates towards younger and fertile women. Declines among non-Option B+ women most likely reflect earlier initiation during pregnancies before deteriorations in health. The decreased proportion of men among first-time initiates represents a growing gender disparity in HIV services that deserves immediate attention.
authors.affiliation: Center for World Health, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, United States of America.
authors.forename: Kathryn
authors.identifier: http://orcid.org/0000-0002-5622-3401
authors.initials: K
authors.lastname: Dovel
authors.affiliation: Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, United States of America.
authors.forename: Sara
authors.initials: S
authors.lastname: Yeatman
authors.affiliation: Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi.|Dignitas International, Zomba, Malawi.
authors.forename: Joep J
authors.initials: JJ
authors.lastname: van Oosterhout
authors.affiliation: Dignitas International, Zomba, Malawi.|Department of Family and Community Medicine, University of Toronto, Toronto, Canada.|Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Chan
authors.affiliation: Dignitas International, Zomba, Malawi.
authors.forename: Alfred
authors.initials: A
authors.lastname: Mantengeni
authors.affiliation: Dignitas International, Zomba, Malawi.|Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: Landes
authors.affiliation: Dignitas International, Zomba, Malawi.
authors.forename: Richard
authors.initials: R
authors.lastname: Bedell
authors.affiliation: District Health Office, Ministry of Health, Zomba, Malawi.
authors.forename: Gift
authors.initials: G
authors.lastname: Kawalazira
authors.affiliation: Dignitas International, Zomba, Malawi.|Department of Family and Community Medicine, University of Toronto, Toronto, Canada.|Department of Family and Community Medicine, University Health Network, Toronto Western Hospital, Toronto, Canada.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Sodhi
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006268:Health Facilities; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi; D008297:Male
chemical_list: D044966:Anti-Retroviral Agents