Malawi has one of the highest rates of HIV prevalence in the world, and accounts for 4% of the total number of people living in sub-Saharan Africa with HIV. Approximately one million people in Malawi were living with HIV in 2016, with 24,000 HIV-related deaths. The Option B+ program, first implemented in Malawi, aimed to initiate ART for all pregnant women, regardless of their CD4 cell count or disease stage. This study serves to analyze and assess the effectiveness of Option B+ retention, in relation to the facilitation of how various social and cultural barriers were handled. A literature review of 29 publications was conducted. Careful evaluation of various studies indicates that although there is a myriad of reasons explaining low levels of retention, the women who were at the highest risk for low retention were young pregnant women who were treated on the same day of HIV-diagnosis. Solutions focused around women and their partners or communities showed promising evidence of success in increasing adherence, as these strategies likely provided women reliable social and emotional support to address major barriers to retention such as a lack of support from male partners, ineffective education from healthcare workers, or stigma towards their HIV disclosure statue.
References
[1]
UNAIDS (2014) The Gap Report. Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, 334. http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf
[2]
World Health Organization (2010) Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infections in Infants. World Health Organization, Geneva. http://whqlibdoc.who.int/publications/2010/9789241599818_eng.pdf
[3]
Government of Malawi Ministry of Health (2015) Malawi AIDS Response Progress Report 2015. http://www.unaids.org/sites/default/files/country/documents/MWI_narrative_report_2015.pdf
[4]
Kalua, T., Barr, B.A.T., van Oosterhout, J.J., Mbori-Ngacha, D., Schouten, E.J., Gupta, S., et al. (2017) Lessons Learned from Option B+ in the Evolution toward “Test and Start” from Malawi, Cameroon, and the United Republic of Tanzania. Journal of Acquired Immune Deficiency Syndromes, 75, S43-S50. https://doi.org/10.1097/QAI.0000000000001326
[5]
Kamuyango, A.A., Hirschhorn, L.R., Wang, W., Jansen, P. and Hoffman, R.M. (2014) One-Year Outcomes of Women Started on Antiretroviral Therapy during Pregnancy before and after the Implementation of Option B+ in Malawi: A Retrospective Chart Review. World Journal of Aids, 4, 332-337. https://doi.org/10.4236/wja.2014.43039
[6]
Chimbwandira, F., Mhango, E., Makombe, S., et al. (2013) Impact of an Innovative Approach to Prevent Mother-to-Child Transmission of HIV—Malawi, July 2011-September 2012. MMWR Morbidity and Mortality Weekly Report, 62, 148-151.
[7]
Government of Malawi Ministry of Health (2016) Integrated HIV Program Report: January 2016-March 2016.
[8]
Harries, A.D., Ford, N., Jahn, A., et al. (2016) Act Local, Think Global: How the Malawi Experience of Scaling Up Antiretroviral Treatment Has Informed Global Policy. BMC Public Health, 16, Article No. 938. https://doi.org/10.1186/s12889-016-3620-x
[9]
Kim, M.H., Zhou, A., Mazenga, A., et al. (2016) Why Did I Stop? Barriers and Facilitators to Uptake and Adherence to ART in Option B+ HIV Care in Lilongwe, Malawi. PLoS ONE, 11, e0149527. https://doi.org/10.1371/journal.pone.0149527
[10]
Tenthani, L., Haas, A.D., Tweya, H., et al. (2014) Retention in Care under Universal Antiretroviral Therapy for HIV Infected Pregnant and Breastfeeding Women (“Option B+”) in Malawi. AIDS (London, England), 28, 589-598. https://doi.org/10.1097/QAD.0000000000000143
[11]
Chan, A.K., Kanike, E., Bedell, R., et al. (2016) Same Day HIV Diagnosis and Antiretroviral Therapy Initiation Affects Retention in Option B+ Prevention of Mother-to-Child Transmission Services at Antenatal Care in Zomba District, Malawi. Journal of the International AIDS Society, 19, 20672. https://doi.org/10.7448/IAS.19.1.20672
[12]
Landes, M., Sodhi, S., Matengeni, A., et al. (2016) Characteristics and Outcomes of Women Initiating ART during Pregnancy versus Breastfeeding in Option B+ in Malawi. BMC Public Health, 16, Article No. 713. https://doi.org/10.1186/s12889-016-3380-7
[13]
Van Lettow, M., Bedell, R., Mayuni, I., et al. (2014) Towards Elimination of Mother-to-Child Transmission of HIV: Performance of Different Models of Care for Initiating Lifelong Antiretroviral Therapy for Pregnant Women in Malawi (Option B+). Journal of the International AIDS Society, 17, 18994. https://doi.org/10.7448/IAS.17.1.18994
[14]
Wilkinson, L.S., Skordis-Worrall, J., Ajose, O. and Ford, N. (2015) Self-Transfer and Mortality amongst Adults Lost to Follow-Up in ART Programmes in Low- and Middle-Income Countries: Systematic Review and Meta-Analysis. Tropical Medicine & International Health: TM & IH, 20, 365-379. https://doi.org/10.1111/tmi.12434
