TY - JOUR TI - From policy to practice: exploring the implementation of antiretroviral therapy access and retention policies between 2013 and 2016 in six sub-Saharan African countries AU - Ambia, J. AU - Renju, J. AU - Wringe, A. AU - Todd, J. AU - Geubbels, E. AU - Nakiyingi-Miiro, J. AU - Urassa, M. AU - Lutalo, T. AU - Crampin, A. C. AU - Kwaro, D. AU - Kyobutungi, C. AU - Chimbindi, N. AU - Gomez-Olive, F. X. AU - Tlhajoane, M. AU - Njamwea, B. AU - Zaba, B. AU - Mee, P. T2 - BMC Health Serv Res AB - BACKGROUND: Understanding the implementation of 2013 World Health Organization (WHO) consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection at the facility level provides important lessons for the roll-out of future HIV policies. METHODS: A national policy review was conducted in six sub-Saharan African countries to map the inclusion of the 2013 WHO HIV treatment recommendations. Twenty indicators of policy adoption were selected to measure ART access (n = 12) and retention (n = 8). Two sequential cross-sectional surveys were conducted in facilities between 2013/2015 (round 1) and 2015/2016 (round 2) from ten health and demographic surveillance sites in Kenya, Malawi, South Africa, Tanzania, Uganda and Zimbabwe. Using standardised questionnaires, facility managers were interviewed. Descriptive analyses were used to assess the change in the proportion of facilities that implemented these policy indicators between rounds. RESULTS: Although, expansion of ART access was explicitly stated in all countries' policies, most lacked policies that enhanced retention. Overall, 145 facilities were included in both rounds. The proportion of facilities that initiated ART at CD4 counts of 500 or less cells/muL increased between round 1 and 2 from 12 to 68%, and facilities initiating patients on 2013 WHO recommended ART regimen increased from 42 to 87%. There were no changes in the proportion of facilities reporting stock-outs of first-line ART in the past year (18 to 11%) nor in the provision of three-month supply of ART (43 to 38%). None of the facilities provided community-based ART delivery. CONCLUSION: The increase in ART initiation CD4 threshold in most countries, and substantial improvements made in the provision of WHO recommended first-line ART regimens demonstrates that rapid adoption of WHO recommendations is possible. However, improved logistics and resources and/or changes in policy are required to further minimise ART stock-outs and allow lay cadres to dispense ART in the community. Increased efforts are needed to offer longer durations between clinic visits, a strategy purported to improve retention. These changes will be important as countries move to implement the revised 2015 WHO guidelines to initiate all HIV positive people onto ART regardless of their immune status. DA - 2017/11/21/ PY - 2017 DO - 10.1186/s12913-017-2678-1 VL - 17 IS - 1 SP - 758 SN - 1472-6963 (Electronic) 1472-6963 (Linking) UR - https://www.ncbi.nlm.nih.gov/pubmed/29162065 AN - 29162065 KW - *Health Policy KW - Access KW - Adult KW - Africa KW - Africa South of the Sahara KW - Aids KW - Ambulatory Care KW - Anti-Retroviral Agents/supply & distribution/*therapeutic use KW - Art KW - CD4 Lymphocyte Count KW - Cross-Sectional Studies KW - Female KW - Guideline Adherence/statistics & numerical data KW - HIV Infections/*drug therapy KW - Health Facilities KW - Health facility survey KW - Hiv KW - Humans KW - Male KW - Policy review KW - Practice Guidelines as Topic KW - Retention KW - Surveys and Questionnaires KW - WHO guidelines ER -