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Trends in ART Initiation among Men and Non-Pregnant/Non-Breastfeeding Women before and after Option B+ in Southern Malawi.

Trends in ART Initiation among Men and Non-Pregnant/Non-Breastfeeding Women before and after Option B+ in Southern Malawi.
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Dovel K, Yeatman S, van Oosterhout JJ, Chan A, Mantengeni A, Landes M, Bedell R, Kawalazira G, Sodhi S,


Dovel K, Yeatman S, van Oosterhout JJ, Chan A, Mantengeni A, Landes M, Bedell R, Kawalazira G, Sodhi S, (click to view)

Dovel K, Yeatman S, van Oosterhout JJ, Chan A, Mantengeni A, Landes M, Bedell R, Kawalazira G, Sodhi S,

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PloS one 2016 12 2111(12) e0165025 doi 10.1371/journal.pone.0165025

Abstract
BACKGROUND
Option B+ is promoted as a key component to eliminating vertical transmission of HIV; however, little is known about the policy’s impact on non-targeted populations, such as men and non-pregnant/non-breastfeeding women. We compare ART uptake among non-targeted populations during pre/post Option B+ periods in Zomba District, Malawi.

METHODS
Individual-level ART registry data from 27 health facilities were digitized and new ART initiates were disaggregated by sex and type of initiate (Option B+ or not). Data were analyzed over the pre- (January 2009-June 2011) and post- (July 2011- December 2013) Option B+ periods.

RESULTS
After the implementation of Option B+, the total number of new female initiates increased significantly (quarterly median: 547 vs. 816; P = 0.001) and their median age decreased from 34 to 31 years (P = <0.001). Both changes were the result of the rapid and sustained uptake of ART among Option B+ clients. Post-policy, Option B+ clients represented 48% of all new female initiates while the number of females who initiated through CD4 or WHO staging criteria significantly decreased (quarterly median: 547 vs. 419; P = 0.005). The number and age of male initiates remained stable; however, the proportion of men among new initiates decreased (36% vs. 31%; P = <0.001). CONCLUSIONS
Option B+ shifted the profile of first-time initiates towards younger and fertile women. Declines among non-Option B+ women most likely reflect earlier initiation during pregnancies before deteriorations in health. The decreased proportion of men among first-time initiates represents a growing gender disparity in HIV services that deserves immediate attention.

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