"I found that I was well and strong": Women's motivations for remaining on ART under Option B+ in Malawi.

Nozgechi Phiri,Kali Tal,Olivia Keiser,Andreas D Haas,Lyson Tenthani,Malango T Msukwa

doi:10.1371/journal.pone.0197854

Abstract

Most Malawian women who start ART under Option B+ are still in care three years later, a higher than average adherence rate for life-threatening chronic disease treatments, worldwide (50%). We asked 75 Malawian on ART their motivations for remaining in treatment, and what barriers they overcame. Focus groups and interviews included 75 women on ART for 6+ months, at 12 health facilities. Four main motivations for continuing ART emerged: 1) evidence that ART improved their own and their children’s health; 2) strong desire to be healthy and keep their children healthy; 3) treatment was socially supported; 4) HIV/ART counselling effectively showed benefits of ART and told women what to expect. Women surmounted the following barriers: 1) stigma; 2) health care system; 3) economic; 4) side effects. Women stayed on ART because they believed it works. Future interventions should focus on emphasizing ART’s effectiveness, along with other services they provide.

Highlights

In 2011, Malawi implemented an innovative policy (“Option B+”) to prevent mother-to-child transmission (PMTCT) by providing lifelong antiretroviral therapy (ART) to all HIV-infected pregnant and breastfeeding women [1, 2]
We recently reported that 70% of the 29,313 women who started ART under Option B+ in Malawi by June 2012 were still in care three years later [5] and about 70% of the retained women adequately adhered during the first 2 years of ART [6]
We interviewed women and conducted focus group discussions (FGDs) until we reached data saturation

Summary

Introduction

In 2011, Malawi implemented an innovative policy (“Option B+”) to prevent mother-to-child transmission (PMTCT) by providing lifelong ART to all HIV-infected pregnant and breastfeeding women [1, 2]. Option B+ was subsequently adopted by other countries and is recommended by WHO [3]. In Option B+ treatment programs, poor adherence, retention and loss-to-follow-up (LTFU) are still serious concerns, and continuation on long-term therapy is a critical element of HIV care [4]. We recently reported that 70% of the 29,313 women who started ART under Option B+ in Malawi by June 2012 were still in care three years later [5] and about 70% of the retained women adequately adhered during the first 2 years of ART [6]. If we take a global perspective on long-term therapy for chronic life-threatening diseases, Malawi’s Option B+ adherence and retention rates are impressively high, and much higher than in some other countries that have adopted the program. If we take a global perspective on long-term therapy for chronic life-threatening diseases, Malawi’s Option B+ adherence and retention rates are impressively high, and much higher than in some other countries that have adopted the program. [7] Most papers on the Malawi Option B+ program examine retention and adherence, but do not put their findings into

Methods

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Discussion

Conclusion