Background
Methods
Policy review
Health facility survey
Policies | Themes in the conceptual framework | Indicators |
---|---|---|
ART access | Service access and coverage | Proportion of facilities providing ART at no cost |
Proportion of facilities allowing clinical officers and nurses or midwives to initiate ART | ||
Quality of care | Proportion of facilities providing ART training and refresher courses regularly to health care workers | |
Proportion of facilities conducting supervisory visits regularly | ||
Median number of nurses providing HIV care | ||
Proportion of facilities with reliable stock levels of ART in the past year | ||
Proportion of facilities with reliable stock levels of isoniazid preventive therapy (IPT) in the past year | ||
Medical management | Proportion of facilities requiring no laboratory tests before ART initiation | |
Proportion of facilities using WHO ART eligibility threshold as the standard for initiating ART | ||
Proportion of facilities providing IPT to ART patients | ||
Proportion of facilities conducting tuberculosis (TB) screening at every visit | ||
Proportion of facilities providing WHO recommended first-line ART regimen | ||
Retention in care | Coordination of care and patient tracking | Proportion of facilities integrating TB and HIV services |
Proportion of facilities providing three month ART refills | ||
Proportion of facilities conducting pill count in every visit | ||
Support to people living with HIV | Proportion of facilities conducting home visits or making calls or sending text messages to patients with suboptimal adherence | |
Proportion of facilities conducting home visit or making calls or sending text messages to patients who have missed their visits | ||
Proportion of facilities encouraging ART patients to join a peer support group | ||
Proportion of facilities encouraging ART patients to enrol for home based care | ||
Proportion of facilities providing dietary supplements to undernourished patients |
Data management and analysis
Results
National-level policy adoption
Policy implementation
Health facility characteristics
Kenya | Malawi | South Africa | Tanzania | Uganda | Zimbabwe | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | |
Number of facilities |
N = 42 | N = 42 |
N = 6 | N = 6 |
N = 23 | N = 23 |
N = 19 | N = 19 | N = 19 | N = 19 |
N = 36 | N = 36 |
Type of facility | ||||||||||||
Hospital/large health centres (n(%)) | 8 (19.0) | 7 (16.7) | 3 (50.0) | 5 (83.3) | 0 (0.0) | 0 (0.0) | 11 (57.9) | 10 (52.6) | 3 (15.8) | 3 (15.8) | 11 (30.6) | 1 (2.9) |
Sub-district hospitals/ health centres/dispensaries (n(%)) | 34 (81.0) | 35 (83.3) | 3 (50.0) | 1 (16.7) | 23 (100.0) | 23 (100.0) | 8 (42.1) | 9 (47.4) | 16 (84.2) | 16 (84.2) | 25 (69.4) | 34 (97.1) |
Managing authority | ||||||||||||
Government (n(%)) | 34 (81.1) | 34 (81.1) | 3 (50.0) | 3 (50.0) | 0 (0.0) | 0 (0.0) | 16 (84.2) | 17 (89.5) | 14 (73.7) | 14 (73.7) | 27 (75.0) | 26 (72.2) |
Faith-based, NGO, private (n(%)) | 8 (19.0) | 8 (19.0) | 3 (50.0) | 3 (50.0) | 23 (100.0) | 23 (100.0) | 3 (15.8) | 2 (10.5) | 5 (26.3) | 5 (26.3) | 9 (25.0) | 10 (27.8) |
Median number of nurses/midwives providing HIV services [IQR] | 2.8 (2.0–4.0) | 3 (2.0–5.0) | 1.5 (1.0–4.0) | 2 (2.0–3.0) | 5 (3.0–6.0) | 6 (4.0–7.0) | 1 (1.0–6.0) | 3.5 (1.0–5.5) | 3.5 (1.0–6.0) | 2 (2.0–5.0) | 1 (1.0–3.0) | 1 (0.0–3.0) |
Median number of clinicians (doctors and clinical officers) [IQR] | 1 (1.0–2.0) | 1 (1.0–2.0) | 0.5 (0.0–2.0) | 1.5 (1.0–3.0) | 0 (0.0–0.5) | 0 (0.0–0.5) | 2 (0.5–2.0) | 1 (1.0–5.0) | 2 (1.0–3.0) | 2 (1.0–3.0) | 0 (0.0–0.0) | 0 (0.0–0.0) |
Median number of weekly ART clients/HIV staff (nurse and clinicians) [IQR] | 11 (5–17) | 11 (4–18) | 1 (0–1) | 0 (0–2) | 2 (1–12) | 21 (11–44) | 6 (4–10) | 9 (4–19) | 11 (6–16) | 9 (1–15) | 4 (2–15) | 6 (2–12) |
