Maximizing Antiretroviral Therapy in Developing Countries

Murray, Christopher J L

doi:10.1001/jama.2014.16376

Cited by 11 publications

(9 citation statements)

References 2 publications

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“…If health facility factors are not properly taken into consideration, then implementation of decentralized HIV viral load testing will be jeopardized (105,106). Introducing new diagnostic devices into clinics with heavy workloads may cause disruptions in the clinical workflow (107), which can result in a loss of efficiency and a decline in service quality (108,109). Alternatively, the experience of staff in primary health facilities with routine use of rapid diagnostic tests (RDTs) for HIV diagnosis may facilitate the expansion of POC HIV viral load testing (110).…”

Section: Generating the Evidence For Implementation Of Decentralized mentioning

confidence: 99%

Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response

et al. 2019

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SUMMARY The global public health community has set ambitious treatment targets to end the HIV/AIDS pandemic. With the notable absence of a cure, the goal of HIV treatment is to achieve sustained suppression of an HIV viral load, which allows for immunological recovery and reduces the risk of onward HIV transmission. Monitoring HIV viral load in people living with HIV is therefore central to maintaining effective individual antiretroviral therapy as well as monitoring progress toward achieving population targets for viral suppression. The capacity for laboratory-based HIV viral load testing has increased rapidly in low- and middle-income countries, but implementation of universal viral load monitoring is still hindered by several barriers and delays. New devices for point-of-care HIV viral load testing may be used near patients to improve HIV management by reducing the turnaround time for clinical test results. The implementation of near-patient testing using these new and emerging technologies may be an essential tool for ensuring a sustainable response that will ultimately enable an end to the HIV/AIDS pandemic. In this report, we review the current and emerging technology, the evidence for decentralized viral load monitoring by non-laboratory health care workers, and the additional considerations for expanding point-of-care HIV viral load testing.

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Section: Generating the Evidence For Implementation Of Decentralized mentioning

confidence: 99%

Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response

et al. 2019

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“…Scaling up health services involves a complex interplay of policy levers, as planners must balance improving access and equitable provision of care within operational and financial constraints. A focus on efficiency has become particularly attractive for expanding ART in LMICs, as increasing efficiency represents a feasible avenue for elevating service production without a proportional rise in expenditures [ 8 , 9 ]. Otherwise, expanding care hinges upon more government spending, increased DAH, or heightened out-of-pocket payments for patients – and recent projections point to relatively minimal increases in government health spending by LMICs through 2040 [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The potential to expand antiretroviral therapy by improving health facility efficiency: evidence from Kenya, Uganda, and Zambia

Giorgio

Moses

Fullman

et al. 2016

BMC Med

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BackgroundSince 2000, international funding for HIV has supported scaling up antiretroviral therapy (ART) in sub-Saharan Africa. However, such funding has stagnated for years, threatening the sustainability and reach of ART programs amid efforts to achieve universal treatment. Improving health system efficiencies, particularly at the facility level, is an increasingly critical avenue for extending limited resources for ART; nevertheless, the potential impact of increased facility efficiency on ART capacity remains largely unknown. Through the present study, we sought to quantify facility-level technical efficiency across countries, assess potential determinants of efficiency, and predict the potential for additional ART expansion.MethodsUsing nationally-representative facility datasets from Kenya, Uganda and Zambia, and measures adjusting for structural quality, we estimated facility-level technical efficiency using an ensemble approach that combined restricted versions of Data Envelopment Analysis and Stochastic Distance Function. We then conducted a series of bivariate and multivariate regression analyses to evaluate possible determinants of higher or lower technical efficiency. Finally, we predicted the potential for ART expansion across efficiency improvement scenarios, estimating how many additional ART visits could be accommodated if facilities with low efficiency thresholds reached those levels of efficiency.ResultsIn each country, national averages of efficiency fell below 50 % and facility-level efficiency markedly varied. Among facilities providing ART, average efficiency scores spanned from 50 % (95 % uncertainty interval (UI), 48–62 %) in Uganda to 59 % (95 % UI, 53–67 %) in Zambia. Of the facility determinants analyzed, few were consistently associated with higher or lower technical efficiency scores, suggesting that other factors may be more strongly related to facility-level efficiency. Based on observed facility resources and an efficiency improvement scenario where all facilities providing ART reached 80 % efficiency, we predicted a 33 % potential increase in ART visits in Kenya, 62 % in Uganda, and 33 % in Zambia. Given observed resources in facilities offering ART, we estimated that 459,000 new ART patients could be seen if facilities in these countries reached 80 % efficiency, equating to a 40 % increase in new patients.ConclusionsHealth facilities in Kenya, Uganda, and Zambia could notably expand ART services if the efficiency with which they operate increased. Improving how facility resources are used, and not simply increasing their quantity, has the potential to substantially elevate the impact of global health investments and reduce treatment gaps for people living with HIV.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0653-z) contains supplementary material, which is available to authorized users.

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“…[5][6][7][8] Identifying health systems factors -particularly those that are modifiable -that impact the quality of care is therefore crucial to maximize the effectiveness of ART. 9 Though many studies have investigated correlates of ART coverage 2 and retention in care, 7 such research has been framed in terms of identifying individual characteristics that are associated with PMTCT uptake rather than characteristics of health facilities that are associated with high PMTCT service delivery. Those studies that do investigate health facility factors often only evaluate one or a few characteristics as an adjunct to the primary analysis, 10 such as whether PMTCT is integrated in ANC, and therefore cannot compare the relative contribution of different health facility factors on PMTCT service delivery.…”

Section: Introductionmentioning

confidence: 99%

Health facility factors and quality of services to prevent mother-to-child HIV transmission in Côte d’Ivoire, Kenya, and Mozambique

et al. 2016

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This study aimed to identify facility-level characteristics associated with prevention of mother-to-child HIV transmission service quality. This cross-sectional study sampled 60 health facilities in Mozambique, Côte d’Ivoire, and Kenya (20 per country). Performance score – the proportion of pregnant women tested for HIV in first antenatal care visit, multiplied by the proportion of HIV-positive pregnant women who received appropriate antiretroviral medications – was calculated for each facility using routine data from 2012 to 2013. Facility characteristics were ascertained during on-site visits, including workload. Associations between facility characteristics and performance were quantified using generalized linear models with robust standard errors, adjusting for country. Over six months, facilities saw 38,611 first antenatal care visits in total. On-site CD4 testing, Pima CD4 machine, air conditioning, and low or high (but not mid-level) patient volume were each associated with higher performance scores. Each additional first antenatal care visit per nurse per month was associated with a 4% (95% confidence interval: 1%–6%) decline in the odds that an HIV-positive pregnant woman would receive both HIV testing and antiretroviral medications. Physician workload was only modestly associated with performance. Investments in infrastructure and human resources – particularly nurses – may be critical to improve prevent mother-to-child HIV transmission service delivery and protect infants from HIV.

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Maximizing Antiretroviral Therapy in Developing Countries

Cited by 11 publications

References 2 publications

Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response

Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response

The potential to expand antiretroviral therapy by improving health facility efficiency: evidence from Kenya, Uganda, and Zambia

Health facility factors and quality of services to prevent mother-to-child HIV transmission in Côte d’Ivoire, Kenya, and Mozambique

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