A comparative analysis of national HIV policies in six African countries with generalized epidemics
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Authors
Church, Kathryn; Kiweewa, Francis; Dasgupta, Aisha; Mwangome, Mary; Mpandaguta, Edith;Gómez-Olivé, Francesc Xavier;Oti, Samuel;Todd, Jim;Wringe, Alison;Geubbels, Eveline;Crampin, Amelia;Nakiyingi-Miiro, Jessica;Hayashi, Chika;Njage, Muthoni;Wagner, Ryan G;Ario, Alex Riolexus;Makombe, Simon D;Mugurungi, Owen;Zaba, Basia
Issue Date
2015
Type
Journal / periodical articles
Language
Keywords
Research;HIV;Health Policy;HIV policies;Africa
Alternative Title
Abstract
Description
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.
Citation
Publisher
WHO
License
CC BY-NC-SA 3.0 IGO