Factors influencing postnatal Option B+ participation and breastfeeding duration among HIV-positive women in Lilongwe District, Malawi: A qualitative study

Abstract

To ensure the health of mothers and children, prevention of mother-to-child HIV transmission (PMTCT) programs test women for HIV, engage HIV-positive women in care, and promote recommended breastfeeding practices. Under Malawi’s Option B+ PMTCT program, ~20% of women are lost-to-follow-up (LTFU) and little is known about their breastfeeding practices. The purpose of this study is to describe facilitators and barriers to Option B+ participation and how participation influences breastfeeding duration. We conducted in-depth interviews with HIV-positive women in Option B+ (n = 32) or LTFU from Option B+ (n = 32). They were recruited from four government clinics in Lilongwe District and had a child aged 0–23 months. Women in Option B+ had better disclosure experiences and more social support than LTFU women. The most common reasons for LTFU were fear of HIV disclosure, anticipated or experienced stigma, and insufficient social support. Other reasons included: non-acceptance of HIV status, antiretroviral therapy (ART) side effects, lack of funds for transport, and negative experiences with clinic staff. Worries about possible transmission, even while on ART, influenced timing of weaning for some women in Option B+. Despite their knowledge of the risk of HIV transmission to the child, most LTFU women continued to breastfeed after stopping ART because they considered breastmilk to be an important source of nutrients for the child. Given that HIV-positive Malawian women LTFU from Option B+ breastfeed in the absence of ART, efforts are needed to use evidence-based strategies to address the barriers to Option B+ participation and avert preventable transmission through breastmilk.

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].…”

“…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. This indicated that family support is important to get health service but stigma and discrimination affect family support.…”

“…In our study, the main reasons for women not taking PMTCT service mentioned by health workers were disclosure of the result, fear of partner, drug side effect, drug supply interruption, trained health care professional not giving attention to the work and work load. Other studies have also had similar findings [18,19,28].…”

“We have heard it together”: a qualitative analysis of couple HIV testing and counselling recruitment in Malawi’s Option B+ programme

“…Within the Option B+ program, early default is common, often due to an inability to disclose and invite male partners (Tenthani et al, 2013; Flax et al, 2017). Our results show that relatively simple invitation and tracing interventions can play a role in helping women with this difficult process through couple HIV testing and counseling.…”

Unpacking Loss to Follow-Up Among HIV-Infected Women Initiated on Option B+ In Northern Tanzania: A Retrospective Chart Review

“…12,[22][23][24][25] Disclosing one's HIV status enables one to garner social support and removes the element of secrecy; women who have disclosed their HIV status are more likely to show up to their appointments without fear. [25][26][27][28] The present study relied on routinely collected clinical data, which did not include details about the characteristic of the treatment supporter, including the individual's relationship with the patient and the type of support they provide. Further research should explore the characteristics of treatment supporters that facilitate care engagement.…”