NDLI: Healthcare worker experiences with Option B+ for prevention of mother-to-child HIV transmission in eSwatini: findings from a two-year follow-up study

Content Provider	Springer Nature : BioMed Central
Author	DiCarlo, Abby L. Gachuhi, Averie Baird Mthethwa-Hleta, Simangele Shongwe, Siphesihle Hlophe, Thabo Peters, Zachary J. Zerbe, Allison Myer, Landon Langwenya, Nontokozo Okello, Velephi Sahabo, Ruben Nuwagaba-Biribonwoha, Harriet Abrams, Elaine J.
Abstract	Background Prevention of mother-to-child transmission (PMTCT) across sub-Saharan Africa has rapidly shifted towards Option B+, an approach in which all HIV+ pregnant and breastfeeding women initiate lifelong antiretroviral therapy (ART) independent of CD4+ count. Healthcare workers (HCW) are critical to the success of Option B+, yet little is known regarding HCW acceptability of Option B+, particularly over time. Methods Ten health facilities in the Manzini and Lubombo regions of eSwatini transitioned from Option A to Option B+ between 2013 and 2014 as part of the Safe Generations study examining PMTCT retention. Fifty HCWs (5 per facility) completed questionnaires assessing feasibility and acceptability: (1) prior to transitioning to Option B+, (2) two months post transition, and (3) approximately 2 years post Option B+ transition. This analysis describes HCW perceptions and experiences two years after transitioning to Option B+. Results Two years after transition, 80% of HCWs surveyed reported that Option B+ was easy for HCWs, noting that it was particularly easy to explain and coordinate. Immediate ART initiation also reduced delays by eliminating need for laboratory tests prior to ART initiation. Additionally, HCWs reported ease of patient follow-up (58%), documentation (56%), and counseling (58%) under Option B+. Findings also indicate that a majority of HCWs reported that their workloads increased under Option B+. Sixty-eight percent of HCWs at two years post-transition reported more work under Option B+, specifically noting increased involvement in adherence counseling, prescribing/monitoring medications, and appointment scheduling/tracking. Some HCWs attributed their higher workloads to increased client loads, now that all HIV-positive women were initiated on ART. New barriers to patient uptake, and issues related to retention, adherence, and follow-up were also noted as challenges face by HCW when implementing Option B+. Conclusions Overall, HCWs found Option B+ to be acceptable and feasible while providing critical insights into the practical issues of universal ART. Further strengthening of the healthcare system may be necessary to alleviate worker burden and to ensure effective monitoring of client retention and adherence. HCW perceptions and experiences with Option B+ should be considered more broadly as countries implement Option B+ and consider universal treatment for all HIV+ individuals. Trial registration http://clinicaltrials.gov NCT01891799 , registered on July 3, 2013.
Related Links	https://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-019-3997-1.pdf
Ending Page	12
Page Count	12
Starting Page	1
File Format	HTM / HTML
ISSN	14726963
DOI	10.1186/s12913-019-3997-1
Journal	BMC Health Services Research
Issue Number	1
Volume Number	19
Language	English
Publisher	BioMed Central
Publisher Date	2019-04-02
Access Restriction	Open
Subject Keyword	Public Health Health Administration Health Informatics Nursing Research HIV Option B + Prevention of mother-to-child transmission Health care workers Universal antiretroviral therapy
Content Type	Text
Resource Type	Article
Subject	Health Policy

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