Monitoring HIV and AIDS Related Policy Reforms: A Road Map to Strengthen Policy Monitoring and Implementation in PEPFAR Partner Countries

Achieving an AIDS-free generation will require the adoption and implementation of critical health policy reforms. However, countries with high HIV burden often have low policy development, advocacy, and monitoring capacity. This lack of capacity may be a significant barrier to achieving the AIDS-free generation goals. 

This manuscript describes the increased focus on policy development and implementation by the United States President’s Emergency Plan for AIDS Relief (PEPFAR). It evaluates the curriculum and learning modalities used for two regional policy capacity building workshops organized around the PEPFAR Partnership Framework agreements and the Road Map for Monitoring and Implementing Policy Reforms. A total of 64 participants representing the U.S. Government, partner country governments, and civil society organizations attended the workshops. 

On average, participants responded that their policy monitoring skills improved and that they felt they were better prepared to monitor policy reforms three months after the workshop. When followed-up regarding utilization of the Road Map action plan, responses were mixed. Reasons cited for not making progress included an inability to meet or a lack of time, personnel, or governmental support. This lack of progress may point to a need for building policy monitoring systems in high HIV burden countries. Because the success of policy reforms cannot be measured by the mere adoption of written policy documents, monitoring the implementation of policy reforms and evaluating their public health impact is essential. In many high HIV burden countries, policy development and monitoring capacity remains weak. This lack of capacity could hinder efforts to achieve the ambitious AIDS-free generation treatment, care and prevention goals. The Road Map appears to be a useful tool for strengthening these critical capacities.

Below:  Policy Reforms planned in 22 PEPFAR Partnership Frameworks

Full article at:   http://goo.gl/Y9ALjG

By:  Lane J1,2,3, Verani A4, Hijazi M5, Hurley E4, Hagopian A1, Judice N6, MacInnis R6, Sanford S2, Zelek S1, Katz A1.

• 1Department of Global Health, University of Washington, Seattle, Washington, United States of America.
• 2School of Law, University of Washington, Seattle, Washington, United States of America.
• 3Foster Pepper, PLLC, Seattle, Washington, United States of America.
• 4Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
• 5United States Agency for International Development, Washington, District of Columbia, United States of America.
• 6Health Policy Project, Futures Group, Washington, District of Columbia, United States of America. 
• PLoS One. 2016 Feb 25;11(2):e0146720. doi: 10.1371/journal.pone.0146720.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Reframing HIV Care: Putting People at the Centre of Antiretroviral Delivery

The delivery of HIV care in the initial rapid scale-up of HIV care and treatment was based on existing clinic-based models, which are common in highly resourced settings and largely undifferentiated for individual needs. A new framework for treatment based on variable intensities of care tailored to the specific needs of different groups of individuals across the cascade of care is proposed here. 

Service intensity is characterised by four delivery components: (i) types of services delivered, (ii) location of service delivery, (iii) provider of health services and (iv) frequency of health services. How these components are developed into a service delivery framework will vary across countries and populations, with the intention being to improve acceptability and care outcomes. 

The goal of getting more people on treatment before they become ill will necessitate innovative models of delivering both testing and care. As HIV programs expand treatment eligibility, many people entering care will not be ‘patients’ but healthy, active and productive members of society ¹. 

To take the framework to scale, it will be important to: (i) define which individuals can be served by an alternative delivery framework; (ii) strengthen health systems that support decentralisation, integration and task shifting; (iii) make the supply chain more robust; and (iv) invest in data systems for patient tracking and for programme monitoring and evaluation.

