1. 'A way of escaping': a qualitative study exploring reasons for clinic transferring and its impact on engagement in care among women in Option B+
- Author
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Mark N. Lurie, Wiza Kumwenda, Anna Kutengule, Angela M. Bengtson, Vivian F. Go, Mina C. Hosseinipour, and Michael Owino
- Subjects
Adult ,Patient Transfer ,Malawi ,medicine.medical_specialty ,Health (social science) ,Social Psychology ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Ambulatory Care Facilities ,Article ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Qualitative Research ,030505 public health ,business.industry ,Public Health, Environmental and Occupational Health ,virus diseases ,Focus Groups ,medicine.disease ,Infectious Disease Transmission, Vertical ,Breast Feeding ,Family medicine ,Female ,0305 other medical science ,business ,Qualitative research - Abstract
Clinic transfers among women in Option B+ are frequent, often undocumented, and may lead to suboptimal engagement in care and HIV outcomes. The reasons women move between HIV clinics are not well understood. We conducted four focus group discussions (FGD) among HIV-infected pregnant women in Option B+ and four FGDs and five in-depth interviews among healthcare workers (HCWs) at two large ART clinics in Lilongwe, Malawi. Mobility and fear of inadvertent HIV disclosure, particularly due to seeing neighbors or acquaintances at a clinic, were key drivers of transferring between HIV clinics. Women were aware of the need to obtain a formal transfer, but in practice this was often not feasible and led women to self-transfer clinics. Self-transferring to a new clinic frequently resulted to re-testing and re-initiating ART and concerns about disruptions in ART. Strategies to monitor women's engagement in HIV care without requiring a formal transfer are urgently needed.
- Published
- 2019
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