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Influence of evolving HIV treatment guidance on CD4 counts and viral load monitoring: A mixed-methods study in three African countries.

Authors :
Renju, Jenny
Rice, Brian
Songo, John
Hassan, Farida
Chimukuche, Rujeko Samanthia
McLean, Estelle
Kalua, Thokozani
Kajoka, Deborah
Geubbels, Eveline
Moshabela, Mosa
Seeley, Janet
Wringe, Alison
Source :
Global Public Health; Feb2021, Vol. 16 Issue 2, p288-304, 17p
Publication Year :
2021

Abstract

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. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
17441692
Volume :
16
Issue :
2
Database :
Complementary Index
Journal :
Global Public Health
Publication Type :
Academic Journal
Accession number :
148343772
Full Text :
https://doi.org/10.1080/17441692.2020.1805785