Women's preferences regarding infant or maternal antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV during breastfeeding and their views on Option B+ in Dar es Salaam, Tanzania
The WHO 2010 guidelines for prevention of mother-to-child transmission (PMTCT) of HIV recommended prophylactic antiretroviral treatment (ART) either for infants (Option A) or mothers (Option B) during breastfeeding for pregnant women with a CD4 count of >350 cell/µL in low-income countries. In 20...
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| creator | Ngarina, Matilda Tarimo, Edith A M Naburi, Helga Kilewo, Charles Mwanyika-Sando, Mary Chalamilla, Guerino Biberfeld, Gunnel Ekstrom, Anna Mia |
| description | The WHO 2010 guidelines for prevention of mother-to-child transmission (PMTCT) of HIV recommended prophylactic antiretroviral treatment (ART) either for infants (Option A) or mothers (Option B) during breastfeeding for pregnant women with a CD4 count of >350 cell/µL in low-income countries. In 2012, WHO proposed that all HIV-infected pregnant women should receive triple ART for life (B+) irrespective of CD4 count. Tanzania has recently switched from Option A to B+, with a few centers practicing B. However, more information on the real-life feasibility of these options is needed. This qualitative study explored women's preferences for Option A vs B and their views on Option B+ in Dar es Salaam, Tanzania.
We conducted four focus group discussions with a total of 27 pregnant women with unknown HIV status, attending reproductive and child health clinics, and 31 in-depth interviews among HIV-infected pregnant and post-delivery women, 17 of whom were also asked about B+.
Most participants were in favor of Option B compared to A. The main reasons for choosing Option B were: HIV-associated stigma, fear of drug side-effects on infants and difficult logistics for postnatal drug adherence. Some of the women asked about B+ favored it as they agreed that they would eventually need ART for their own survival. Some were against B+ anticipating loss of motivation after protecting the child, fearing drug side-effects and not feeling ready to embark on lifelong medication. Some were undecided.
Option B was preferred. Since Tanzania has recently adopted Option B+, women with CD4 counts of >350 cell/µL should be counseled about the possibility to "opt-out" from ART after cessation of breastfeeding. Drug safety and benefits, economic concerns and available resources for laboratory monitoring and evaluation should be addressed during B+ implementation to enhance long-term feasibility and effectiveness. |
| doi_str_mv | 10.1371/journal.pone.0085310 |
| format | Article |
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We conducted four focus group discussions with a total of 27 pregnant women with unknown HIV status, attending reproductive and child health clinics, and 31 in-depth interviews among HIV-infected pregnant and post-delivery women, 17 of whom were also asked about B+.
Most participants were in favor of Option B compared to A. The main reasons for choosing Option B were: HIV-associated stigma, fear of drug side-effects on infants and difficult logistics for postnatal drug adherence. Some of the women asked about B+ favored it as they agreed that they would eventually need ART for their own survival. Some were against B+ anticipating loss of motivation after protecting the child, fearing drug side-effects and not feeling ready to embark on lifelong medication. Some were undecided.
Option B was preferred. Since Tanzania has recently adopted Option B+, women with CD4 counts of >350 cell/µL should be counseled about the possibility to "opt-out" from ART after cessation of breastfeeding. Drug safety and benefits, economic concerns and available resources for laboratory monitoring and evaluation should be addressed during B+ implementation to enhance long-term feasibility and effectiveness.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0085310</identifier><identifier>PMID: 24465532</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject><![CDATA[Acquired immune deficiency syndrome ; Adult ; AIDS ; Ambulatory care facilities ; Anti-Retroviral Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral drugs ; Breast feeding ; Breast Feeding - statistics & numerical data ; Breastfeeding & lactation ; CD4 antigen ; CD4 Lymphocyte Count ; Child health ; Disease transmission ; Drug therapy ; Drugs ; Feasibility studies ; Female ; Focus Groups ; Highly active antiretroviral therapy ; HIV ; HIV carriers discrimination ; HIV Infections - prevention & control ; HIV Infections - psychology ; HIV Infections - transmission ; HIV-1 - drug effects ; HIV-1 - physiology ; Host-Pathogen Interactions - drug effects ; Human immunodeficiency virus ; Humans ; Infant ; Infant, Newborn ; Infants ; Infectious Disease Transmission, Vertical - prevention & control ; Interviews as Topic ; Logistics ; Medicine ; Motivation ; Patient Preference - psychology ; Patient Preference - statistics & numerical data ; Pharmacovigilance ; Pregnancy ; Pregnancy Complications, Infectious - prevention & control ; Pregnancy Complications, Infectious - psychology ; Pregnancy Complications, Infectious - virology ; Pregnant women ; Prevention ; Prophylaxis ; Reproductive Health