Assessing policy implementation and health systems impacts of Option B+ in three African countries to inform the delivery of Universal Test and Treat.

评估选项 B 在三个非洲国家的政策实施和卫生系统影响，为普遍检测和治疗的实施提供信息。

• 批准号: MR/P014313/1
• 负责人: Alison Wringe
• 金额: $ 70.79万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FP014313%2F1
• 关键词: Assessing; policy; implementation; health; systems

In 2013, the World Health Organisation (WHO) recommended initiation of lifelong antiretroviral therapy (ART) for all HIV-positive pregnant women, regardless of disease stage, in order to minimise transmission risks to their index offspring and offspring of later pregnancies. HIV-exposed infants should receive antiretroviral (ARV) prophylaxis, be tested and receive ART if HIV-positive. In 2015, WHO extended their guidance to recommend immediate ART initiation for all adults diagnosed with HIV (universal Test and Treat (UTT)), following evidence from randomised control trials demonstrating that it reduced sexual transmission and provided individual health benefits for HIV-positive adults.Although few sub-Saharan African countries have introduced UTT policies, many have rolled out Option B+, despite ongoing debates over its cost-effectiveness and health systems impacts, particularly in settings with weak infrastructure. Despite its potential to eliminate HIV in infants and improve maternal health, some argue that poor delivery could lead to resources being channelled away from adult HIV services, detrimentally affecting their quality and health outcomes.There is widespread agreement that research is needed to understand how Option B+ has been implemented in different settings and its corresponding impacts on health systems. Furthermore, there is a key window of opportunity to use the evidence generated by such research to assess how best to prepare these health systems for further expansion of ART services as UTT policies are rolled out.Our study will take place in three HIV community cohort (HCC) sites in rural Malawi, Tanzania and South Africa, representing early, mid-term and late adopters of Option B+ in 2011, 2013 and 2015 respectively, and where UTT policies were being drafted in 2016, in order to answer 4 key research questions:1) What are the Option B+ policy implementation gaps in each setting and how do the actors, policy content, context and processes explain these gaps?2) Have underlying economic and epidemiological assumptions in economic evaluations that demonstrated the anticipated cost-effectiveness of Option B+ been met in each site?3) What are the health systems impacts of Option B+ in each setting?4) What strategies can be developed with policymakers to ensure that health systems are ready for effective delivery of UTT?We will use a comparative, longitudinal approach with mixed methods that include secondary analysis of existing policy reviews, health facility survey data and routine HIV clinic data linked to HCC data. We will also collect new data through an updated review of national HIV policies, a further round of facility surveys, key informant interviews with policymakers and programmers, in-depth interviews with health workers and PMTCT service users, and costing estimates.We will draw on existing frameworks to identify gaps in Option B+ implementation and to explore the policy processes and contexts underlying them. We will then assess whether the costs of implementing Option B+ in purposively sampled health facilities correspond with pre-implementation estimates, and whether epidemiological parameters used for economic evaluations prior to Option B+ implementation align with local estimates derived from the HCC. We will also adapt existing indicators to assess the impacts of Option B+ on governance, financing, service delivery, workforce, information, medical supplies, and use qualitative and HCC data to consider impacts on health systems processes commonly defined as those relating to access, quality and coverage. Using our findings, we will work with key stakeholders to develop tools to assess health systems readiness for UTT, and to monitor health systems impacts through its implementation. The research questions and methods were developed in collaboration with policymakers to support the uptake of the findings into UTT policies in each country and beyond.

