Mother and child silhouette in Africa, with healthcare symbols

Staying on Track: How to Maximize Your HIV Treatment During and After Pregnancy

Theo Raines in Health & Wellness November 2025 • 4 min read.

"A Deep Dive into Adherence Strategies for Women in Malawi's Option B+ Program"

For women living with HIV, consistent adherence to antiretroviral therapy (ART) is essential, especially during and after pregnancy. This adherence not only protects the mother’s health but also significantly reduces the risk of transmitting the virus to her child. However, maintaining this adherence can be challenging, influenced by various personal and systemic factors.

A groundbreaking initiative called Option B+ was introduced in Malawi in 2011, offering lifelong ART to pregnant and breastfeeding women with HIV, regardless of their clinical stage. This program aimed to simplify treatment access and improve outcomes, yet questions remained about how well women adhered to their medication regimens, particularly in the long term. Understanding adherence patterns is crucial for optimizing the effectiveness of such programs and ensuring the well-being of both mother and child.

A recent study delved into the adherence rates among women enrolled in Malawi's Option B+ program. By analyzing pharmacy claim data from 13 large health facilities, researchers uncovered important trends and risk factors affecting adherence. This article breaks down the study’s findings, offering actionable insights for women, healthcare providers, and policymakers alike to improve HIV treatment outcomes during and after pregnancy.

Key Findings: Adherence Patterns in Malawi

Mother and child silhouette in Africa, with healthcare symbols

The study, which examined data from September 2011 to October 2013, defined adherence as the percentage of days covered by pharmacy claims, with 90% or greater adherence considered adequate. The findings revealed that while a significant proportion of women showed good adherence, challenges persisted, especially postpartum.

Here's a breakdown of the key adherence rates observed:

During Pregnancy: 73% of women demonstrated adequate adherence.
First 3 Months Postpartum: Adherence dipped to 66%.
Months 4-21 Postpartum: Adherence rebounded to about 75%.
Consistent Adherence: Only 30% maintained adequate adherence at every visit during the first two years of ART.

These numbers highlight a critical period of vulnerability immediately following childbirth. The study also identified several risk factors associated with inadequate adherence, including starting ART under the Option B+ indication, younger age, and receiving care at a district hospital or health center.

Moving Forward: Improving Adherence and Outcomes

The study underscores the need for targeted interventions to support women in maintaining consistent adherence to ART, particularly during the critical postpartum period. Strategies such as adherence counseling, text message reminders, and community support groups can play a vital role in improving outcomes. Additionally, healthcare providers should be aware of the risk factors for non-adherence and tailor their support accordingly to ensure the long-term success of HIV treatment and prevention efforts.

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This article is based on research published under:

DOI-LINK: 10.1093/cid/ciw500, Alternate LINK

Title: Adherence To Antiretroviral Therapy During And After Pregnancy: Cohort Study On Women Receiving Care In Malawi'S Option B+ Program

Subject: Infectious Diseases

Journal: Clinical Infectious Diseases

Publisher: Oxford University Press (OUP)

Authors: Andreas D. Haas, Malango T. Msukwa, Matthias Egger, Lyson Tenthani, Hannock Tweya, Andreas Jahn, Oliver J. Gadabu, Kali Tal, Luisa Salazar-Vizcaya, Janne Estill, Adrian Spoerri, Nozgechi Phiri, Frank Chimbwandira, Joep J. Van Oosterhout, Olivia Keiser

Published: 2016-07-26

Everything You Need To Know

What is Option B+ and how does it aim to improve outcomes for women with HIV during and after pregnancy?

Option B+ is a program introduced in Malawi in 2011 that provides lifelong antiretroviral therapy (ART) to pregnant and breastfeeding women living with HIV, regardless of their clinical stage. The aim of Option B+ is to simplify treatment access and improve health outcomes for both the mother and child by preventing mother-to-child transmission of HIV.

In the context of the Malawi study, how was adherence to antiretroviral therapy (ART) defined and why is consistent adherence so important?

Adherence, in the context of HIV treatment, refers to the extent to which a person takes their antiretroviral therapy (ART) as prescribed. In the Malawi study, adherence was specifically measured by the percentage of days covered by pharmacy claims. The study considered adherence adequate if a woman had medication claims covering 90% or more of the days within a given period. Consistent adherence is critical for maintaining the effectiveness of ART and preventing drug resistance.

What were the key adherence rates observed among women enrolled in Malawi's Option B+ program during pregnancy and postpartum?

The study revealed that adherence to antiretroviral therapy (ART) varied among women in Malawi's Option B+ program, with 73% demonstrating adequate adherence during pregnancy. However, this rate dipped to 66% in the first three months postpartum, rebounding to about 75% between months 4 and 21 postpartum. Critically, only 30% of women maintained adequate adherence at every visit during the first two years of ART, highlighting a significant challenge in ensuring consistent treatment.

What risk factors were identified in the Malawi study as being associated with inadequate adherence to antiretroviral therapy (ART)?

Several risk factors were identified in the Malawi study as being associated with inadequate adherence to antiretroviral therapy (ART). These include starting ART under the Option B+ indication, younger age, and receiving care at a district hospital or health center. Recognizing these factors allows healthcare providers to tailor their support and interventions more effectively to improve adherence rates among women at higher risk.

What strategies can be implemented to improve adherence to antiretroviral therapy (ART) among women in programs like Option B+?

To improve adherence to antiretroviral therapy (ART) among women in programs like Option B+, several strategies can be implemented. These include providing adherence counseling to help women understand the importance of consistent medication intake, using text message reminders to prompt timely adherence, and establishing community support groups where women can share experiences and support each other. Healthcare providers should also be aware of individual risk factors for non-adherence and adjust their support accordingly to ensure the long-term success of HIV treatment and prevention.