Services - statistics & numerical data ; Side effects ; Systematic review ; Tanzania - epidemiology ; Womens health ; Young Adult]]></subject><ispartof>PloS one, 2014-01, Vol.9 (1), p.e85310</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Ngarina et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Ngarina et al 2014 Ngarina et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c6070-b648745994f2b472f648cfa42fefd94883ee97454220acc04a7245d616b2e0673</citedby><cites>FETCH-LOGICAL-c6070-b648745994f2b472f648cfa42fefd94883ee97454220acc04a7245d616b2e0673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899007/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899007/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24465532$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ngarina, Matilda</creatorcontrib><creatorcontrib>Tarimo, Edith A M</creatorcontrib><creatorcontrib>Naburi, Helga</creatorcontrib><creatorcontrib>Kilewo, Charles</creatorcontrib><creatorcontrib>Mwanyika-Sando, Mary</creatorcontrib><creatorcontrib>Chalamilla, Guerino</creatorcontrib><creatorcontrib>Biberfeld, Gunnel</creatorcontrib><creatorcontrib>Ekstrom, Anna Mia</creatorcontrib><title>Women's preferences regarding infant or maternal antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV during breastfeeding and their views on Option B+ in Dar es Salaam, Tanzania</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The WHO 2010 guidelines for prevention of mother-to-child transmission (PMTCT) of HIV recommended prophylactic antiretroviral treatment (ART) either for infants (Option A) or mothers (Option B) during breastfeeding for pregnant women with a CD4 count of >350 cell/µL in low-income countries. In 2012, WHO proposed that all HIV-infected pregnant women should receive triple ART for life (B+) irrespective of CD4 count. Tanzania has recently switched from Option A to B+, with a few centers practicing B. However, more information on the real-life feasibility of these options is needed. This qualitative study explored women's preferences for Option A vs B and their views on Option B+ in Dar es Salaam, Tanzania.
We conducted four focus group discussions with a total of 27 pregnant women with unknown HIV status, attending reproductive and child health clinics, and 31 in-depth interviews among HIV-infected pregnant and post-delivery women, 17 of whom were also asked about B+.
Most participants were in favor of Option B compared to A. The main reasons for choosing Option B were: HIV-associated stigma, fear of drug side-effects on infants and difficult logistics for postnatal drug adherence. Some of the women asked about B+ favored it as they agreed that they would eventually need ART for their own survival. Some were against B+ anticipating loss of motivation after protecting the child, fearing drug side-effects and not feeling ready to embark on lifelong medication. Some were undecided.
Option B was preferred. Since Tanzania has recently adopted Option B+, women with CD4 counts of >350 cell/µL should be counseled about the possibility to "opt-out" from ART after cessation of breastfeeding. Drug safety and benefits, economic concerns and available resources for laboratory monitoring and evaluation should be addressed during B+ implementation to enhance long-term feasibility and effectiveness.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adult</subject><subject>AIDS</subject><subject>Ambulatory care facilities</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Breast feeding</subject><subject>Breast Feeding - statistics & numerical data</subject><subject>Breastfeeding & lactation</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count</subject><subject>Child health</subject><subject>Disease transmission</subject><subject>Drug therapy</subject><subject>Drugs</subject><subject>Feasibility studies</subject><subject>Female</subject><subject>Focus Groups</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV carriers discrimination</subject><subject>HIV Infections - prevention & control</subject><subject>HIV Infections - psychology</subject><subject>HIV Infections - transmission</subject><subject>HIV-1 - drug effects</subject><subject>HIV-1 - physiology</subject><subject>Host-Pathogen Interactions - drug effects</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infants</subject><subject>Infectious Disease Transmission, Vertical - prevention & control</subject><subject>Interviews as Topic</subject><subject>Logistics</subject><subject>Medicine</subject><subject>Motivation</subject><subject>Patient Preference - psychology</subject><subject>Patient Preference - statistics & numerical data</subject><subject>Pharmacovigilance</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Infectious - prevention & control</subject><subject>Pregnancy Complications, Infectious - psychology</subject><subject>Pregnancy Complications, Infectious - virology</subject><subject>Pregnant women</subject><subject>Prevention</subject><subject>Prophylaxis</subject><subject>Reproductive Health Services - statistics & numerical data</subject><subject>Side effects</subject><subject>Systematic review</subject><subject>Tanzania - epidemiology</subject><subject>Womens health</subject><subject>Young