WHO, 2015. 11 p.
Church, Kathryn
Kiweewa, Francis
Dasgupta, Aisha
Mwangome, Mary
Mpandaguta, Edith
Gómez-Olivé, Francesc Xavier
Oti, Samuel
Todd, Jim
Wringe, Alison
Geubbels, Eveline
Crampin, Amelia
Nakiyingi-Miiro, Jessica
Hayashi, Chika
Njage, Muthoni
Wagner, Ryan G
Ario, Alex Riolexus
Makombe, Simon D
Mugurungi, Owen
Zaba, Basia
Periodical title: 
Bulletin of the World Health Organization, 93: 457-467
Objective: To compare national human immunodeficiency virus (HIV) policies influencing access to HIV testing and treatment services in six sub-Saharan African countries. Methods: We reviewed HIV policies as part of a multi-country study on adult mortality in sub-Saharan Africa. A policy extraction tool was developed and used to review national HIV policy documents and guidelines published in Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zimbabwe between 2003 and 2013. Key informant interviews helped to fill gaps in findings. National policies were categorized according to whether they explicitly or implicitly adhered to 54 policy indicators, identified through literature and expert reviews. We also compared the national policies with World Health Organization (WHO) guidance. Findings: There was wide variation in policies between countries; each country was progressive in some areas and not in others. Malawi was particularly advanced in promoting rapid initiation of antiretroviral therapy. However, no country had a consistently enabling policy context expected to increase access to care and prevent attrition. Countries went beyond WHO guidance in certain areas and key informants reported that practice often surpassed policy. Conclusion: Evaluating the impact of policy differences on access to care and health outcomes among people living with HIV is challenging. Certain policies will exert more influence than others and official policies are not always implemented. Future research should assess the extent of policy implementation and link these findings with HIV outcomes.
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