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; (2015) A comparative analysis of national HIV policies in six African countries with generalized epidemics. Bulletin of the World Health Organization, 93 (7). pp. 457-67. ISSN 0042-9686 DOI: 10.2471/BLT.14.147215

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Abstract

To compare national human immunodeficiency virus (HIV) policies influencing access to HIV testing and treatment services in six sub-Saharan African countries. 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. 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. 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. Abstract available from the publisher. Abstract available from the publisher. Abstract available from the publisher. Abstract available from the publisher. Abstract available from the publisher.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Population Studies (1974-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Population Studies Group
MEIRU
PubMed ID: 26170503
Web of Science ID: 358888100012
URI: http://researchonline.lshtm.ac.uk/id/eprint/2242012

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