“A way of escaping”: a qualitative study exploring reasons for clinic transferring and its impact on engagement in care among women in Option B+

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.

KEYWORDS:

• Engagement in HIV care
• clinic transfer
• Option B+
• default
• pregnancy
• HIV

Acknowledgements

We thank the women and healthcare workers who participated in this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

* A version of this work was presented at the 22nd International AIDS Conference in Amsterdam, Netherlands, July 23–27, 2018.

Additional information

Funding

This work was supported by the National Institute of Mental Health [grant number K99MH112413] and the University of North Carolina at Chapel Hill Center for AIDS Research [grant number P30 AI50410].