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Exploring the evolution of policies for universal antiretroviral therapy and their implementation across three sub-Saharan African countries: Findings from the SHAPE study

Universal antiretroviral therapy (ART) strategies have dramatically changed HIV programming across sub-Saharan Africa. We explored factors that influenced the development, adoption and implementation of universal ART policies in Tanzania, South Africa and Malawi. We conducted 26 key informant interv...

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Autores principales: Kumwenda, Moses, Skovdal, Morten, Wringe, Alison, Kalua, Thoko, Kweka, Hadija, Songo, John, Hassan, Farida, Chimukuche, Rujeko Samanthia, Moshabela, Mosa, Seeley, Janet, Renju, Jenny
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7612916/
https://www.ncbi.nlm.nih.gov/pubmed/33275872
http://dx.doi.org/10.1080/17441692.2020.1851386
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author Kumwenda, Moses
Skovdal, Morten
Wringe, Alison
Kalua, Thoko
Kweka, Hadija
Songo, John
Hassan, Farida
Chimukuche, Rujeko Samanthia
Moshabela, Mosa
Seeley, Janet
Renju, Jenny
author_facet Kumwenda, Moses
Skovdal, Morten
Wringe, Alison
Kalua, Thoko
Kweka, Hadija
Songo, John
Hassan, Farida
Chimukuche, Rujeko Samanthia
Moshabela, Mosa
Seeley, Janet
Renju, Jenny
author_sort Kumwenda, Moses
collection PubMed
description Universal antiretroviral therapy (ART) strategies have dramatically changed HIV programming across sub-Saharan Africa. We explored factors that influenced the development, adoption and implementation of universal ART policies in Tanzania, South Africa and Malawi. We conducted 26 key informant interviews and applied Kingdon’s ‘streams’ model to explore how problems, policies and politics converged to provide a window of opportunity for universal ART roll-out. Weak health systems and sub-optimal care retention were raised as problems during Option B+ implementation, which preceded universal ART, and persisted after its implementation. The adoption and implementation of Option B+ policy facilitated the uptake of universal ART. Politics played out through pressures from different stakeholders to accelerate or slow down implementation, from governments, civil society groups, researchers and donors. Policy processes leading to universal ART were open to pressures and influence. The extraordinary financial support which enabled the widespread and rapid implementation of universal ART skewed the power balance and sometimes left little space for locally-derived solutions to respond to specific health system abilities and epidemiological contexts. Donors may be more effective if they ensure a greater focus on strengthening the whole health system as well as accounting for local contextual factors and recent policy development histories when funding policy implementation.
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spelling pubmed-76129162022-06-28 Exploring the evolution of policies for universal antiretroviral therapy and their implementation across three sub-Saharan African countries: Findings from the SHAPE study Kumwenda, Moses Skovdal, Morten Wringe, Alison Kalua, Thoko Kweka, Hadija Songo, John Hassan, Farida Chimukuche, Rujeko Samanthia Moshabela, Mosa Seeley, Janet Renju, Jenny Glob Public Health Article Universal antiretroviral therapy (ART) strategies have dramatically changed HIV programming across sub-Saharan Africa. We explored factors that influenced the development, adoption and implementation of universal ART policies in Tanzania, South Africa and Malawi. We conducted 26 key informant interviews and applied Kingdon’s ‘streams’ model to explore how problems, policies and politics converged to provide a window of opportunity for universal ART roll-out. Weak health systems and sub-optimal care retention were raised as problems during Option B+ implementation, which preceded universal ART, and persisted after its implementation. The adoption and implementation of Option B+ policy facilitated the uptake of universal ART. Politics played out through pressures from different stakeholders to accelerate or slow down implementation, from governments, civil society groups, researchers and donors. Policy processes leading to universal ART were open to pressures and influence. The extraordinary financial support which enabled the widespread and rapid implementation of universal ART skewed the power balance and sometimes left little space for locally-derived solutions to respond to specific health system abilities and epidemiological contexts. Donors may be more effective if they ensure a greater focus on strengthening the whole health system as well as accounting for local contextual factors and recent policy development histories when funding policy implementation. 2021-02-01 2020-12-04 /pmc/articles/PMC7612916/ /pubmed/33275872 http://dx.doi.org/10.1080/17441692.2020.1851386 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
spellingShingle Article
Kumwenda, Moses
Skovdal, Morten
Wringe, Alison
Kalua, Thoko
Kweka, Hadija
Songo, John
Hassan, Farida
Chimukuche, Rujeko Samanthia
Moshabela, Mosa
Seeley, Janet
Renju, Jenny
Exploring the evolution of policies for universal antiretroviral therapy and their implementation across three sub-Saharan African countries: Findings from the SHAPE study
title Exploring the evolution of policies for universal antiretroviral therapy and their implementation across three sub-Saharan African countries: Findings from the SHAPE study
title_full Exploring the evolution of policies for universal antiretroviral therapy and their implementation across three sub-Saharan African countries: Findings from the SHAPE study
title_fullStr Exploring the evolution of policies for universal antiretroviral therapy and their implementation across three sub-Saharan African countries: Findings from the SHAPE study
title_full_unstemmed Exploring the evolution of policies for universal antiretroviral therapy and their implementation across three sub-Saharan African countries: Findings from the SHAPE study
title_short Exploring the evolution of policies for universal antiretroviral therapy and their implementation across three sub-Saharan African countries: Findings from the SHAPE study
title_sort exploring the evolution of policies for universal antiretroviral therapy and their implementation across three sub-saharan african countries: findings from the shape study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7612916/
https://www.ncbi.nlm.nih.gov/pubmed/33275872
http://dx.doi.org/10.1080/17441692.2020.1851386
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