ArticlePloS one2019
"I do all I can but I still fail them": Health system barriers to providing Option B+ to pregnant and lactating women in Malawi.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Barriers and facilitators to HIV and syphilis rapid diagnostic testing in antenatal care settings in low-income and middle-income countries: a systematic review.BMJ global health · 2022Pooled it
- Process Evaluation of Services for HIV-Infected Post-Partum Women and HIV-Exposed Infants in Primary Health Care Blantyre Malawi.Health services insights · 2024Article
- Virological non-suppression among adult males attending HIV care services in the fishing communities in Bulisa district, Uganda.PloS one · 2023Article
- Understanding the meanings of male partner support in the adherence to therapy among HIV-positive women: a gender analysis.Global health action · 2022Article
- Factors associated with a history of treatment interruption among pregnant women living with HIV in Malawi: A cross-sectional study.PloS one · 2022Article
- Improving Male Partner Involvement in HIV-Positive Women's Care Through Behavioral Change Interventions in Malawi (WeMen Study): A Prospective, Controlled Before-and-After Study.Frontiers in public health · 2022Article
- Understanding the influence of health systems on women's experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa.Global public health · 2021Article
- "She Just Told Me Not To Cry": A Qualitative Study of Experiences of HIV Testing and Counseling (HTC) Among Pregnant Women Living with HIV in Tanzania.AIDS and behavior · 2021Article
- Social determinants of male partner attendance in women's prevention-of mother-to-child transmission program in Malawi.BMC public health · 2020Article
- "BMJ global health · 2020Article
- Monitoring Patient Adherence and Follow-up in Option B+ Program: Understanding Healthcare Workers' Practices, Challenges, and Facilitators in Lilongwe, Malawi.Journal of the International Association of Providers of AIDS CareArticle
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Malawi's Option B+ program is based on a 'test and treat' strategy that places all HIV-positive pregnant and lactating women on lifelong antiretroviral therapy. The steep increase in patient load placed severe pressure on a health system that has struggled for decades with inadequate supply of health care workers (HCWs) and poor infrastructure. We set out to explore health system barriers to Option B+ by asking HCWs in Malawi about their experiences treating pregnant and lactating women. We observed and conducted semi-structured interviews (SSIs) with 34 HCWs including nine expert clients (ECs) at 14 health facilities across Malawi, then coded and analyzed the data. We found that HCWs implementing Option B+ are so overburdened in Malawi that it reduces their ability to provide quality care to patients, who receive less counseling than they should, wait longer than is reasonable, and have very little privacy. Interventions that increase the number of HCWs and upgrade infrastructure to protect the privacy of HIV-infected pregnant and lactating women and their husbands could increase retention, but facilities will need to be improved to support men who accompany their partners on clinic visits.
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Registered trials
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