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
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 p...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2017-04-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13012-017-0574-z |
| _version_ | 1811214948701831168 |
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| author | Ellen McRobie Alison Wringe Jessica Nakiyingi-Miiro Francis Kiweewa Tom Lutalo Gertrude Nakigozi Jim Todd Jeffrey William Eaton Basia Zaba Kathryn Church |
| author_facet | Ellen McRobie Alison Wringe Jessica Nakiyingi-Miiro Francis Kiweewa Tom Lutalo Gertrude Nakigozi Jim Todd Jeffrey William Eaton Basia Zaba Kathryn Church |
| author_sort | Ellen McRobie |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T06:14:08Z |
| format | Article |
| id | doaj.art-ba63cb5e38d24b7fa38641236ccafbb6 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-04-12T06:14:08Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-ba63cb5e38d24b7fa38641236ccafbb62022-12-22T03:44:35ZengBMCImplementation Science1748-59082017-04-0112111210.1186/s13012-017-0574-zHIV policy implementation in two health and demographic surveillance sites in Uganda: findings from a national policy review, health facility surveys and key informant interviewsEllen McRobie0Alison Wringe1Jessica Nakiyingi-Miiro2Francis Kiweewa3Tom Lutalo4Gertrude Nakigozi5Jim Todd6Jeffrey William Eaton7Basia Zaba8Kathryn Church9Imperial College LondonLondon School of Hygiene and Tropical MedicineMRC/UVRI Uganda Research Institute on AIDSMakerere University Walter Reed ProjectRakai Health Sciences ProgramRakai Health Sciences ProgramLondon School of Hygiene and Tropical MedicineImperial College LondonLondon School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical MedicineAbstract 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.http://link.springer.com/article/10.1186/s13012-017-0574-zHIVHIV policiesHealth servicesUganda |
| spellingShingle | Ellen McRobie Alison Wringe Jessica Nakiyingi-Miiro Francis Kiweewa Tom Lutalo Gertrude Nakigozi Jim Todd Jeffrey William Eaton Basia Zaba Kathryn Church 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 Implementation Science HIV HIV policies Health services Uganda |
| 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | HIV HIV policies Health services Uganda |
| url | http://link.springer.com/article/10.1186/s13012-017-0574-z |
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