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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. Objectif Comparer les politiques nationales de lutte contre le virus de Hmmunodefidence humaine (VIH) qui Influenced l'acces aux services de depistage et de traitement du VIH dans six pays d'Afrique subsaharienne. Methodes Nous avons examine les politiques de lutte contre le VIH dans le cadre d'une etude multi-pays sur la mortalite des adultes en Afrique subsaharienne. Un outil d'extraction de donnees a ete mis au point et utllise afin d'examlner les documents et les directives des politiques nationales de lutte contre le VIH publles en Afrique du Sud, au Kenya, au Malawi, en Ouganda, en Republique-Unie deTanzanie et au Zimbabwe entre 2003 et 2013. Des entretiens avec des informateurs cles ont permis de combler les carences de ces resultats. Les politiques nationales ont ete classees suivant leur degre de correspondance, explicite ou implicite, avec 54 indicateurs relatlfs aux politiques, determines d'apres des analyses documentales et des examens d'experts. Nous avons egalement compare les politiques nationales avec les recommandations de l'Organisation mondlale de la Sante (QMS). Resultats Nous avons observe de grandes differences entre les politiques de ces pays; chaque pays etait avance dans certains domaines et pas dans d'autres. Le Malawi l'etait particulierement en matiere de promotion du demarrage rapidedu traitement antiretroviral. Cependant, aucun pays n'avalt un contexte politique pouvant systematiquement permettre d'augmenter l'acces aux soins et d'eviter l'arret du traitement. Dans certains domaines, les pays allaient plus loin que les recommandations de l'OMS et les Informateurs ont Indique que la pratique depassait souvent le cadre des politiques. Conclusion Evaluer l'impact des differentes politiques sur l'acces aux soins et les resultats en termes de sante des personnes qul vivent avec le VIH n'est pas chose simple. Certaines politiques exercent une influence plus forte que d'autres et les politiques officielles ne sont pas toujours mises en oeuvre. Des recherches ulterleures devraient evaluer le degre de mise en oeuvre des politiques et mettre en lien leurs conclusions avec les resultats de la lutte contre le VIH. Objetivo Comparar las politicas nacionales relativas al virus de la inmunodeficiencia humana (VIH) que influencian el acceso a las pruebas del VIH y a los tratamientos en seis paises sub-saharianos. Metodos Se revisaron las politicas relativas al VIH como parte de un estudio multinacional sobre la mortalidad de adultos en Africa Subsahanana. Se desarrollo una herramienta de extraccion de politicas y se utilizo para revisar los documentos y guias de las politicas nacionales relativas al VIH publicadas en Kenla, Malawi, Republica Unida de Tanzanla, Sudafrica, Uganda y Zlmbabue entre 2003 y 2013. Se hicieron entrevistas a Informantes claves que ayudaron a llenar los vacios en los resultados. Las politicas nacionales se clasificaron segun si se adhirieron explicita o implicitamente a 54 Indicadores de politicas, Identificados mediante bibliografia y opiniones de expertos. Asimismo, se compararon las politicas nacionales con las directrices de la Organizacion Mundial de la Salud (OMS). Resultados Se descubrio que habia una amplia variedad entre las politicas de los paises. Cada pais estaba mas avanzado en algunas areas que en otras. Malawi estaba especialmente avanzado en'la promocion de empezar rapidamente la terapia antirretroviral. Sin embargo, ningun pais tenia un contexto de Introduccion de politicas consistente que Incrementara el acceso a la atencion primaria y evitara la desercion. Algunos paises Iban mas alla de las orientaciones de la OMS en algunas areas e informantes clave Informaron de que la practica a menudo superaba la politica. Conclusion Evaluar el impacto de las diferencias en las politicas relativas en el acceso a la atencion primaria y los resultados en la salud entre aquellas personas con VIH es un reto. Algunas politicas ejerceran mas Influencia que otras y las politicas oficiales no siempre se aplican. Las Investigaciones futuras deberian evaluar el grado de aplicacion de las politicas y vincular estos resultados con los resultados del VIH., Introduction By the end of 2012, more than 7.5 million of the estimated 23.5 million people living with human immunodeficiency virus (HIV) in Africa were receiving treatment, compared to only [...]

