"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 Article scientifique Article "I do all I can but I still fail them": Health system barriers to providing Option B+ to pregnant and lactating women in Malawi eng 2019 author Phiri Nozgechi 922400 author Tal Kali 873428 author Somerville Claire author Msukwa Malango 922401 author Keiser Olivia 0000-0001-8191-2789 873427 e0222138 10.1371/journal.pone.0222138 31513684 1932-6203 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. Dewey 613 Swiss National Science Foundation 163878 CH Autre Bill and Melinda Gates Foundation (Global Health grant OPP1090200) 66 Institut de santé globale 22A1 false 1246 Maladies infectieuses et modèles mathématiques 988 https://figshare.com/articles/_I_do_all_I_can_but_I_still_fail_them_Health_system_barriers_to_providing_Option_B_to_pregnant_and_lactating_women_in_Malawi/9818183 PLOS ONE 14 9 add41800-1e50-4bfb-9dc7-df3992ddaa53 Article (Published version) Public Phiri_PlosOne_2019.pdf 552349 application/pdf CC BY openAccess Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut de santé globale

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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	PLOS ONE			2019	389	300

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Msukwa, Malango