HIV policy implementation in two health and demographic surveillance sites in Uganda: findings from a national policy review, health facility surveys, and key informant interviews

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Title: HIV policy implementation in two health and demographic surveillance sites in Uganda: findings from a national policy review, health facility surveys, and key informant interviews
Authors: McRobie, E
Wringe, A
Nakiyingi-Miiro, J
Kiweqewa, F
Lutalo, T
Nakigozi, G
Todd, J
Eaton, JW
Zaba, B
Church, K
Item Type: Journal Article
Abstract: Background Successful HIV testing, care and treatment policy implementation is essential for realising the reductions in morbidity and mortality those policies are designed to target. While adoption of new HIV policies is rapid, less is known about the facility-level implementation of new policies and the factors influencing this. Methods We assessed implementation of national policies about HIV testing, treatment and retention at health facilities serving two health and demographic surveillance sites (HDSS) (10 in Kyamulibwa, 14 in Rakai). Ugandan Ministry of Health HIV policy documents were reviewed in 2013, and pre-determined indicators were extracted relating to the content and nature of guidance on HIV service provision. Facility-level policy implementation was assessed via a structured questionnaire administered to in-charge staff from each health facility. Implementation of policies was classified as wide (≥75% facilities), partial (26–74% facilities) or minimal (≤25% facilities). Semi-structured interviews were conducted with key informants (policy-makers, implementers, researchers) to identify factors influencing implementation; data were analysed using the Framework Method of thematic analysis. Results Most policies were widely implemented in both HDSS (free testing, free antiretroviral treatment (ART), WHO first-line regimen as standard, Option B+). Both had notable implementation gaps for policies relating to retention on treatment (availability of nutritional supplements, support groups or isoniazid preventive therapy). Rakai implemented more policies relating to provision of antiretroviral treatment than Kyamulibwa and performed better on quality of care indicators, such as frequency of stock-outs. Factors facilitating implementation were donor investment and support, strong scientific evidence, low policy complexity, phased implementation and effective planning. Limited human resources, infrastructure and health management information systems were perceived as major barriers to effective implementation. Conclusions Most HIV policies were widely implemented in the two settings; however, gaps in implementation coverage prevail and the value of ensuring complete coverage of existing policies should be considered against the adoption of new policies in regard to resource needs and health benefits.
Issue Date: 5-Apr-2017
Date of Acceptance: 14-Mar-2017
ISSN: 1748-5908
Publisher: BioMed Central
Journal / Book Title: Implementation Science
Volume: 12
Copyright Statement: © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
HIV policies
Health services
11 Medical And Health Sciences
08 Information And Computing Sciences
Publication Status: Published
Article Number: 47
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

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