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In Option B+, side-effects and needing time to think are key reasons for not taking HIV medication
Roger Pebody, 2016-05-19 07:20:00

A qualitative study of women in Malawi who chose not to take HIV treatment as part of the country’s Option B+ programme, or who interrupted their treatment, has found that needing more time to think, concerns about partner support, and side-effects were important reasons for declining to take HIV treatment. While these themes have appeared in other studies of non-adherence to HIV treatment in other settings, they seem to be especially significant in the context of Option B+. In this programme, pregnant women who may feel healthy are asked to begin HIV treatment on the day of their diagnosis and to continue it for the rest of their life.

This is one of the first qualitative studies of the barriers and facilitators to retention in Option B+ programmes. Findings are published in PLOS One and also in Social Science & Medicine.

Option B+ takes its name from two options for antiretroviral treatment during pregnancy and breastfeeding set out in World Health Organization guidelines in 2011. Option B recommended treatment for life for all pregnant women with CD4 cell counts below 350 cells/mm3, but required CD4 cell counts. For countries with limited capacity to carry out CD4 testing, treatment for all pregnant women regardless of CD4 cell count is a more practical approach, and Malawi introduced Option B + in 2011.

The Malawi Option B+ programme offers antiretroviral therapy (ART) to all pregnant women with HIV, regardless of CD4 cell count or disease stage, with the intention that therapy will be continued after the pregnancy ends. It was designed to be a simple approach to implement in the context of extremely limited resources. Option B+ has helped Malawi achieve a dramatic scale-up of HIV treatment in women, but retention remains a challenge - two years after beginning treatment, only 68% of women are still in care.

In-depth, qualitative interviews were conducted in 2014 with 65 women who were offered HIV treatment by the Option B+ programme. Ten had refused to begin ART, 26 had started ART and then stopped during their pregnancy, and 29 had begun ART and remained on it. As the researchers were interested in barriers to engaging in care, women who had refused or stopped ART were oversampled.

Two-thirds were newly diagnosed, while one third had been previously diagnosed with HIV but had not been eligible for treatment. In this mostly urban sample, most women were in their twenties or thirties. Two thirds had completed less than secondary school education and three quarters were married or cohabiting.