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A comparative analysis of national HIV policies in six African countries with generalized epidemics.

Church K, Kiweewa F, Dasgupta A, Mwangome M, Mpandaguta E, Gómez-Olivé FX, Oti S, Todd J, Wringe A, Geubbels E, Crampin A, Nakiyingi-Miiro J, Hayashi C, Njage M, Wagner RG, Ario AR, Makombe SD, Mugurungi O, Zaba B - Bull. World Health Organ. (2015)

Bottom Line: We also compared the national policies with World Health Organization (WHO) guidance.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, England .

ABSTRACT

Objective: To compare national human immunodeficiency virus (HIV) policies influencing access to HIV testing and treatment services in six sub-Saharan African countries.

Methods: We reviewed HIV policies as part of a multi-country study on adult mortality in sub-Saharan Africa. A policy extraction tool was developed and used to review national HIV policy documents and guidelines published in Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zimbabwe between 2003 and 2013. Key informant interviews helped to fill gaps in findings. National policies were categorized according to whether they explicitly or implicitly adhered to 54 policy indicators, identified through literature and expert reviews. We also compared the national policies with World Health Organization (WHO) guidance.

Findings: There was wide variation in policies between countries; each country was progressive in some areas and not in others. Malawi was particularly advanced in promoting rapid initiation of antiretroviral therapy. However, no country had a consistently enabling policy context expected to increase access to care and prevent attrition. Countries went beyond WHO guidance in certain areas and key informants reported that practice often surpassed policy.

Conclusion: Evaluating the impact of policy differences on access to care and health outcomes among people living with HIV is challenging. Certain policies will exert more influence than others and official policies are not always implemented. Future research should assess the extent of policy implementation and link these findings with HIV outcomes.

No MeSH data available.


Related in: MedlinePlus

Conceptual framework of HIV policy and service factors influencing HIV-related adult mortality
© Copyright Policy - open-access
Related In: Results  -  Collection

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Figure 1: Conceptual framework of HIV policy and service factors influencing HIV-related adult mortality

Mentions: A conceptual framework was developed, identifying key HIV policy and programmatic factors that may influence HIV-related adult mortality (Fig. 1). These factors were derived from a review of the literature (including a recent systematic review on health sector interventions to ensure a continuum of care),10 an initial review of World Health Organization (WHO) guidelines and expert review of indicators by 28 HIV researchers and clinicians. Through the literature review and preliminary analysis of ALPHA network mortality data, we identified three attrition points to inform the structure of our policy review: (i) access to HIV testing and counselling; (ii) access to HIV care and treatment (including assessment of eligibility for treatment initiation and initiation itself); and (iii) retention on ART. Across these three attrition points (diagnosis, HIV care and retention), relevant factors fell into the following five areas: (i) service access and coverage; (ii) quality of care; (iii) coordination of care and patient tracking; (iv) medical management; and (v) support to people living with HIV.


A comparative analysis of national HIV policies in six African countries with generalized epidemics.

Church K, Kiweewa F, Dasgupta A, Mwangome M, Mpandaguta E, Gómez-Olivé FX, Oti S, Todd J, Wringe A, Geubbels E, Crampin A, Nakiyingi-Miiro J, Hayashi C, Njage M, Wagner RG, Ario AR, Makombe SD, Mugurungi O, Zaba B - Bull. World Health Organ. (2015)

Conceptual framework of HIV policy and service factors influencing HIV-related adult mortality
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4490813&req=5

Figure 1: Conceptual framework of HIV policy and service factors influencing HIV-related adult mortality
Mentions: A conceptual framework was developed, identifying key HIV policy and programmatic factors that may influence HIV-related adult mortality (Fig. 1). These factors were derived from a review of the literature (including a recent systematic review on health sector interventions to ensure a continuum of care),10 an initial review of World Health Organization (WHO) guidelines and expert review of indicators by 28 HIV researchers and clinicians. Through the literature review and preliminary analysis of ALPHA network mortality data, we identified three attrition points to inform the structure of our policy review: (i) access to HIV testing and counselling; (ii) access to HIV care and treatment (including assessment of eligibility for treatment initiation and initiation itself); and (iii) retention on ART. Across these three attrition points (diagnosis, HIV care and retention), relevant factors fell into the following five areas: (i) service access and coverage; (ii) quality of care; (iii) coordination of care and patient tracking; (iv) medical management; and (v) support to people living with HIV.

Bottom Line: We also compared the national policies with World Health Organization (WHO) guidance.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, England .

ABSTRACT

Objective: To compare national human immunodeficiency virus (HIV) policies influencing access to HIV testing and treatment services in six sub-Saharan African countries.

Methods: We reviewed HIV policies as part of a multi-country study on adult mortality in sub-Saharan Africa. A policy extraction tool was developed and used to review national HIV policy documents and guidelines published in Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zimbabwe between 2003 and 2013. Key informant interviews helped to fill gaps in findings. National policies were categorized according to whether they explicitly or implicitly adhered to 54 policy indicators, identified through literature and expert reviews. We also compared the national policies with World Health Organization (WHO) guidance.

Findings: There was wide variation in policies between countries; each country was progressive in some areas and not in others. Malawi was particularly advanced in promoting rapid initiation of antiretroviral therapy. However, no country had a consistently enabling policy context expected to increase access to care and prevent attrition. Countries went beyond WHO guidance in certain areas and key informants reported that practice often surpassed policy.

Conclusion: Evaluating the impact of policy differences on access to care and health outcomes among people living with HIV is challenging. Certain policies will exert more influence than others and official policies are not always implemented. Future research should assess the extent of policy implementation and link these findings with HIV outcomes.

No MeSH data available.


Related in: MedlinePlus