Exploring the Experiences of Women and Health Care Workers in the Context of PMTCT Option B Plus in Malawi

Journal Article
  • Fabian Cataldo
  • L. Chiwaula
  • M. Nkhata
  • M. van Lettow
  • F. Kasenda
  • N. E. Rosenberg
  • H. Tweya
  • V. Sampathkumar
  • M. Hosseinipour
  • E. Schouten
  • A. Kapito-Tembo
  • M. Eliya
  • F. Chimbwandira
  • S. Phiri
  • PURE Malawi Consortium
Journal of Acquired Immune Deficiency Syndromes
April 2017; 74 (5): 517-22. DOI: 10.1097/QAI.0000000000001273.



Malawi has embarked on a "test-and-treat" approach to prevent mother-to-child transmission (PMTCT) of HIV, known as "Option B+," offering all HIV-infected pregnant and breastfeeding women lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage. A cross-sectional qualitative study was conducted to explore early experiences surrounding "Option B+" for patients and health care workers (HCWs) in Malawi.


Study participants were purposively selected across 6 health facilities in 3 regional health zones in Malawi. Semi-structured interviews were conducted with women enrolled in "Option B+" (n = 24), and focus group discussions were conducted with HCWs providing Option B+ services (n = 6 groups of 8 HCWs). Data were analyzed using a qualitative thematic coding framework.


Patients and HCWs identified the lack of male involvement as a barrier to retention in care and expressed concerns at the rapidity of the test-and-treat process, which makes it difficult for patients to "digest" a positive diagnosis before starting ART. Fear regarding the breach of privacy and confidentiality were also identified as contributing to loss to follow-up of women initiated under the Option B+. Disclosure remains a difficult process within families and couples. Lifelong ART was also perceived as an opportunity to plan future pregnancies.


As "Option B+" continues to be rolled out, novel interventions to support and retain women into care must be implemented. These include providing space, time, and support to accept a diagnosis before starting ART, engaging partners and families, and addressing the need for peer support and confidentiality.