Exploring factors associated with ART adherence and retention in care under Option B+ strategy in Malawi: A qualitative study

Abstract

Although several studies have documented challenges related to inadequate adherence to antiretroviral therapy (ART) and high loss to follow-up (LTFU) among Option B+ women, there is limited understanding of why these challenges occur and how to address them. This qualitative study examines women’s experiences with ART adherence and retention in care. Between July and October 2015, in-depth interviews were conducted with 39 pregnant and lactating women who initiated ART at Bwaila Hospital in Lilongwe, Malawi. Study participants included 14 in care and 25 out of care women, according to facility records. Data were analyzed using an inductive, open-coding approach to thematic analysis. Ten of the respondents (7 out of care, 3 in-care) had stopped and re-started treatment before the interview date. One of the most important factors influencing adherence and retention was the strength of women’s support systems. In contrast to women in-care, most out-of-care women lacked emotional and financial support from male partners, received minimal counseling from providers at initiation, lacked designated guardians to assist with medication refills or clinic appointments, and were highly mobile. Mobility led to difficulties in accessing treatment in new settings. The most common reasons women re-started treatment following interruptions were due to providers’ counseling and encouragement and the mother’s desire to be healthy. Improved counseling at initiation, active follow-up counseling, women’s economic empowerment interventions, promotion of peer counseling schemes and meaningful engagement of male partners can help in addressing the identified barriers and promoting sustained retention of Option B+ women.

Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

“…Among the personal factors, non-supportive or abusive spousal behaviour was frequently reported as a crucial factor associated with LTFUs, consistent with findings from other studies [10][11][12][13][14]32 . Men are considered to be the primary decision makers regarding family matters, not only in Malawi but also many parts of Sub-Saharan Africa 11 .…”

“…In our study, shortage of health commodities; and inadvertent disclosure of HIV status by health care workers were not reported as causes of LTFU despite being reported in other studies [12][13][14]22,23 . This is good news as resource allocation and ensuring constant supply of HIV supplies is backbone in diagnosis and control of spread of HIV through viral suppression.…”

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 is in line with findings of other study done in Ethiopia revealed that health workers are not happy to handle deliveries for women who are known HIV positive due to fear of accidental infection [22]. Other studies have also had similar findings [17,23,[28][29][30][31].…”

“…The findings of this study revealed that mother support groups are facilitator of PMTCT service utilization. The findings also similar with other studies in Malawi reported that promotion of peer counseling schemes for PMTCT [30]. This indicated that mother support group served as peer educators in health facilities to provide education and psychosocial support to HIV positive pregnant and lactating women promotes PMTCT service utilization.…”

Mother to Child Transmission of HIV after Option B+ in Low Income Environment

“…PMTCT treatment than women who tested positive during pregnancy [24]. In a qualitative study, Gugsa et al identified Improved counseling at initiation, active follow-up counseling, women's economic empowerment interventions, promotion of peer counseling schemes as measures to improve adherence [25]. The hypothesis of the contribution of the strong desire of a HIV free newborn not to repeat the stigma raised above for the coming child, the free of charge antiretroviral drug taken once daily, the relatively short duration of pregnancy window observance assessment as compared to lifelong observance assessment and the therapeutic education aimed at strengthening observance as factors explaining this adherence not assessed in this study are to be confirmed…”