A comparative study of policy and practice factors influencing progression through the HIV care con - PowerPoint Presentation

A comparative study of policy and practice factors influencing progression through the HIV care con
A comparative study of policy and practice factors influencing progression through the HIV care con

A comparative study of policy and practice factors influencing progression through the HIV care con - Description


Kenya Fredrick Odhiambo Otieno Coauthors C Cawley E McRobie D Kwaro M Njage J Todd K Church P Mee B Zaba S Oti B Njamwea A Nyaguara A Wringe ID: 803414 Download

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explicit hiv policies 100 hiv explicit 100 policies kisumu hdss implementation art health policy clients care testing pmtct wide

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Slide1

A comparative study of policy and practice factors influencing progression through the HIV care continuum in Kisumu and Nairobi in KenyaFredrick Odhiambo Otieno Co-authors: C Cawley, E McRobie, D Kwaro, M Njage, J Todd, K Church, P Mee, B Zaba, S Oti, B Njamwea, A Nyaguara, A WringeBarriers must fall16:30 – 18:00, 21 July 2016AIDS Conference, Durban

Slide2

BackgroundDiverse policies on HIV testing, PMTCT and ART across Africa [1]Little evidence of whether policies are implemented in health facilitiesIdentifying policy implementation gaps essential for improving programmes and meeting 90:90:90 targetsThe ALPHA Network is a collaboration of 10 African Health and Demographic Surveillance sites (HDSS) ALPHA is investigating how HIV mortality may be influenced by HIV policies and their implementation. [1] Church et al. Bull WHO 2015

Slide3

Aim: To describe national HIV care and treatment policies, and assess their implementation in health facilities serving the HDSS populations in Kisumu and NairobiAim and SettingFigure: Location of 2 HDSS sites, Kisumu and Nairobi,

Kisumu

:

~ 132,000 residents in HDSS

95%

Luo

tribe

Subsistence farming and fishing

HIV prevalence ~ 15.1% (2012)

Nairobi:

~ 120,000 residents in HDSS

Two informal settlements (slums)

HIV prevalence ~ 4,9% (2012)

Slide4

Conceptual framework

Slide5

MethodsReviewed 20 national HIV policy documents covering HCT, PMTCT and ART published Jan 2003 - June 2013Applied a policy extraction tool with pre-defined policy indicators to each document to capture key policy content and record whether policies were explicit, implicit or absent.Administered questionnaires on HCT, PMTCT and ART to in-charge staff at HIV clinics serving the HDSS populations in 2013.Measured the proportion of facilities implementing each policyMortality rates among PLHIV in Kisumu were classified by last HIV clinic attended, by linking HIV clinic records with HDSS data

Slide6

HDSS SITEResults: Facilities surveyedSMALLER FACILITIESLARGE FACILITIES

8

0%

4

0%

20%

0%

60%

Kisumu

(n=34)

Nairobi

(n=10)

Small clinic

Large clinic

District referral hospital

Small hospital

Percentage of facilities

100%

Slide7

Health facility characteristics NairobiKisumuTotal number of clinics (n(%))10 (100)

34 (

100)

HIV testing

100

100

PMTCT

100

100

HIV

care

and treatment

80

94

HR indicators (median

(range)

)

Clinicians*

2.5

(0-8)

1

(0

-

34.5

)

Nurses/midwives

6.5

(0

-18)

2

(

0

-62)

HIV

testing clients/week

78

(

11-1237)

39

(

0-206)

Weekly HTC

clients/staff

+

1.3

(0.8-42)

3.7

(0-41.2

)

No

. ART clients/week

50

(

35-141)

37

(

0-154)

*Doctor, clinical officer, assistant medical officer

Slide8

Health facility characteristics NairobiKisumuTotal number of clinics (n(%))10 (100)

34 (

100)

HIV testing

100

100

PMTCT

100

100

HIV

care

and treatment

80

94

HR indicators (median

(range)

)

Clinicians*

2.5

(0-8)

1

(0

-

34.5

)

Nurses/midwives

6.5

(0

-18)

2

(

0

-62)

HIV

testing clients/week

78

(

11-1237)

39

(

0-206)

Weekly HTC

clients/staff+1.3 (0.8-42)3.7 (0-41.2)No. ART clients/week 50 (35-141)37 (0-154)No. weekly ART clients/ health worker 4.8 (3.3-8.8)11.7 (0-38.5)*Doctor, clinical officer, assistant medical officer

Slide9

Implementation of HCT policiesExplicit, wide (>70%) Not explicit, wide (>70%)Explicit, partial (30-70%)Not explicit, partial (30-70%)Explicit, poor (<30%)

Not explicit, poor (<30%)

Slide10

Implementation of policies influencing ART access Explicit, wide (>70%) Not explicit, wide (>70%)Explicit, partial (30-70%)Not explicit, partial (30-70%)Explicit, poor (<30%)

Not explicit, poor (<30%)

Slide11

Implementation: RetentionExplicit, wide (>70%) Not explicit, wide (>70%)Explicit, partial (30-70%)Not explicit, partial (30-70%)Explicit, poor (<30%)

Not explicit, poor (<30%)

Slide12

Mortality rate by facility type (Kisumu)Hospitals

Slide13

Overall, widespread implementation of most explicit HIV care and treatment policies in Nairobi and Kisumu HDSSImplementation notably stronger for policies relating to ART access and retention in care. Gaps: A few explicit policies relating to PMTCT and implementation of HIV testing policies were weak. In order to achieve 90-90-90 targets efforts to improve entry into care will be crucial.Limitation: ALPHA studies not nationally representative (but most health services in the study sites provided through national programmes)Policy review currently being updated to capture recent shifts (i.e. Option B+, test and treat etc.) and a second round of health facility surveys are underway.Discussion

Slide14

AcknowledgementsThis study was made possible with support from: The Wellcome Trust (085477/Z/08/Z)The Bill and Melinda Gates Foundation (OPP1082114).Study participants and field workers for their time and contribution to the studyColleagues at KEMRI-CGHR in Kisumu, APHRC in Nairobi and the ALPHA Network at the London School of Hygiene and Tropical Medicine

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