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Option B+ in Mozambique: Formative Research Findings for the Design of a Facility-Level Clustered Randomized Controlled Trial to Improve ART Retention in Antenatal Care
Open accessAbstract
Introduction: With the rollout of “Option B+” in Mozambique in 2013, initial data indicated major challenges to early retention in antiretroviral therapy (ART) among HIV-positive pregnant women. We sought to develop and test a pilot intervention in 6 large public clinics in central Mozambique to improve retention of mothers starting ART in antenatal care. The results from the formative research from this study described here were used to design the intervention. Methods: The research was initiated in early 2013 and completed in early 2014 in each of the 6 study clinics and consisted of (1) patient flow mapping and measurement of retention through collection of health systems data from antenatal care registries, pharmacy registries, ART clinic databases, (2) workforce assessment and measurement of patient waiting times, and (3) patient and worker individual interviews and focus groups. Results: Coverage of HIV testing and ART initiation were over 90% at all sites, but retention at 30-, 60-, and 90-day pharmacy refill visits was very low ranging from only 5% at 1 site to 30% returning at 90 days. These data revealed major systemic bottlenecks that contributed to poor adherence and retention in the first month after ART initiation. Long wait times, short consultations, and poor counseling were identified as barriers. Conclusions: Based on these findings, we designed an intervention with these components: (1) workflow modification to redefine nurse tasks, shift tasks to community health workers, and enhance patient tracking and (2) an adherence and retention package to systematize active patient follow-up, ensure home visits by community health workers, use text messaging, and intensify counseling by health staff. This intervention is currently under evaluation using a stepped wedge design.
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Health system challenges to implementing Option B+ include health facility resource limitations such as shortage of staff and drugs.
“There are also multiple health system challenges to implementing Option B+. The most common among them are health facility resource limitations such as shortage of staff and drugs [10,20,21].”
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Metadata
- Authors
- Napúa, M., Pfeiffer, J. T., Chale, F., Hoek, R., Manuel, J., Michel, C., Cowan, J. G., Cowan, J. F., Gimbel, S., Sherr, K., Gloyd, S., & Chapman, R. R.
- Affiliations
- Ministry of Health (MZ)
- University of Washington (US)
- Health Alliance International (US)
- Beira Operational Research Center, Ministry of Health, Beira, Mozambique;
- Corresponding author
- Napúa, Manuel
- ORCID
- Venue
- JAIDS Journal of Acquired Immune Deficiency Syndromes
- Published
- 2016-08-01
- Volume
- 72
- Issue
- 2
- Pages
- S181-S188
- ISSN
- 1525-4135 (ISSN-L)
- PMC
- PMC5113244
- OpenAlex
- W2463162069
- Cited by
- 34
- References
- 21
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 4 · 2019: 9 · 2018: 6 · 2017: 7 · 2016: 1
- FWCI
- 7.07
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- JAIDS Journal of Acquired Immune Deficiency Syndromes (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- University of Washington
- U.S. President’s Emergency Plan for AIDS Relief
- National Institutes of Health
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD074557)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- Option B+, antiretroviral therapy retention, HIV-positive pregnant women, prenatal care, Mozambique, patient waiting time, community health workers, patient tracking, text messaging, adherence counseling, stepped wedge design, intervention design
- MeSH terms
- Female, Humans, Infant, Newborn, Malawi, Mozambique, Patient Compliance, Pregnancy, Pregnancy Complications, Infectious, Stereotyping, Infectious Disease Transmission, Vertical, Anti-HIV Agents
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