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Objective To assess adoption of World Health Organization (WHO) guidance into national policies for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) and to monitor implementation of guidelines at facility level in rural Malawi, South Africa and the United Republic of Tanzania. Methods We summarized national PMTCT policies and WHO guidance for 15 indicators across the cascades of maternal and infant care over 2013-2016. Two survey rounds were conducted (2013-2015 and 2015-2016) in 46 health facilities serving five health and demographic surveillance system populations. We administered structured questionnaires to facility managers to describe service delivery. We report the proportions of facilities implementing each indicator and the frequency and durations of stock-outs of supplies, by site and survey round. Findings In all countries, national policies influencing the maternal and infant PMTCT cascade of care aligned with WHO guidelines by 2016; most inter-country policy variations concerned linkage to routine HIV care. The proportion of facilities delivering post-test counselling, same-day antiretroviral therapy (ART) initiation, antenatal care and ART provision in the same building, and Option B+ increased or remained at 100% in all sites. Progress in implementing policies on infant diagnosis and treatment varied across sites. Stock- outs of HIV test kits or antiretroviral drugs in the past year declined overall, but were reported by at least one facility per site in both rounds. Conclusion Progress has been made in implementing PMTCT policy in these settings. However, persistent gaps across the infant cascade of care and supply-chain challenges, risk undermining infant HIV elimination goals. Objectif Evaluer la transposition des recommandations de l'Organisation mondiale de la Sante (OMS) dans les politiques nationales de prevention de la transmission mere-enfant (PTME) du virus de l'immunodeficience humaine (VIH) et controler l'application de ces politiques dans les centres de sante de zones rurales d'Afrique du Sud, du Malawi et de Republique-Unie de Tanzanie. Methodes Nous avons repertorie les politiques nationales de PTME et les recommandations de l'OMS pour 15 indicateurs, sur toute la chaine de soins de sante de la mere et du nourrisson, sur la periode comprise entre 2013 et 2016. Deux series d'enquetes ont ete realisees (2013-2015 et 2015-2016) dans 46 centres de sante au service des populations de cinq systemes de surveillance demographique et de sante. Nous avons interroge les responsables de ces centres a l'aide de questionnaires directifs afin d'obtenir une description de la prestation des soins. Nous avons calcule la proportion de centres ayant applique chaque indicateur ainsi que la frequence et la duree des ruptures de stock de fournitures, pour chaque zone etudiee et chaque serie d'enquetes. Resultats En 2016, dans tous les pays etudies, les lignes directrices de l'OMS avaient ete prises en compte dans les politiques nationales relatives a la chaine des soins de PTME du VIH; la plupart des differences constatees entre les politiques de ces differents pays concernaient la liaison avec les soins de routine contre le VIH. La proportion des centres offrant des conseils apres depistage, proposant de debuter une therapie antiretrovirale (TAR) le jour meme, fournissant dans un meme endroit des soins prenataux et des TAR et appliquant l'Option B+ a augmente ou est restee a 100% dans toutes les zones etudiees. Les progres dans l'application des politiques en matiere de diagnostic et de traitement du nourrisson ont ete variables d'une zone a une autre. Les ruptures de stock de kits de depistage du VIH ou de medicaments antiretroviraux au cours de l'annee precedente ont generalement diminue, mais dans chaque zone, sur les deux periodes etudiees, au moins une structure a ete confrontee a ce probleme. Conclusion Des progres ont ete faits dans l'application des politiques de PTME dans ces regions. Neanmoins, des manquements persistants dans la chaine de soins de sante du nourrisson et les problemes des chaines d'approvisionnement risquent de compromettre l'atteinte des objectifs d'elimination du VIH chez le nourrisson. Objetivo Evaluar la adopcion de las directrices de la Organizacion Mundial de la Salud (OMS) en las politicas nacionales de prevencion de la transmision del virus de la inmunodeficiencia humana (VIH) de madre a hijo y supervisar la aplicacion de las directrices a nivel de las instalaciones sanitarias en las zonas rurales de Malawi, la Republica Unida de Tanzania y Sudafrica. Metodos Resumimos las politicas nacionales de PTMI y las directrices de la OMS para 15 indicadores en toda la serie de servicios de atencion maternoinfantil durante el periodo 2013-2016. Se realizaron dos rondas de encuestas (2013-2015 y 2015-2016) en 46 instalaciones sanitarias que atienden a cinco poblaciones del sistema de vigilancia sanitaria y demografica. Se administraron cuestionarios estructurados a los gestores de las instalaciones para describir la prestacion de servicios. Informamos las proporciones de las instalaciones que aplican cada indicador y la frecuencia y duracion de la falta de existencias de suministros, por emplazamiento y ronda de encuestas. Resultados En todos los paises, las politicas nacionales que influyen en la serie de servicios de atencion maternoinfantil de la PTMI se ajustaron a las directrices de la OMS para 2016; la mayoria de las variaciones de las politicas entre paises se referian a la vinculacion con la atencion habitual de la infeccion por el VIH. La proporcion de instalaciones que ofrecen asesoramiento posterior a la prueba, iniciacion de la terapia antirretrovirica en el mismo dia, atencion prenatal y suministro de terapia antirretrovirica en el mismo edificio, y la Opcion B+ aumentaron o se mantuvieron en el 100 % en todos los emplazamientos. El progreso en la aplicacion de las politicas de diagnostico y tratamiento del lactante vario de un emplazamiento a otro. Las existencias de kits de pruebas del VIH o de medicamentos antirretrovirales se redujeron en general en el ultimo ano, pero en ambas rondas se informo de la existencia de al menos una instalacion por emplazamiento. Conclusion Se ha progresado en la aplicacion de la politica de PTMI en estos ambitos. Sin embargo, las persistentes brechas en la serie de servicios de atencion infantil y los desafios de la cadena de suministro pueden socavar los objetivos de eliminacion del VIH infantil., [phrase omitted] Introduction In recent years, ambitious global commitments have been made to improve programmes for the prevention of motherto-child transmission (PMTCT) of human immunodeficiency virus (HIV). In 2011, the [...]

