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. 2021 Feb;16(2):167-185.
doi: 10.1080/17441692.2020.1851385. Epub 2020 Dec 7.

Understanding the influence of health systems on women's experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa

Shannon M Williams  1 , Jenny Renju  1   2 , Mosa Moshabela  3   4 , Alison Wringe  1
Affiliations

Understanding the influence of health systems on women's experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa

Shannon M Williams et al. Glob Public Health. 2021 Feb.

Abstract

We explored women's experiences of Option B+ in sub-Saharan African health facility settings through a meta-ethnography of 32 qualitative studies published between 2010 and 2019. First and second-order constructs were identified from the data and authors' interpretations respectively. Using a health systems lens, third-order constructs explored how the health systems shaped women's experiences of Option B+ and their subsequent engagement in care. Women's experiences of Option B+ services were influenced by their interactions with health workers, which were often reported to be inadequate and rushed, reflecting insufficient staffing or training to address pregnant women's needs. Women's experiences were also undermined by various manifestations of stigma which persisted in the absence of resources for social or mental health support, and were exacerbated by space constraints in health facilities that infringed on patient confidentiality. Sub-optimal service accessibility, drug stock-outs and inadequate tracing systems also shaped women's experiences of care. Strengthening health systems by improving health worker capacity to provide respectful and high-quality clinical and support services, improving supply chains and improving the privacy of consultation spaces would improve women's experiences of Option B+ services, thereby contributing to improved care retention. These lessons should be considered as universal test and treat programmes expand.

Keywords: Option B+; Qualitative research; health systems; pregnant women; sub-Saharan Africa.

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Conflict of interest statement

Disclosure statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1
Figure 1. Flow chart showing the identification and selection of the included articles.
Figure 2
Figure 2. Geographic location of the studies included in the meta-ethnography.
Figure 3
Figure 3. Conceptual framework illustrating how women’s experiences (2nd order constructs) are shaped by health system elements (3rd order constructs) subsequently influencing care engagement and outcomes.
See this image and copyright information in PMC

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