2013年，世界卫生组织（WHO）建议对所有艾滋病毒阳性孕妇开始终身抗逆转录病毒治疗（ART），无论疾病阶段如何，以最大限度地降低其指数后代和后期怀孕后代的传播风险。接触艾滋病毒的婴儿应接受抗逆转录病毒（ARV）预防，接受检测，如果艾滋病毒呈阳性，应接受抗逆转录病毒治疗。2015年，世卫组织扩大了其指导范围，建议所有确诊感染艾滋病毒的成年人立即开始抗逆转录病毒治疗。（普遍检测和治疗（UTT）），根据随机对照试验的证据，它减少了性传播，并为艾滋病毒阳性成年人提供了个人健康益处。尽管撒哈拉以南非洲国家很少引入UTT政策，但许多国家已经推出了选项B+，尽管目前正在就其成本效益和卫生系统影响进行辩论，特别是在基础设施薄弱的情况下。尽管方案B+有可能消除婴儿体内的艾滋病毒并改善孕产妇健康，但一些人认为，分娩不良可能导致资源从成人艾滋病毒服务中流失，从而不利地影响其质量和健康结果，人们普遍认为，需要进行研究，以了解方案B+在不同环境中的实施情况及其对卫生系统的相应影响。此外，有一个关键的机会窗口，利用这些研究产生的证据，以评估如何最好地准备这些卫生系统进一步扩大抗逆转录病毒治疗服务的政策推出。我们的研究将在三个艾滋病毒社区队列（HCC）在农村马拉维，坦桑尼亚和南非，代表早期，中期和后期采用选项B+在2011年的网站，2013年和2015年，以及2016年正在起草的UTT政策，以回答4个关键的研究问题：1）在每种情况下，选项B+政策执行差距是什么？参与者、政策内容、背景和过程如何解释这些差距？2)经济评价中的基本经济和流行病学假设是否证明了每个研究中心的方案B+的预期成本效益？3)备选方案B+在每种情况下对卫生系统有哪些影响？4)可以与政策制定者一起制定哪些战略，以确保卫生系统为有效提供UTT做好准备？我们将使用比较的纵向方法和混合方法，包括对现有政策审查、卫生设施调查数据和与HCC数据相关的常规HIV诊所数据进行二次分析。我们还将通过对国家艾滋病毒政策的最新审查、新一轮的设施调查、与政策制定者和方案制定者的关键知情人访谈、与卫生工作者和预防母婴传播服务使用者的深入访谈以及成本估算来收集新的数据。我们将利用现有框架来确定选项B+实施中的差距，并探索这些差距背后的政策过程和背景。然后，我们将评估在有目的抽样的卫生设施中实施方案B+的成本是否与实施前的估计一致，以及在实施方案B+之前用于经济评估的流行病学参数是否与从HCC得出的当地估计一致。我们还将调整现有指标，以评估方案B+对治理、筹资、服务提供、劳动力、信息、医疗用品的影响，并使用定性和HCC数据来考虑对卫生系统流程的影响，这些流程通常被定义为与获取、质量和覆盖面有关的流程。利用我们的研究结果，我们将与主要利益相关者合作开发工具，以评估卫生系统对UTT的准备情况，并通过其实施监测卫生系统的影响。研究问题和方法是与政策制定者合作开发的，以支持将研究结果纳入每个国家和其他国家的UTT政策。

项目成果

From policy to practice: exploring the implementation of antiretroviral therapy access and retention policies between 2013 and 2016 in six sub-Saharan African countries.

• DOI: 10.1186/s12913-017-2678-1
• 发表时间: 2017-11-21
• 期刊: BMC health services research
• 影响因子: 2.8
• 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
• 通讯作者: Mee P

Investigating clinic transfers among HIV patients considered lost to follow-up to improve understanding of the HIV care cascade: Findings from a cohort study in rural north-eastern South Africa.

• DOI: 10.1371/journal.pgph.0000296
• 发表时间: 2022
• 期刊: PLOS global public health

Successes and challenges in optimizing the viral load cascade to improve antiretroviral therapy adherence and rationalize second-line switches in Swaziland.

• DOI: 10.1002/jia2.25194
• 发表时间: 2018-10
• 期刊: Journal of the International AIDS Society
• 影响因子: 6
• 作者: Etoori D;Ciglenecki I;Ndlangamandla M;Edwards CG;Jobanputra K;Pasipamire M;Maphalala G;Yang C;Zabsonre I;Kabore SM;Goiri J;Teck R;Kerschberger B
• 通讯作者: Kerschberger B

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland.

• DOI: 10.1186/s12889-018-5258-3
• 发表时间: 2018-03-20
• 期刊: BMC public health
• 影响因子: 4.5
• 作者: Etoori D;Kerschberger B;Staderini N;Ndlangamandla M;Nhlabatsi B;Jobanputra K;Mthethwa-Hleza S;Parker LA;Sibanda S;Mabhena E;Pasipamire M;Kabore SM;Rusch B;Jamet C;Ciglenecki I;Teck R
• 通讯作者: Teck R

Consequences of male partner engagement policies on HIV care-seeking in three African countries: Findings from the SHAPE UTT study.

• DOI: 10.1080/17441692.2020.1805788
• 发表时间: 2021-03
• 期刊: Global public health
• 影响因子: 3.3
• 作者: Dube A;Renju J;Wamoyi J;Hassan F;Seeley J;Chimukuche RS;Songo J;Kalua T;Crampin A;Moshabela M;Wringe A
• 通讯作者: Wringe A