Introduction: Observational studies have shown considerable attrition among adolescents living with HIV across the 'cascade' of HIV care in sub-Saharan Africa, leading to higher mortality rates compared to HIV-infected adults or children. We synthesized evidence from qualitative studies on factors that promote or undermine engagement with HIV services among adolescents living with HIV in sub-Saharan Africa. Methods: We systematically searched five databases for studies published between 2005 and 2016 that met pre-defined inclusion criteria. We used a meta-ethnographic approach to identify first, second and third order constructs from eligible studies, and applied a socio-ecological framework to situate our results across different levels of influence, and in relation to each stage of the HIV cascade. Results and discussion: We identified 3089 citations, of which 24 articles were eligible for inclusion. Of these, 17 were from Southern Africa while 11 were from Eastern Africa. 6 explored issues related to HIV testing, 11 explored treatment adherence, and 7 covered multiple stages of the cascade. Twelve third-order constructs emerged to explain adolescents' engagement in HIV care. Stigma was the most salient factor impeding adolescents' interactions with HIV care over the past decade. Self-efficacy to adapt to life with HIV and support from family or social networks were critical enablers supporting uptake and retention in HIV care and treatment programmes. Provision of adolescent-friendly services and health systems issues, such as the availability of efficient, confidential and comfortable services, were also reported to drive sustained care engagement. Individual-level factors, including past illness experiences, identifying mechanisms to manage pill-taking in social situations, financial (in)stability and the presence/absence of future aspirations also shaped adolescents HIV care engagement. Conclusions: Adolescents' initial and ongoing use of HIV care was frequently undermined by individual-level issues; although family, community and health systems factors played important roles. Interventions should prioritise addressing psychosocial issues among adolescents to promote individual-level engagement with HIV care, and ultimately reduce mortality. Further research should explore issues relating to care linkage and ART initiation in different settings, particularly as 'test and treat' policies are scaled up. Keywords: adolescents; HIV /AIDS; sub-Saharan Africa; antiretroviral therapy; HIV care cascade; HIV care continuum; qualitative research; meta-ethnography; stigma, Introduction Globally, it has been estimated that approximately 2.1 million adolescents aged 10-19 years are living with HIV, with nearly 85% of this population residing in sub-Saharan Africa (SSA) [1]. [...]

Little is known about the nature and mechanisms of factors that facilitate or inhibit the scale-up and subsequent implementation of school-based adolescent sexual and reproductive health (ASRH) interventions. We present process evaluation findings examining the factors that affected the 10-fold scale-up of such an intervention, focussing on teachers' attitudes and experiences. Qualitative interviews and focus group discussions with teachers, head teachers, ward education coordinators and school committees from eight schools took place before, during and after intervention implementation. The results were triangulated with observations of training sessions and training questionnaires. The training was well implemented and led to some key improvements in teachers' ASRH knowledge, attitudes and perceived self-efficacy, with substantial improvements in knowledge about reproductive biology and attitudes towards confidentiality. The trained teachers were more likely to consider ASRH a priority in schools and less likely to link teaching ASRH to the early initiation of sex than non-trained teachers. Facilitating factors included teacher enjoyment, their recognition of training benefits, the participatory teaching techniques, support from local government as well as the structured nature of the intervention. Challenges included differential participation by male and female teachers, limited availability of materials and high turnover of trained teachers.