Introduction: Despite the rollout of antiretroviral therapy (ART), challenges remain in ensuring timely access to care and treatment for people living with HIV. As part of a multi-country study to investigate HIV mortality, we conducted health facility surveys within 10 health and demographic surveillance system sites across six countries in Eastern and Southern Africa to investigate clinic-level factors influencing (i) use of HIV testing services, (ii) use of HIV care and treatment and (iii) patient retention on ART. Methods: Health facilities (n = 156) were sampled within 10 surveillance sites: Nairobi and Kisumu (Kenya), Karonga (Malawi), Agincourt and uMkhanyakude (South Africa), Ifakara and Kisesa (Tanzania), Kyamulibwa and Rakai (Uganda) and Manicaland (Zimbabwe). Structured questionnaires were administered to in-charge staff members of HIV testing, prevention of mother-to-child transmission (PMTCT) and ART units within the facilities. Forty-one indicators influencing uptake and patient retention along the continuum of HIV care were compared across sites using descriptive statistics. Results: The number of facilities surveyed ranged from six in Malawi to 36 in Zimbabwe. Eighty percent were governmentrun; 73% were lower-level facilities and 17% were district/referral hospitals. Client load varied widely, from less than one up to 65 HIV testing clients per provider per week. Most facilities (>80%) delivered services or interventions that would support patient retention in care such as delivering free services, offering PMTCT within antenatal care, pre-ART monitoring and adherence counselling. Many facilities under-delivered in several areas, however, such as targeted testing for high- risk groups (21%) and mobile testing (36%). There were also intra-site and inter-site differences, including in the delivery of Option B+ (ranging from 6% in Kisumu to 93% in Kyamulibwa), and nurse-led ART initiation (ranging from 50% in Kisesa to 100% in Karonga and Agincourt). Only facilities in Malawi did not require additional lab tests for ART initiation. Stock-outs of HIV test kits and antiretroviral drugs were particularly common in Tanzania. Conclusions: We identified a high standard of health facility performance in delivering strategies that may support progression through the continuum of HIV care. HIV testing policy and practice was particularly weak. Inter- and intracountry differences in quality and coverage represent opportunities to improve the delivery of comprehensive services to people living with HIV. Keywords: HIV; ART; PMTCT; retention; health services; facility surveys; multi-country; continuum, Introduction In 2015 in Eastern and Southern Africa, 10.3 million people were accessing antiretroviral therapy (ART), representing an estimated 54% [50-58%] of all people living with HIV (PLHIV) in the [...]

Background: Estimating cause-related mortality among the dead is not common, yet for clinical and public health purposes, a lot can be learnt from the dead. HIV/AIDS accounted for the third most frequent cause of deaths in Kenya; 39.7 deaths per 100,000 population in 2019. OraQuick Rapid HIV-1/2 has previously been validated on oral fluid and implemented as a screening assay for HIV self-testing in Kenya among living subjects. We assessed the feasibility and diagnostic accuracy of OraQuick Rapid HIV-1/2 for HIV screening among decedents., Methods: Trained morticians collected oral fluid from 132 preembalmed and postembalmed decedents aged >18 months at Jaramogi Oginga Odinga Teaching and Referral Hospital mortuary in western Kenya and tested for HIV using OraQuick Rapid HIV-1/2. Test results were compared with those obtained using the national HIV Testing Services algorithm on matched preembalming whole blood specimens as a gold standard (Determine HIV and First Response HIV 1-2-O). We calculated positive predictive values, negative predictive values, area under the curve, and sensitivity and specificity of OraQuick Rapid HIV-1/2 compared with the national HTS algorithm., Results: OraQuick Rapid HIV-1/2 had similar sensitivity of 92.6% [95% confidence interval (CI): 75.7 to 99.1] on preembalmed and postembalmed samples compared with the gold standard. Specificity was 97.1% (95% CI: 91.9 to 99.4) and 95.2% (95% CI: 89.2 to 98.4) preembalming and postembalming, respectively. Preembalming and postembalming positive predictive value was 89.3% (95% CI: 71.8 to 97.7) and 83.3% (95% CI: 65.3 to 94.4), respectively. The area under the curve preembalming and postembalming was 94.9% (95% CI: 89.6 to 100) and 93.9% (95% CI: 88.5 to 99.4), respectively., Conclusions: The study showed a relatively high-performance sensitivity and specificity of OraQuick Rapid HIV-1/2 test among decedents, similar to those observed among living subjects. OraQuick Rapid HIV-1/2 presents a convenient and less invasive screening test for surveillance of HIV among decedents within a mortuary setting., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To identify and describe populations at risk for HIV in 3 clinical research centers in Kenya and South Africa., Design: Prospective cohort study., Methods: Volunteers reporting recent sexual activity, multiple partners, transactional sex, sex with an HIV-positive partner, or, if male, sex with men (MSM; in Kenya only) were enrolled. Sexually active minors were enrolled in South Africa only. Risk behavior, HIV testing, and clinical data were obtained at follow-up visits., Results: From 2005 to 2008, 3023 volunteers were screened, 2113 enrolled, and 1834 contributed data on HIV incidence. MSM had the highest HIV incidence rate of 6.8 cases per 100 person-years [95% confidence interval (CI): 4.9 to 9.2] followed by women in Kilifi and Cape Town (2.7 cases per 100 person-years, 95% CI: 1.7 to 4.2). No seroconversions were observed in Nairobi women or men in Nairobi or Cape Town who were not MSM. In 327 MSM, predictors of HIV acquisition included report of genital ulcer (Hazard Ratio: 4.5, 95% CI: 1.7 to 11.6), not completing secondary school education (HR: 3.4, 95% CI: 1.6 to 7.2) and reporting receptive anal intercourse (HR: 8.2, 95% CI: 2.7 to 25.0). Paying for sex was inversely associated with HIV infection (HR: 0.2, 95% CI: 0.04 to 0.8). 279 (13.0%) volunteers did not return after the first visit; subsequent attrition rates ranged from 10.4 to 21.8 volunteers per 100 person-years across clinical research centers., Conclusions: Finding, enrolling, and retaining risk populations for HIV prevention trials is challenging in Africa. African MSM are not frequently engaged for research, have high HIV incidence, need urgent risk reduction counseling, and may represent a suitable population for future HIV prevention trials.