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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 :
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
Source :
Global Public Health. 16:288-304
Publication Year :
2020
Publisher :
Informa UK Limited, 2020.

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.

Details

ISSN :
17441706 and 17441692
Volume :
16
Database :
OpenAIRE
Journal :
Global Public Health
Accession number :
edsair.doi.dedup.....682e7d079709edbdb7d05dfb77037c62
Full Text :
https://doi.org/10.1080/17441692.2020.1805785