From policy to practice: exploring the implementation of antiretroviral therapy access and retention policies between 2013 and 2016 in six sub-Saharan African countries.
From policy to practice: exploring the implementation of antiretroviral therapy access and retention policies between 2013 and 2016 in six sub-Saharan African countries.
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DOI：
10.1186/s12913-017-2678-1
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发表时间：
2017-11-21
影响因子：
2.8
通讯作者：
Mee P
中科院分区：
文献类型：
--
作者：
Ambia J;Renju J;Wringe A;Todd J;Geubbels E;Nakiyingi-Miiro J;Urassa M;Lutalo T;Crampin AC;Kwaro D;Kyobutungi C;Chimbindi N;Gomez-Olive FX;Tlhajoane M;Njamwea B;Zaba B;Mee P
了解2013年世界卫生组织（世卫组织）关于在设施一级使用抗逆转录病毒药物治疗和预防艾滋病毒感染的综合准则的执行情况，为今后艾滋病毒政策的推出提供了重要的经验教训。在六个撒哈拉以南非洲国家进行了国家政策审查，以规划纳入2013年世卫组织艾滋病毒治疗建议的情况。选择了20个政策采纳指标来衡量抗逆转录病毒治疗的获得（n = 12）和保留（n = 8）。在2013/2015年（第1轮）和2015/2016年（第2轮）之间，在肯尼亚，马拉维，南非，坦桑尼亚，乌干达和津巴布韦的10个健康和人口监测点进行了两次连续的横断面调查。使用标准化的问卷调查，设施管理人员进行了采访。描述性分析用于评估在两轮之间实施这些政策指标的设施比例的变化。虽然所有国家的政策都明确规定扩大抗逆转录病毒疗法的普及，但大多数国家缺乏加强保留的政策。总共有145个设施被列入两轮。在第1轮和第2轮之间，在CD 4计数为500个细胞/μL或更低时启动ART的机构比例从12%增加到68%，启动2013年WHO推荐的ART方案的机构从42%增加到87%。在过去一年中，报告一线抗逆转录病毒药物库存短缺的设施比例（18%至11%）和提供三个月抗逆转录病毒药物供应的设施比例（43%至38%）没有变化。没有一个设施提供基于社区的抗逆转录病毒疗法。大多数国家抗逆转录病毒治疗启动CD 4阈值的提高，以及世卫组织建议的一线抗逆转录病毒治疗方案的提供方面的重大改进，表明迅速采纳世卫组织的建议是可能的。然而，需要改善后勤和资源和/或改变政策，以进一步减少抗逆转录病毒药物的缺货，并允许非专业干部在社区分发抗逆转录病毒药物。需要加大努力，延长门诊间隔时间，这是一项旨在提高保留率的战略。随着各国开始实施修订的2015年世卫组织指南，使所有艾滋病毒阳性者开始接受抗逆转录病毒治疗，无论其免疫状况如何，这些变化将非常重要。本文的在线版本（10.1186/s12913-017-2678-1）包含补充材料，可供授权用户使用。
Understanding the implementation of 2013 World Health Organization (WHO) consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection at the facility level provides important lessons for the roll-out of future HIV policies. A national policy review was conducted in six sub-Saharan African countries to map the inclusion of the 2013 WHO HIV treatment recommendations. Twenty indicators of policy adoption were selected to measure ART access (n = 12) and retention (n = 8). Two sequential cross-sectional surveys were conducted in facilities between 2013/2015 (round 1) and 2015/2016 (round 2) from ten health and demographic surveillance sites in Kenya, Malawi, South Africa, Tanzania, Uganda and Zimbabwe. Using standardised questionnaires, facility managers were interviewed. Descriptive analyses were used to assess the change in the proportion of facilities that implemented these policy indicators between rounds. Although, expansion of ART access was explicitly stated in all countries’ policies, most lacked policies that enhanced retention. Overall, 145 facilities were included in both rounds. The proportion of facilities that initiated ART at CD4 counts of 500 or less cells/μL increased between round 1 and 2 from 12 to 68%, and facilities initiating patients on 2013 WHO recommended ART regimen increased from 42 to 87%. There were no changes in the proportion of facilities reporting stock-outs of first-line ART in the past year (18 to 11%) nor in the provision of three-month supply of ART (43 to 38%). None of the facilities provided community-based ART delivery. The increase in ART initiation CD4 threshold in most countries, and substantial improvements made in the provision of WHO recommended first-line ART regimens demonstrates that rapid adoption of WHO recommendations is possible. However, improved logistics and resources and/or changes in policy are required to further minimise ART stock-outs and allow lay cadres to dispense ART in the community. Increased efforts are needed to offer longer durations between clinic visits, a strategy purported to improve retention. These changes will be important as countries move to implement the revised 2015 WHO guidelines to initiate all HIV positive people onto ART regardless of their immune status. The online version of this article (10.1186/s12913-017-2678-1) contains supplementary material, which is available to authorized users.
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DOI：
10.1097/qai.0000000000000553
发表时间：
2015-05-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Fox MP;Rosen S
通讯作者：
Rosen S
影响因子：
2.6
作者：
Slaymaker E;Todd J;Marston M;Calvert C;Michael D;Nakiyingi-Miiro J;Crampin A;Lutalo T;Herbst K;Zaba B
通讯作者：
Zaba B
影响因子：
6
作者：
Church K;Machiyama K;Todd J;Njamwea B;Mwangome M;Hosegood V;Michel J;Oti S;Nyamukapa C;Crampin A;Amek N;Nakigozi G;Michael D;Gómez-Olivé FX;Nakiyingi-Miiro J;Zaba B;Wringe A
通讯作者：
Wringe A
影响因子：
64.8
作者：
Working Group on Modelling of Antiretroviral Therapy Monitoring Strategies in Sub-Saharan Africa;Phillips A;Shroufi A;Vojnov L;Cohn J;Roberts T;Ellman T;Bonner K;Rousseau C;Garnett G;Cambiano V;Nakagawa F;Ford D;Bansi-Matharu L;Miners A;Lundgren JD;Eaton JW;Parkes-Ratanshi R;Katz Z;Maman D;Ford N;Vitoria M;Doherty M;Dowdy D;Nichols B;Murtagh M;Wareham M;Palamountain KM;Chakanyuka Musanhu C;Stevens W;Katzenstein D;Ciaranello A;Barnabas R;Braithwaite RS;Bendavid E;Nathoo KJ;van de Vijver D;Wilson DP;Holmes C;Bershteyn A;Walker S;Raizes E;Jani I;Nelson LJ;Peeling R;Terris-Prestholt F;Murungu J;Mutasa-Apollo T;Hallett TB;Revill P
通讯作者：
Revill P
DOI：
10.1097/qad.0b013e32834b6480
发表时间：
2011-10-23
期刊：
AIDS (London, England)
影响因子：
--
作者：
Brennan AT;Long L;Maskew M;Sanne I;Jaffray I;MacPhail P;Fox MP
通讯作者：
Fox MP