Influence of evolving HIV treatment guidance on CD4 counts and viral load monitoring: A mixed-methods study in three African countries
| Autor: | Estelle McLean, Deborah Kajoka, Janet Seeley, Rujeko Samanthia Chimukuche, Jenny Renju, Thokozani Kalua, Eveline Geubbels, Alison Wringe, Brian Rice, Mosa Moshabela, Farida Hassan, John Songo |
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| Rok vydání: | 2020 |
| Předmět: |
Supply chain
Human immunodeficiency virus (HIV) HIV Infections Funding Mechanism medicine.disease_cause World health South Africa 03 medical and health sciences 0302 clinical medicine Nursing Political science medicine Humans 030212 general & internal medicine Hiv treatment 030505 public health biology Corporate governance Public Health Environmental and Occupational Health Viral Load biology.organism_classification CD4 Lymphocyte Count Tanzania Health Facilities 0305 other medical science Viral load |
| Zdroj: | Global Public Health. 16:288-304 |
| ISSN: | 1744-1706 1744-1692 |
| DOI: | 10.1080/17441692.2020.1805785 |
| Popis: | Little is known about how CD4 and viral load testing have evolved following implementation of universal test and treat (UTT) in African settings. We reviewed World Health Organization (WHO) guidance from 2013 to 2018, and compared it against national HIV policies in Malawi, Tanzania and South Africa. Three surveys rounds were conducted in 2013, 2016 and 2017-2018 in 33 health facilities across the three settings to assess implementation of national policies on the use of biological markers. Qualitative interviews were conducted with 26 HIV policymakers or programme managers, 21 providers and 66 people living with HIV to explore understandings and experiences of these tests. Various factors influenced adoption and implementation of WHO guidance, including historical policies on CD4 counts, governance issues, supply chain challenges and funding mechanisms. Facility-level practices relating to the use of these tests often diverged from national policies. Patients and providers valued both tests, but did not always understand their roles. In addition to continued support for scaling-up viral load testing, renewed focus should be placed on the ongoing value of point-of-care CD4 tests in the UTT era, including its role in assessing disease progression and informing clinical management of cases to reduce HIV-related mortality. |
| Databáze: | OpenAIRE |
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