title: Exploring the Experiences of Women and Health Care Workers in the Context of PMTCT Option B Plus in Malawi.
abstract: 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.
authors.affiliation: *Medical and Research Department, Dignitas International, Zomba, Malawi; †Chancellor College, University of Malawi, Zomba, Malawi; ‡The University of North Carolina Project, Lilongwe, Malawi; §The Lighthouse Trust, Lilongwe, Malawi; ‖mothers2mothers, Lilongwe, Malawi; ¶Management Sciences for Health, Lilongwe, Malawi; #College of Medicine, University of Malawi, Blantyre, Malawi; and **Ministry of Health, Lilongwe, Malawi.
authors.forename: Fabian
authors.initials: F
authors.lastname: Cataldo
authors.forename: Levison
authors.initials: L
authors.lastname: Chiwaula
authors.forename: Misheck
authors.initials: M
authors.lastname: Nkhata
authors.forename: Monique
authors.initials: M
authors.lastname: van Lettow
authors.forename: Florence
authors.initials: F
authors.lastname: Kasende
authors.forename: Nora E
authors.initials: NE
authors.lastname: Rosenberg
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.forename: Veena
authors.initials: V
authors.lastname: Sampathkumar
authors.forename: Mina
authors.initials: M
authors.lastname: Hosseinipour
authors.forename: Erik
authors.initials: E
authors.lastname: Schouten
authors.forename: Atupele
authors.initials: A
authors.lastname: Kapito-Tembo
authors.forename: Michael
authors.initials: M
authors.lastname: Eliya
authors.forename: Frank
authors.initials: F
authors.lastname: Chimbwandira
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control*; D006282:Health Personnel; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007407:Interviews as Topic; D008295:Malawi; D009035:Mothers; D010342:Patient Acceptance of Health Care; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents