Assessing the implementation of facility-based HIV testing policies in Malawi, South Africa and Tanzania from 2013–2018: Findings from SHAPE-UTT study

Lameck B Luwanda,Seema Vyas,John Songo,Rujeko Samanthia Chimukuche,Estelle Mclean,Farida Hassan,Erik Schouten,Jim Todd,Eveline Geubbels,Alison Wringe,Jenny Renju

doi:10.1080/17441692.2020.1763420

Abstract

ABSTRACT National HIV testing policies aim to increase the proportion of people living with HIV who know their status. National HIV testing policies were reviewed for each country from 2013 to 2018, and compared with WHO guidance. Three rounds of health facility surveys were conducted to assess facility level policy implementation in Karonga (Malawi), uMkhanyakude (South Africa), and Ifakara (Tanzania). A policy ‘implementation’ score was developed and applied to each facility by site for each round. Most HIV testing policies were explicit and aligned with WHO recommendations. Policies about service coverage, access, and quality of care were implemented in >80% of facilities per site and per round. However, linkage to care and the provision of outreach HIV testing for key populations were poorly implemented. The proportion of facilities reporting HIV test kit stock-outs in the past year reduced over the study period in all sites, but still occurred in ≥17% of facilities per site by 2017. The implementation score improved over time in Karonga and Ifakara and declined slightly in uMkhanyakude. Efforts are needed to address HIV test kit stock-outs and to improve linkage to care among people testing positive in order to reach the 90-90-90 targets.

Highlights

Over the past two decades national governments in sub-Saharan Africa (SSA) have rapidly scaled up of HIV testing and treatment services in a bid to reduce HIV-related mortality and bring the epidemic under control (Murray et al, 2014; Reiniers et al, 2017; Slaymaker et al, 2014; UNAIDS, 2017a)
Efforts have accelerated since 2016, partly driven by the 2015 UNAIDS ‘90-90-90’ targets, where the first ‘90’ aim for 90% of people living with HIV (PLHIV) knowing their status by 2020 (UNAIDS, 2014)
There have been few studies that have investigated the extent to which health facilities in rural African settings have been able to keep pace with changing HIV testing policies. This study addresses this gap by assessing the implementation of HIV testing and counselling policies in rural health facilities in Malawi, South Africa and Tanzania over the period 2013–2018

Summary

Introduction

Over the past two decades national governments in sub-Saharan Africa (SSA) have rapidly scaled up of HIV testing and treatment services in a bid to reduce HIV-related mortality and bring the epidemic under control (Murray et al, 2014; Reiniers et al, 2017; Slaymaker et al, 2014; UNAIDS, 2017a). Efforts have accelerated since 2016, partly driven by the 2015 UNAIDS ‘90-90-90’ targets, where the first ‘90’ aim for 90% of people living with HIV (PLHIV) knowing their status by 2020 (UNAIDS, 2014). By 2017, estimates showed that more than two-thirds of the 36.9 million PLHIV in the region were aware of their HIV status (UNAIDS, 2018), recent surveys suggest that there is substantial variation across countries (Ministry of Health of Lesotho, 2017; Ministry of Health of Malawi, 2017; Ministry of Health of Swaziland, 2017; Ministry of Health of Zambia, 2016; MoHCC, 2016; MoHCGEC, 2017b).

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