ArticleJournal of the International AIDS Society2017
Awareness and perceived fairness of Option B+ in Malawi: A population-level perspective
Article in Journal of the International AIDS Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Do Women Enrolled in PMTCT Understand the Recommendations: A Case Study from Kilimanjaro.Patient preference and adherence · 2021Article
- Changing Childbearing Norms During an Era of ART Expansion in Malawi, 2009 to 2015.AIDS and behavior · 2020Article
- Level of Knowledge About Prevention of Mother-to-Child Transmission of HIV Option B+ and Associated Factors Among ANC Clients in Kombolcha Town, South Wollo Amhara Regional State, Ethiopia, 2017.HIV/AIDS (Auckland, N.Z.) · 2020Article
- Tsogolo la Thanzi: A Longitudinal Study of Young Adults Living in Malawi's HIV Epidemic.Studies in family planning · 2019Article
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Abstract
introductionPolicies for rationing antiretroviral therapy (ART) have been subject to on-going ethical debates. Introduced in Malawi in 2011, Option B+ prioritized HIV-positive pregnant women for lifelong ART regardless of the underlying state of their immune system, shifting the logic of allocation away from medical eligibility. Despite the rapid expansion of this policy, we know little about how it has been understood and interpreted by the people it affects.
methodsWe assessed awareness and perceived fairness of the prioritization system for ART among a population-based sample of young women (n = 1440) and their partners (n = 574) in southern Malawi. We use a card-sort technique to elicit understandings of who gets ART under Option B+ and who should be prioritized, and we compare perceptions to actual ART policy using sequence analysis and optimal matching. We then use ordered logistic regression to identify the factors associated with policy awareness.
resultsIn 2015, only 30.7% of women and 21.1% of male partners understood how ART was being distributed. There was widespread confusion around whether otherwise healthy HIV-positive pregnant women could access ART under Option B + . Nonetheless, more young adults thought that the fairest policy should prioritize such women than believed the actual policy did. Women who were older, more educated or had recently engaged with the health system through antenatal care or ART had more accurate understandings of Option B + . Among men, policy awareness was lower, and was patterned only by education.
conclusionAlthough most respondents were unaware that Option B+ afforded ART access to healthy-pregnant women, Malawians support the prioritization of pregnant women. Countries adopting Option B+ or other new ART policies such as universal test-and-treat should communicate the policies and their rationales to the public - such transparency would be more consistent with a fair and ethical process and could additionally serve to clarify confusion and enhance retention..
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