A longitudinal review of national HIV policy and progress made in health facility implementation in eastern Zimbabwe

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Title: A longitudinal review of national HIV policy and progress made in health facility implementation in eastern Zimbabwe
Author(s): Tlhajoane, M
Masoka, T
Mpandaguta, E
Rhead, R
Church, K
Wringe, A
Kadzura, N
Arinaminpathy, N
Nyamukapa, C
Schur, N
Mugurungi, O
Skovdal, M
Eaton, J
Gregson, S
Item Type: Journal Article
Abstract: Background In recent years, WHO has made major changes to its guidance on the provision of HIV care and treatment services. We conducted a longitudinal study from 2013 to 2015 to establish how these changes have been translated into national policy in Zimbabwe and to measure progress in implementation within local health facilities. Methods National HIV programme policy guidelines published between 2003 and 2013 (n = 9) and 2014 and 2015 (n = 5) were reviewed to assess adoption of WHO recommendations on HIV testing services, prevention of mother-to-child transmission (PMTCT) of HIV, and provision of antiretroviral therapy (ART). Changes in local implementation of these policies over time were measured in two rounds of a survey conducted at 36 health facilities in Eastern Zimbabwe in 2013 and 2015. Results High levels of adoption of WHO guidance into national policy were recorded, including adoption of new recommendations made in 2013–2015 to introduce PMTCT Option B+ and to increase the threshold for ART initiation from CD4 ≤ 350 cells/mm3 to ≤ 500 cells/mm3. New strategies to implement national HIV policies were introduced such as the decentralisation of ART services from hospitals to clinics and task-shifting of care from doctors to nurses. The proportions of health facilities offering free HIV testing and counselling, PMTCT (including Option B+) and ART services increased substantially from 2013 to 2015, despite reductions in numbers of health workers. Provision of provider-initiated HIV testing remained consistently high. At least one test-kit stock-out in the prior year was reported in most facilities (2013: 69%; 2015: 61%; p = 0.44). Stock-outs of first-line ART and prophylactic drugs for opportunistic infections remained low. Repeat testing for HIV-negative individuals within 3 months decreased (2013: 97%; 2015: 72%; p = 0.01). Laboratory testing remained low across both survey rounds, despite policy and operational guidelines to expand coverage of diagnostic services. Conclusions Good progress has been made in implementing international guidance on HIV service delivery in Zimbabwe. Further novel implementation strategies may be needed to achieve the latest targets for universal ART eligibility.
Publication Date: 21-Sep-2018
Date of Acceptance: 2-Aug-2018
URI: http://hdl.handle.net/10044/1/62707
DOI: https://dx.doi.org/10.1186/s12961-018-0358-1
ISSN: 1478-4505
Publisher: BioMed Central
Journal / Book Title: Health Research Policy and Systems
Volume: 16
Sponsor/Funder: Wellcome Trust
Bill & Melinda Gates Foundation
Wellcome Trust
Funder's Grant Number: 084401/Z/07/Z
n/a
105265/Z/14/Z
Copyright Statement: © The Author(s). 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), 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 ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.
Keywords: 1605 Policy And Administration
Health Policy & Services
Publication Status: Published
Article Number: ARTN 92
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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