Limits...
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

WHO guidance and policies in six African countries influencing access to HIV care and treatment, 2003 to mid-2013 26,29,31,34,42,45,52–55,57–84
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Figure 3: WHO guidance and policies in six African countries influencing access to HIV care and treatment, 2003 to mid-2013 26,29,31,34,42,45,52–55,57–84

Mentions: Fig. 3 summarizes policies influencing access to care and treatment services, which varied more across countries. Free public sector access to PMTCT and ART was guaranteed everywhere, either explicitly in HIV policies or national health policies or implied in the national constitution, although WHO documents only implied free public sector access through promotion of universal access to HIV services. All countries promoted PMTCT availability within antenatal care and all allowed task-shifting of ART initiation to clinical officers, medical assistants or nurses (albeit with important variations in year of policy formulation, with Kenya, Malawi and the United Republic of Tanzania allowing task shifting as early as 2004/2005). Only Malawi and Uganda had explicit policies stating that all sites providing ART should also be able to initiate ART.


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)

WHO guidance and policies in six African countries influencing access to HIV care and treatment, 2003 to mid-2013 26,29,31,34,42,45,52–55,57–84
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: WHO guidance and policies in six African countries influencing access to HIV care and treatment, 2003 to mid-2013 26,29,31,34,42,45,52–55,57–84
Mentions: Fig. 3 summarizes policies influencing access to care and treatment services, which varied more across countries. Free public sector access to PMTCT and ART was guaranteed everywhere, either explicitly in HIV policies or national health policies or implied in the national constitution, although WHO documents only implied free public sector access through promotion of universal access to HIV services. All countries promoted PMTCT availability within antenatal care and all allowed task-shifting of ART initiation to clinical officers, medical assistants or nurses (albeit with important variations in year of policy formulation, with Kenya, Malawi and the United Republic of Tanzania allowing task shifting as early as 2004/2005). Only Malawi and Uganda had explicit policies stating that all sites providing ART should also be able to initiate ART.

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