Exploring the acceptability of Option B plus among HIV-positive Nigerian women engaged and not engaged in the prevention of mother-to-child transmission of HIV cascade: a qualitative study

Abstract

The acceptability of lifelong antiretroviral therapy (ART) among HIV-positive women in high-burden Nigeria, is not well-known. We explored readiness of users and providers of prevention of mother-to-child transmission of HIV (PMTCT) services to accept lifelong ART -before Option B plus was implemented in Nigeria. We conducted 142 key informant interviews among 100 PMTCT users (25 pregnant-newly-diagnosed, 26 pregnant-in-care, 28 lost-to-follow-up (LTFU) and 21 postpartum women living with HIV) and 42 PMTCT providers in rural North-Central Nigeria. Qualitative data were manually analyzed via Grounded Theory. PMTCT users had mixed views about lifelong ART, strongly influenced by motivation to prevent infant HIV and by presence or absence of maternal illness. Newly-diagnosed women were most enthusiastic about lifelong ART, however postpartum and LTFU women expressed conditionalities for acceptance and adherence, including minimal ART side effects and potentially serious maternal illness. Providers corroborated user findings, identifying the postpartum period as problematic for lifelong ART acceptability/adherence. Option B plus scale-up in Nigeria will require proactively addressing PMTCT user fears about ART side effects, and continuous education on long-term maternal and infant benefits. Structural barriers such as the availability of trained providers, long clinic wait times and patient access to ART should also be addressed.

COVID-19 may Exacerbate the Clinical, Structural and Psychological Barriers to Retention in Care Among Women Living with HIV in Rural and Peri-Urban Settings in Uganda

“…Additionally, some women reported refusing treatments since they felt they were not sick at the moment and therefore did not need HIV treatment. Under the option B+, women diagnosed during pregnancy or breastfeeding are immediately initiated on ART irrespective of CD4 count or clinical staging, which makes them likely to miss out on key initiation procedures such as psychological preparation, an essential aspect in retention in care [12,13]. Women under option B + are likely not to be well counselled and tend to suffer from stigma related challenges including lack of disclosure [8,10].…”

“…Women under option B + are likely not to be well counselled and tend to suffer from stigma related challenges including lack of disclosure [8,10]. This concern has been reported to be a hindrance to the success of Option B + and the Test and Treat strategies where, clients initiated under these programs possess a higher possibility of dropping out of care as they perceive themselves as healthy compared with those initiated under the conventional WHO staging criteria [8,13,19,20]. These ndings highlight a critical need for adequate preparation of women initiated on ART under option B+.…”

“…This and other clinical related challenges have been reported by other authors [7,25], and contribute greatly to attrition from HIV care. Worse still, women initiated on ART under option B + may experience these barriers more severely due to the possible lack of psychological preparation [12,13]. Targeting healthcare workers has been highly recommended [25].…”

“…Therefore, retaining pregnant and breastfeeding women in care might require targeted interventions. Because many women may be identi ed for the rst time as HIV infected while pregnant, psychological preparation while initiating ART and during follow up care has been identi ed as a key need for retaining them in care [12,13]. Tracing and supporting reengagement in care of previously lost to follow-up clients has also shown to be successful in the general population [9] and could be opted in Prevention of Mother to Child Transmission of HIV (PMTCT) services.…”

“…Tracing and supporting reengagement in care of previously lost to follow-up clients has also shown to be successful in the general population [9] and could be opted in Prevention of Mother to Child Transmission of HIV (PMTCT) services. Other factors documented to facilitate retention in care among pregnant/breastfeeding women include; health bene ts of HIV treatment for themselves and their babies, and support from spouses, family and friends [11,13]. Decentralised community models used in general ART could also be adopted for delivery of PMTCT services to increase retention, however, these are yet to be adopted in Uganda.…”