Initiatives to promote uptake and adherence to Option B+ program among rural pregnant women living with HIV in Malawi

Abstract Background Malawi is the first country in the world to introduce Option B+, a test-and treat program for preventing vertical transmission of HIV from mothers to young children during pregnancy or breastfeeding. The program has significantly reduced the number of children that contract HIV from their mothers. Although this is the case, gaps remain as the program is marred with challenges such as clients opting out, low drug adherence, and default. This study examines the effectiveness of individual and community level approaches used to promote uptake of Option B+ program through reduction of intimate partner violence (IPV) in central Malawi. Methods A retrospective narrative qualitative research method was used to understand strategies that HIV positive pregnant women and community stakeholders used to improve uptake of Option B+ program. Twenty-five participants that were directly involved in Option B+ program as beneficiaries and service providers were interviewed. The interviews were audio recoded and transcribed verbatim. Data was manually coded to derive key themes and concepts. Results Prevalent forms of IPV against HIV pregnant mothers during initial stage of Option B+ program was identified. They include husband restricting women from taking Antiretroviral Therapy (ART), declining the use of condoms, and reducing family support. Various risk-taking behaviours was used to minimize IPV when some pregnant women were diagnosed HIV positive. These include opting out of the program, concealing the HIV serostatus and ART drugs. The integration of community based reproductive health initiatives such as expert clients, male championship, and safe motherhood into Option B+ program reduced cases of IPV and improved couple uptake of HIV testing. Conclusion Integration of Option B+ program with community based reproductive health promotion initiatives has a potential of reducing IPV against HIV positive pregnant women. The strategy can also increase the number of couples that can adopt Option B+ program in rural communities.