Acceptability of lifelong treatment among HIV-positive pregnant and breastfeeding women (Option B+) in selected health facilities in Zimbabwe: a qualitative study

Abstract

BackgroundZimbabwe’s Ministry of Health and Child Care (MOHCC) adopted 2013 World Health Organization (WHO) prevention of mother-to-child HIV transmission (PMTCT) guidelines recommending initiation of HIV-positive pregnant and breastfeeding women (PPBW) on lifelong antiretroviral treatment (ART) irrespective of clinical stage (Option B+). Option B+ was officially launched in Zimbabwe in November 2013; however the acceptability of life-long ART and its potential uptake among women was not known.MethodsA qualitative study was conducted at selected sites in Harare (urban) and Zvimba (rural) to explore Option B+ acceptability; barriers, and facilitators to ART adherence and service uptake. In-depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with PPBW, healthcare providers, and community members. All interviews were audio-recorded, transcribed, and translated; data were coded and analyzed in MaxQDA v10.ResultsForty-three IDIs, 22 FGDs, and five KIIs were conducted. The majority of women accepted lifelong ART. There was however, a fear of commitment to taking lifelong medication because they were afraid of defaulting, especially after cessation of breastfeeding. There was confusion around dosage; and fear of side effects, not having enough food to take drugs, and the lack of opportunities to ask questions in counseling. Participants reported the need for strengthening community sensitization for Option B+. Facilitators included receiving a simplified pill regimen; ability to continue breastfeeding beyond 6 months like HIV-negative women; and partner, community and health worker support. Barriers included distance of health facility, non-disclosure of HIV status, poor male partner support and knowing someone who had negative experience on ART.ConclusionsThis study found that Option B+ is generally accepted among PPBW as a means to strengthen their health and protect their babies. Consistent with previous literature, this study demonstrated the importance of male partner and community support in satisfactory adherence to ART and enhancing counseling techniques. Strengthening community sensitization and male knowledge is critical to encourage women to disclose their HIV status and ensure successful adherence to ART. Targeting and engaging partners of women will remain key determinants to women’s acceptance and adherence on ART under Option B+.

Factors influencing prevention of mother to child HIV transmission service utilization among HIV positive women in Amhara National Regional State, Ethiopia: A thematic content analysis

“…This support can be like remind to take their drugs and counseling. The findings described in this study were similar to those reported in other studies in Zimbabwe [21] partner, community and health worker support were facilitators to PMTCT service utilization. Other study also had similar findings [31].…”

“…Frequently mentioned individual and family related factors identified in this study were fear of divorce, lack of family support, lack of partner support and lack of time. Like our research, other studies found that non-disclosure of HIV status, fear of divorce, fear of HIV stigma, and lack of partners support were some of the most common barriers to PMTCT service utilization [16,[19][20][21][22][23][24][25][26]. Another study in Sudan [27], and in Malawi [28] also revealed that women are not likely to disclose their HIV status due to stigma.…”

PMTCT care cascade and factors associated with attrition in the first four years after Option B+ implementation in Mozambique

“…We observed that the initiation of ART on the same day as HIV diagnosis significantly increased both the risk of having an NFU status and non-retention, confirming that pregnant women may still experience considerable staff pressure to undergo immediate ART initiation without sufficient time to disclose to their partner or relative or reflect on their HIV serostatus and the implications of lifelong treatment [16][17][18]21]. A greater degree of acceptability of lifelong treatment under Option B+ can be achieved with male-partner knowledge and support as well as strengthened community sensitization [22,23]. The strengths of our study lie in the number of sites included, which resulted in the inclusion of more than 40 000 eligible women in the analysis, increasing the statistical power and reliability of our results.…”

“…More than 12% of the women had no education, 63% were unemployed and 56% were in a couple or married. The median gestational age at ART initiation for the 'B+ pregnant' women was 25 weeks (IQR: [19][20][21][22][23][24][25][26][27][28][29]. The median follow-up time under ART was 13 months (IQR: .…”

Optimizing Test and Treat in Malawi: health care worker perspectives on barriers and facilitators to ART initiation among HIV-infected clients who feel healthy

“…However, only a handful of studies on ART barriers have been conducted after the implementation of universal Test and Treat [12,13]. Literature from Option B +, a policy that has provided universal treatment for pregnant/breastfeeding women since 2016, found unique barriers to ART initiation among healthy women, including concerns about partner support, feeling healthy, poor knowledge about early ART initiation, needing time to accept their new status, and fear of side effects [15][16][17][18]. Additional information is needed to understand how ART initiation barriers may be similar or different for healthy clients under new universal Test and Treat policies compared to barriers described under prior guidelines that used clinical staging to determine ART eligibility.…”