Identifying gaps in HIV policy and practice along the HIV care continuum: evidence from a national policy review and health facility surveys in urban and rural Kenya.
Identifying gaps in HIV policy and practice along the HIV care continuum: evidence from a national policy review and health facility surveys in urban and rural Kenya.
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DOI：
10.1093/heapol/czx091
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发表时间：
2017-11-01
影响因子：
3.2
通讯作者：
Wringe A
中科院分区：
文献类型：
--
作者：
Cawley C;McRobie E;Oti S;Njamwea B;Nyaguara A;Odhiambo F;Otieno F;Njage M;Shoham T;Church K;Mee P;Todd J;Zaba B;Reniers G;Wringe A
在过去十年中，世卫组织关于提供艾滋病毒服务的指导沿着诊断到治疗的连续性发生了迅速变化，但这些建议在肯尼亚被采纳为国家政策并随后在卫生设施中得到实施的程度尚不清楚。查明政策覆盖面和执行方面的差距，对于突出需要改进服务提供的领域，从而取得更好的卫生成果十分重要。我们比较了世卫组织的指导与各国在艾滋病毒检测和咨询、预防母婴传播、艾滋病毒治疗和继续护理方面的政策。然后，我们调查了这些国家政策在肯尼亚的一个农村（基苏穆）和一个城市（内罗毕）的卫生设施的实施情况。使用向内罗毕10个卫生机构和基苏穆34个卫生机构的负责人员发放的结构化问卷记录了实施情况。如果据报告政策在70%以上的设施中得到广泛执行，则将其定义为广泛执行;如果据报告在30-70%的设施中得到部分执行，则将其定义为部分执行;如果据报告在30%以下的设施中得到执行，则将其定义为执行有限。总体而言，肯尼亚的国家艾滋病毒护理和治疗政策与世卫组织的指导方针保持一致。促进获得治疗和继续接受护理的政策得到广泛执行，但促进获得艾滋病毒检测的若干政策以及最近针对艾滋病毒抗体阳性孕妇的备选方案B+政策只得到部分或有限执行。如果要进一步降低肯尼亚的发病率和死亡率负担，并随着该国逐步普及抗逆转录病毒疗法，就需要努力改善旨在提高诊断率的政策的执行情况，从而便利接受艾滋病毒护理。
The last decade has seen rapid evolution in guidance from the WHO concerning the provision of HIV services along the diagnosis-to-treatment continuum, but the extent to which these recommendations are adopted as national policies in Kenya, and subsequently implemented in health facilities, is not well understood. Identifying gaps in policy coverage and implementation is important for highlighting areas for improving service delivery, leading to better health outcomes. We compared WHO guidance with national policies for HIV testing and counselling, prevention of mother-to-child transmission, HIV treatment and retention in care. We then investigated implementation of these national policies in health facilities in one rural (Kisumu) and one urban (Nairobi) sites in Kenya. Implementation was documented using structured questionnaires that were administered to in-charge staff at 10 health facilities in Nairobi and 34 in Kisumu. Policies were defined as widely implemented if they were reported to occur in > 70% facilities, partially implemented if reported to occur in 30–70% facilities, and having limited implementation if reported to occur in < 30% facilities. Overall, Kenyan national HIV care and treatment policies were well aligned with WHO guidance. Policies promoting access to treatment and retention in care were widely implemented, but there was partial or limited implementation of several policies promoting access to HIV testing, and the more recent policy of Option B+ for HIV-positive pregnant women. Efforts are needed to improve implementation of policies designed to increase rates of diagnosis, thus facilitating entry into HIV care, if morbidity and mortality burdens are to be further reduced in Kenya, and as the country moves towards universal access to antiretroviral therapy.
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影响因子：
4.2
作者：
Brodish P;Singh K;Rinyuri A;Njeru C;Kingola N;Mureithi P;Sambisa W;Weir S
通讯作者：
Weir S
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：
7.2
作者：
McRobie, Ellen;Wringe, Alison;Church, Kathryn
通讯作者：
Church, Kathryn
影响因子：
3.7
作者：
Cawley, Caoimhe;Wringe, Alison;Zaba, Basia
通讯作者：
Zaba, Basia
影响因子：
5.4
作者：
Parkhurst, JO;Lush, L
通讯作者：
Lush, L