Malawi has undertaken a "test-and-treat" approach to prevent mother-to-child transmission (PMTCT) of HIV, known as Option B+. This approach offers all pregnant and breastfeeding women with HIV lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage. A cross-sectional, qualitative study explored experiences surrounding Option B+ for patients and health care workers in Malawi. Results found that patients and health care workers identified the lack of male involvement as a barrier to retaining care, concerns around the rapidity of the test-and-treat process, fear regarding the breach of confidentiality as contributors of loss to follow-up of women who had initiated Option B+. The study concludes that interventions to support and retain women in care are needed, such as providing space and time to accept a diagnosis prior to beginning ART, engaging partners and families, and addressing confidentiality issues and the need for peer support.