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“I do all I can but I still fail them”: Health system barriers to providing Option B+ to pregnant and lactating women in Malawi


Autoři: Nozgechi Phiri aff001;  Kali Tal aff001;  Claire Somerville aff004;  Malango T. Msukwa aff001;  Olivia Keiser aff001
Působiště autorů: Institute of Global Health, University of Geneva, Geneva, Switzerland aff001;  Baobab Health Trust, Lilongwe, Malawi aff002;  Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland aff003;  Gender Centre, Graduate Institute, Geneva, Switzerland aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222138

Souhrn

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.

Klíčová slova:

People and places – Population groupings – Professions – Medical personnel – Geographical locations – Africa – Malawi – Medicine and health sciences – Health care – Health care providers – Nurses – Health education and awareness – Women's health – Maternal health – Antenatal care – Pregnancy – Obstetrics and gynecology – Pathology and laboratory medicine – Pathogens – Immunology – Public and occupational health – Preventive medicine – Antiviral therapy – Diagnostic medicine – HIV diagnosis and management – Biology and life sciences – Microbiology – Medical microbiology – Microbial pathogens – Viral pathogens – Immunodeficiency viruses – HIV – Retroviruses – Lentivirus – Organisms – Viruses – RNA viruses – Vaccination and immunization


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