Problem statements
1. The scale-up of ART in low- and middle-income countries has led to overburdened health systems
•HIV clinics are overcrowded and waiting times are long
•Many countries lack sufficient clinical personnel to treat the increasing numbers of patients eligible for ART
•Health systems are geared to acute disease response rather than to providing chronic care
2. The needs of people who are stable on and adherent to ART are different to those of people who are unwell or non-adherent
•Current models of care are not patient-centered
•People with widely divergent needs have only one access point to the clinic to receive care
•Stable people do not need regular contact with the healthcare facility
3. Alternative care models implemented in resource-limited settings have not been taken to scale
•There are limited robust measures of impact and outcomes of alternative delivery frameworks

Below:  Four levers to tailor or adapt care to people’s needs (service frequency, location, intensity and cadre)

Below:  Categories of care models

Full article at:   http://goo.gl/5LxyOE

By:   Chris Duncombe,1 Scott Rosenblum,1 Nicholas Hellmann,2 Charles Holmes,3 Lynne Wilkinson,4 Marc Biot,4 Helen Bygrave,4 David Hoos,5 and Geoff Garnett1

¹The Bill and Melinda Gates Foundation, Seattle, WA, USA

²Elizabeth Glaser Pediatric AIDS Foundation, Washington D.C, USA

³Centre for Infectious Disease Research in Zambia, Lusaka, Zambia

⁴Medecins Sans Frontieres Operational Centre, Brussels, Belgium

⁵Mailman School of Public Health, Columbia University, New York, NY, USA

Corresponding Author Chris James Duncombe, Bill and Melinda Gates Foundation, 440 5th Ave North, Seattle, Washington, 98109. E-mail:gro.noitadnuofsetag@ebmocnuD.sirhC

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Persistent HIV-Related Stigma in Rural Uganda During a Period of Increasing HIV Incidence Despite Treatment Expansion

OBJECTIVE:

Programme implementers have argued that the increasing availability of antiretroviral therapy (ART) will reduce the stigma of HIV. We analyzed data from Uganda to assess how HIV-related stigma has changed during a period of ART expansion.

METHODS:

We analyzed data from the Uganda AIDS Rural Treatment Outcomes study during 2007-2012 to estimate trends in internalized stigma among people living with HIV (PLHIV) at the time of treatment initiation. We analyzed data from the Uganda Demographic and Health Surveys from 2006 to 2011 to estimate trends in stigmatizing attitudes and anticipated stigma in the general population. We fitted regression models adjusted for sociodemographic characteristics, with year of data collection as the primary explanatory variable.

RESULTS:

We estimated an upward trend in internalized stigma among PLHIV presenting for treatment initiation [adjusted b = 0.18; 95% confidence interval (CI), 0.06-0.30]. In the general population, the odds of reporting anticipated stigma were greater in 2011 compared with 2006 [adjusted odds ratio (OR) = 1.80; 95% CI, 1.51-2.13], despite an apparent decline in stigmatizing attitudes (adjusted OR = 0.62; 95% CI, 0.52-0.74).

CONCLUSION:

Internalized stigma has increased over time among PLHIV in the setting of worsening anticipated stigma in the general population. Further study is needed to better understand the reasons for increasing HIV-related stigma in Uganda and its impact on HIV prevention efforts.

Purchase full article at:  http://goo.gl/T4wyeQ

By:  Chan BT1, Weiser SD, Boum Y, Siedner MJ, Mocello AR, Haberer JE, Hunt PW, Martin JN, Mayer KH, Bangsberg DR, Tsai AC.

• 1aDivision of Infectious Diseases, Massachusetts General Hospital bDivision of Infectious Diseases, Brigham and Women's Hospital cHarvard Medical School, Boston, Massachusetts dDivision of HIV/AIDS, San Francisco General Hospital, University of California at San Francisco (UCSF) eCenter for AIDS Prevention Studies, UCSF, San Francisco, California, USA fEpicentre, Mbarara, Uganda gMassachusetts General Hospital Center for Global Health, Boston, Massachusetts hDepartment of Epidemiology and Biostatistics, UCSF, San Francisco, California iDivision of Infectious Diseases, Beth Israel Deaconess Medical Center jFenway Health, Boston, Massachusetts, USA kMbarara University of Science and Technology, Mbarara, Uganda lChester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA. 

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health