Acceptability and implementation experiences of the “test and treat” antiretroviral therapy policy guideline among patients and healthcare workers in Lusaka district of Zambia.
Loading...
Date
2019
Authors
Mulinda, Mweemba B
Journal Title
Journal ISSN
Volume Title
Publisher
The University of Zambia
Abstract
The World Health Organization stated that there is now sufficient proof that earlier use of antiretroviral therapy results in better clinical outcomes for people living with human immunodeficiency virus compared with delayed treatment and thus recommended immediate antiretroviral therapy initiation irrespective of the stage of the disease or Cluster of Differentiation 4+ count for adults, adolescents and children. The new antiretroviral therapy policy is dubbed “Test and Treat” whose implementation started in October 2016 in Lusaka District of Zambia by the Ministry of health and cooperating partners. Test and Treat has since been rolled out to other districts. This is all to further accelerate efforts to meet the ambitious
Fast-Track target for 2020, including achieving major reductions in the number of people dying from HIV-related causes. The main purpose of the study was to explore acceptability and implementation experiences of “Test and Treat” as a new antiretroviral therapy policy guideline among healthcare workers and patients in Lusaka District. The study further sought to investigate the health system’s capacity to support the policy in Lusaka District. This was a qualitative study that used exploratory case study. The research was undertaken in five Anti-retroviral therapy healthcare centres in Lusaka District, between July 2017 and May 2018. Five focus group discussions were conducted with individuals who were human immuno-deficiency virus positive and were on anti-retroviral therapy. Five In-depth interviews were held with at least two Psychosocial Counselors at each centre and twenty five key informant interviews with healthcare professionals involved in implementing the program. All interviews
were audio-recorded and were conducted within the healthcare facility. From the information recorded in each discussion, major themes and sub-themes were identified which were linked to direct quotes from the respondents. Interviews were transcribed and accuracy was checked. Software called Nvivo 10 was used to analyze data and for easy information management. The findings of the study revealed that, there was high acceptability of “Test and Treat” among the patients and healthcare workers. They observed that the implementation of this policy has resulted in; improved health outcomes, no advancement to acquired immune-deficiency syndrome stage, higher productivity at work places and reduced hospital visits among the patients who were receiving treatment. The study however observed that; difficult disclosure; cultural implications; ethical implications; lack of initial physiological baseline parameters such as CD4 Count and Liver function test results and stigmatization and discrimination were major hindrances to acceptability and smooth implementation of the policy. “Test and Treat” was viewed to have relative advantage over other previous HIV/AIDS intervention strategies as it has been observed to be largely compatible with other health systems operations available in most healthcare facilities. It has been tried elsewhere with positive results according to literature reviewed as such there is no much complexities reported.
Observed outcomes of clinical trials done so far reveal programme simplicity leading to high acceptability and smooth implementation.
Description
Thesis of Master of Public Health in Health Policy and Management