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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
- 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.
- Subjects :
- Supply chain
Human immunodeficiency virus (HIV)
HIV Infections
Funding Mechanism
medicine.disease_cause
World health
South Africa
03 medical and health sciences
0302 clinical medicine
Nursing
Political science
medicine
Humans
030212 general & internal medicine
Hiv treatment
030505 public health
biology
Corporate governance
Public Health, Environmental and Occupational Health
Viral Load
biology.organism_classification
CD4 Lymphocyte Count
Tanzania
Health Facilities
0305 other medical science
Viral load
Subjects
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