[15]
McLean, E., Renju, J., Wamoyi, J., et al. (2017) “I Wanted to Safeguard the Baby”: A Qualitative Study to Understand the Experiences of Option B+ for Pregnant Women and the Potential Implications for “Test-and-Treat” in Four Sub-Saharan African Settings. Sexually Transmitted Infections, 93, e052972. https://doi.org/10.1136/sextrans-2016-052972
[16]
Rosenberg, N.E., Gross, R., Mtande, T., Maman, S., Golin, C.E., Saidi, F., Manthalu, O., Hoffman, I., Hosseinipour, M.C. and Miller, W.C. (2017) “We Have Heard It Together”: A Qualitative Analysis of Couple HIV Testing and Counselling Recruitment in Malawi’s Option B+ Programme. African Journal of AIDS Research, 16, 215-223. https://doi.org/10.2989/16085906.2017.1362017
[17]
Haas, A.D., van Oosterhout, J.J., Tenthani, L., et al. (2017) HIV Transmission and Retention in Care among HIV-Exposed Children Enrolled in Malawi’s Prevention of Mother-to-Child Transmission Programme. Journal of the International AIDS Society, 20, 21947. https://doi.org/10.7448/IAS.20.1.21947
[18]
Tweya, H., Gugsa, S., Hosseinipour, M., Speight, C., Ng’ambi, W., Bokosi, M., Chikonda, J., Chauma, A., Khomani, P., Phoso, M., et al. (2014) Understanding Factors, Outcomes and Reasons for Loss to Follow-Up among Women in Option B+ PMTCT Programme in Lilongwe, Malawi. Tropical Medicine & International Health: TM & IH, 19, 1360-1366. https://doi.org/10.1111/tmi.12369
[19]
Flax, V.L., Hamela, G., Mofolo, I., Hosseinipour, M.C., Hoffman, I.F. and Maman, S. (2017) Factors Influencing Postnatal Option B+ Participation and Breastfeeding Duration among HIV-Positive Women in Lilongwe District, Malawi: A Qualitative Study. PLoS ONE, 12, e0175590. https://doi.org/10.1371/journal.pone.0175590
[20]
Flax, V.L., Yourkavitch, J., Okello, E.S., Kadzandira, J., Katahoire, A.R. and Munthali, A.C. (2017) “If My Husband Leaves Me, I Will Go Home and Suffer, So Better Cling to Him and Hide This Thing”: The Influence of Gender on Option B+ Prevention of Mother-to-Child Transmission Participation in Malawi and Uganda. PLoS ONE, 12, e0178298. https://doi.org/10.1371/journal.pone.0178298
[21]
Yeatman, S. and Trinitapoli, J. (2017) Awareness and Perceived Fairness of Option B+ in Malawi: A Population-Level Perspective. Journal of the International AIDS Society, 20, 21467. https://doi.org/10.7448/IAS.20.1.21467
[22]
Cataldo, F., Seeley, J., Nkhata, M.J., et al. (2018) She Knows That She Will Not Come Back: Tracing Patients and New Thresholds of Collective Surveillance in PMTCT Option B+. BMC Health Services Research, 18, Article No. 76. https://doi.org/10.1186/s12913-017-2826-7
[23]
Katirayi, L., Namadingo, H., Phiri, M., et al. (2016) HIV-Positive Pregnant and Postpartum Women’s Perspectives about Option B+ in Malawi: A Qualitative Study. Journal of the International AIDS Society, 19, 20919. https://doi.org/10.7448/IAS.19.1.20919
[24]
Gugsa, S., Potter, K., Tweya, H., et al. (2017) Exploring Factors Associated with ART Adherence and Retention in Care under Option B+ Strategy in Malawi: A Qualitative Study. PLoS ONE, 12, e0179838. https://doi.org/10.1371/journal.pone.0179838
[25]
Rosenberg, N.E., Mtande, T.K., Saidi, F., et al. (2015) Recruiting Male Partners for Couple HIV Testing and Counselling in Malawi’s Option B+ Programme: An Unblinded Randomised Controlled Trial. The Lancet HIV, 2, e483-e491. https://doi.org/10.1016/S2352-3018(15)00182-4
[26]
Wesevich, A., Mtande, T., Saidi, F., Cromwell, E., Tweya, H., Hosseinipour, M.C., Hoffman, I., Miller, W.C. and Rosenberg, N.E. (2017) Role of Male Partner Involvement in ART Retention and Adherence in Malawi’s Option B+ Program. AIDS Care, 29, 1417-1425. https://doi.org/10.1080/09540121.2017.1308464
[27]
Besada, D., Rohde, S., Goga, A., et al. (2016) Strategies to Improve Male Involvement in PMTCT Option B+ in Four African Countries: A Qualitative Rapid Appraisal. Global Health Action, 9, 33507. https://doi.org/10.3402/gha.v9.33507
[28]
Herce, M.E., Mtande, T., Chimbwandira, F., Mofolo, I., Chingondole, C.K., et al. (2015) Supporting Option B+ Scale Up and Strengthening the Prevention of Mother-to-Child Transmission Cascade in Central Malawi: Results from a Serial Cross-Sectional Study. BMC Infectious Diseases, 15, Article No. 328. https://doi.org/10.1186/s12879-015-1065-y
[29]
Phiri, S., Tweya, H., van Lettow, M., Rosenberg, N.E., Trapence, C., Kapito-Tembo, A., et al. (2017) Impact of Facility- and Community-Based Peer Support Models on Maternal Uptake and Retention in Malawi’s Option B+ HIV Prevention of Mother-to-Child Transmission Program: A 3-Arm Cluster Randomized Controlled Trial (PURE Malawi). Journal of Acquired Immune Deficiency Syndromes, 75, S140-S148. https://doi.org/10.1097/QAI.0000000000001357