Median number of ART clients per week (including those starting or coming for a follow-up visit) [IQR] | 40 (23–75) | 52 (25–92) | 3 (2–3) | 3 (1–17) | 10 (7–43) | 151 (70–245) | 34 (14–42) | 63 (31–216) | 49 (24–64) | 26 (5–73) | 11 (2–30) | 11 (7–26) |
Service access and coverage
Quality of care
Kenya | Malawi | South Africa | Tanzania | Uganda | Zimbabwe | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | |
Number of facilities |
N = 38 |
N = 40 |
N = 5 | N = 5 | N = 23 | N = 23 |
N = 15 | N = 15 | N = 19 |
N = 18 | N = 15 |
N = 35 |
Availability of ART guidelines in the facility (n(%)) | 33 (86.8) | 40 (100.0) | 3 (60.0) | 4 (80.0) | 23 (100.0) | 23 (100.0) | 15 (100.0) | 15 (100.0) | 16 (84.2) | 18 (100.0) | 6 (40.0) | 28 (80.0) |
Supervisory visits conducted at least once a year (n(%)) | 36 (94.7) | 39 (97.5) | 4 (80.0) | 5 (100.0) | 21 (91.3) | 23 (100.0) | 14 (93.3) | 14 (93.3) | 18 (94.7) | 18 (100.0) | 15 (100.0) | 33 (94.3) |
First-line ART is in stock (n(%)) | 31 (81.6) | 37 (92.5) | 4 (80.0) | 5 (100.0) | 20 (87.0) | 20 (87.0) | 10 (66.7) | 10 (66.7) | 16 (84.2) | 15 (83.3) | 14 (93.3) | 35 (100.0) |
ART regimens containing TDF with EFV is in stock (n(%)) | 4 (10.5) | 29 (72.5) | 5 (100.0) | 5 (100.0) | 21 (91.3) | 23 (100.0) | 2 (13.3) | 11 (73.3) | 12 (63.2) | 17 (94.4) | 4 (26.7) | 33 (94.3) |
IPT is in stock (n(%)) | 22 (57.9) | 37 (92.5) | 5 (100.0) | 4 (80.0) | 20 (87.0) | 23 (100.0) | 2 (13.3) | 2 (13.3) | 0 (0.0) | 2 (11.1) | 8 (53.3) | 15 (42.9) |
CTX is in stock (n(%)) | 38 (100.0) | 40 (100.0) | 5 (100.0) | 5 (100.0) | 21 (91.3) | 22 (95.7) | 9 (60.0) | 6 (40.0) | 19 (100.0) | 19 (100.0) | 33 (91.7) | 34 (97.1) |
Medical management
First-line ART regimens
Retention in care
Coordination of care and patient tracking
Support to people living with HIV
Indicators | Kenya | Malawi | South Africa | Tanzania | Uganda | Zimbabwe | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | |
Number of facilities | N = 38 | N = 40 | N = 5 | N = 5 | N = 23 | N = 23 | N = 15 | N = 15 | N = 19 | N = 18 | N = 15 | N = 35 |
Facilities that conducted pill count in every visit (n (%)) | 30 (78.9) | 35 (87.5) | 5 (100.0) | 5 (100.0) | 12 (52.2) | 7 (30.4) | 10 (66.7) | 7 (46.7) | 15 (78.9) | 12 (66.7) | 13 (92.9) | 35 (100) |
Facilities with missing data (n) | 1 | |||||||||||
Facilities that conducted home visits or made calls or sent text messages to patients with suboptimal adherence (n (%)) | 12 (31.6) | 19 (47.5) | 0 (0.0) | 1 (20.0) | 1 (4.3) | 10 (43.5) | 0 (0.0) | 2 (13.3) | 9 (47.4) | 8 (44.4) | 4 (26.7) | 12 (34.3) |
Facilities that conducted home visits or made calls or sent text messages to patients who had missed their visits (n (%)) | 36 (94.7) | 40 (100.0) | 4 (80.0) | 5 (100.0) | 23 (100.0) | 23 (100.0) | 9 (60.0) | 10 (66.7) | 18 (94.7) | 18 (100.0) | 12 (80.0) | 35 (100.0) |
Facilities that encouraged ART patients to join a peer support group (n (%)) | 38 (100.0) | 36 (90.0) | 5 (100.0) | 5 (100.0) | 13 (92.9) | 20 (87.0) | 13 (86.7) | 10 (66.7) | 15 (83.3) | 18 (100.0) | 13 (86.7) | 30 (85.7) |
Facilities with missing data (n) | 9 | 1 | ||||||||||
Facilities that provided nutritional supplements to those undernourished (n (%)) | 38 (100.0) | 38 (95.00 | 5 (100.0) | 5 (100.0) | 23 (100.0) | 23 (100.0) | 3 (21.0) | 3 (20.0) | 9 (47.4) | 9 (50.0) | 12 (80.0) | 27 (77.1) |
Facilities with missing data (n) | 1 | |||||||||||
Facilities that encouraged ART patients to enrol for home based care (n (%)) | 35 (94.6) | 29 (72.5) | 5 (100.0) | 5 (100.0) | 22 (100.0) | 21 (91.3) | 13 (100.0) | 13 (100.0) | 16 (84.2) | 17 (94.4) | 15 (100.0) | 32 (91.4) |
Facilities with missing data (n) | 1 | 1 |