Adult</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk21r1EAQx4Motla_geiCoIjeuUk2T2-EWh96UDiwtb5cJsnsZUuyG3dzZ-uH9DM5uaalBwqSF5vZ_c1_hnkIgqchn4dxFr67sGtnoJ331uCc8zyJQ34v2A-LOJqlEY_v3_nfCx55f8F5Eudp-jDYi4RIkySO9oPf322H5pVnvUOFDk2Fnjlcgau1WTFtFJiBWcc6GHCMx8jWDgdnN9qR2TvbN1ctXGrPFHGks0FCrGFWsc4ODbrZYGdVo9uaDQ6M77T30_vx4pzVazeGKh2CHxTiNjAYghvUjm00_vSM8GW_Vf3whrJiH8ExyvQUWoDuLTsD8wuMhsfBAwWtxyfTeRB8-_zp7Oh4drL8sjg6PJlVKc_4rExFnomkKISKSpFFiuxKgYgUqroQeR4jFgSIKOJQVVxAFomkTsO0jJCnWXwQPL_W7Vvr5dQKL0NRhCHVuxiJxTVRW7iQvdMduCtpQcvthXUrCW7QVYsyiccAWGZ5mYu0pFTCSCBkdVqqWJRIWu-naOuyw7qi-lLpd0R3X4xu5MpuZJwXBedjMi8mAWd_rNEP_0h5olZAWVHrLYlV1K1KHooszxORhTlR879Q9NXY6YqGUWm633F4veNAzICXwwrW3svF6df_Z5fnu-zLO2yD0A6Nt-16nBK_C4prsHLWe5rz28qFXI67dFMNOe6SnHaJ3J7drfqt083yxH8AD0YdjA</recordid><startdate>20140122</startdate><enddate>20140122</enddate><creator>Ngarina, Matilda</creator><creator>Tarimo, Edith A M</creator><creator>Naburi, Helga</creator><creator>Kilewo, Charles</creator><creator>Mwanyika-Sando, Mary</creator><creator>Chalamilla, Guerino</creator><creator>Biberfeld, Gunnel</creator><creator>Ekstrom, Anna Mia</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20140122</creationdate><title>Women's preferences regarding infant or maternal antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV during breastfeeding and their views on Option B+ in Dar es Salaam, Tanzania</title><author>Ngarina, Matilda ; Tarimo, Edith A M ; Naburi, Helga ; Kilewo, Charles ; Mwanyika-Sando, Mary ; Chalamilla, Guerino ; Biberfeld, Gunnel ; Ekstrom, Anna Mia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c6070-b648745994f2b472f648cfa42fefd94883ee97454220acc04a7245d616b2e0673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adult</topic><topic>AIDS</topic><topic>Ambulatory care facilities</topic><topic>Anti-Retroviral Agents - 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In 2012, WHO proposed that all HIV-infected pregnant women should receive triple ART for life (B+) irrespective of CD4 count. Tanzania has recently switched from Option A to B+, with a few centers practicing B. However, more information on the real-life feasibility of these options is needed. This qualitative study explored women's preferences for Option A vs B and their views on Option B+ in Dar es Salaam, Tanzania.
We conducted four focus group discussions with a total of 27 pregnant women with unknown HIV status, attending reproductive and child health clinics, and 31 in-depth interviews among HIV-infected pregnant and post-delivery women, 17 of whom were also asked about B+.
Most participants were in favor of Option B compared to A. The main reasons for choosing Option B were: HIV-associated stigma, fear of drug side-effects on infants and difficult logistics for postnatal drug adherence. Some of the women asked about B+ favored it as they agreed that they would eventually need ART for their own survival. Some were against B+ anticipating loss of motivation after protecting the child, fearing drug side-effects and not feeling ready to embark on lifelong medication. Some were undecided.
Option B was preferred. Since Tanzania has recently adopted Option B+, women with CD4 counts of >350 cell/µL should be counseled about the possibility to "opt-out" from ART after cessation of breastfeeding. Drug safety and benefits, economic concerns and available resources for laboratory monitoring and evaluation should be addressed during B+ implementation to enhance long-term feasibility and effectiveness.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24465532</pmid><doi>10.1371/journal.pone.0085310</doi><tpages>e85310</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2014-01, Vol.9 (1), p.e85310 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1491120397 |
| source | Public Library of Science (PLoS) Journals Open Access; MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acquired immune deficiency syndrome Adult AIDS Ambulatory care facilities Anti-Retroviral Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Breast feeding Breast Feeding - statistics & numerical data Breastfeeding & lactation CD4 antigen CD4 Lymphocyte Count Child health Disease transmission Drug therapy Drugs Feasibility studies Female Focus Groups Highly active antiretroviral therapy HIV HIV carriers discrimination HIV Infections - prevention & control HIV Infections - psychology HIV Infections - transmission HIV-1 - drug effects HIV-1 - physiology Host-Pathogen Interactions - drug effects Human immunodeficiency virus Humans Infant Infant, Newborn Infants Infectious Disease Transmission, Vertical - prevention & control Interviews as Topic Logistics Medicine Motivation Patient Preference - psychology Patient Preference - statistics & numerical data Pharmacovigilance Pregnancy Pregnancy Complications, Infectious - prevention & control Pregnancy Complications, Infectious - psychology Pregnancy Complications, Infectious - virology Pregnant women Prevention Prophylaxis Reproductive Health Services - statistics & numerical data Side effects Systematic review Tanzania - epidemiology Womens health Young Adult |
| title | Women's preferences regarding infant or maternal antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV during breastfeeding and their views on Option B+ in Dar es Salaam, Tanzania |
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