The short-term effects of the implementation of the "Treat All" guidelines on ART service delivery costs in Namibia

Schütte, Carl; Forsythe, Steven; Mdala, Johnface F.; Zieman, Brady; Linder, Rachael; Vu, Lung

doi:10.1371/journal.pone.0228135

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…The probable reasons for a good level of ASM acceptance by high-income groups may be related to these patients having higher-level incomes being employed, engaged in income-generating activities, having convenient drug storage, reducing working time lost due to frequent health facility visits, and experiencing better access information from different sources. This result does not coincide with the study conducted in Kenya, Cameroon, and Namibia [32][33][34], which may reflect the country-level differences in available infrastructure.…”

Section: Plos Onecontrasting

confidence: 94%

Uptake of appointment spacing model of care and associated factors among stable adult HIV clients on antiretroviral treatment Northwest Ethiopia

Asrade¹,

Moges

Meseret

et al. 2022

PLoS ONE

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Introduction Ethiopia launched an Appointment Spacing Model in 2017, which involved a six-month clinical visit and medication refill cycle. This study aimed to assess the uptake of the Appointment Spacing Model of care and associated factors among stable adult HIV clients on ART in Ethiopia. Methods A cross-sectional study was conducted from October 3 to November 30, 2020 among 415 stable adult ART clients. EpiData version 4.2 was used for data entry and SPSS version 25 was used for cleaning and analysis. A multivariable logistic regression model was fitted to identify associated factors, with CI at 95% with AOR being reported to show the strength of association. Results The uptake of the appointment spacing model was 50.1%. Residence [AOR: 2.33 (95% CI: 1.27, 4.26)], monthly income [AOR: 2.65 (95% CI: 1.13, 6.24)], social support [AOR: 2.21 (95% CI: 1.03, 4.71)], duration on ART [AOR: 2.41 (95% CI: 1.48, 3.92)], baseline regimen change [AOR: 2.20 (95% CI: 1.02, 4.78)], viral load [AOR: 2.80 (95% CI: 1.06, 7.35)], and alcohol abstinence [AOR: 2.02 (95% CI: 1.21, 3.37)] were statistically significant. Conclusions The uptake of the ASM was low. Behavioral change communication, engaging income-generating activities, and facility-level service providers’ training may improve the uptake.

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Section: Plos Onecontrasting

confidence: 94%

Uptake of appointment spacing model of care and associated factors among stable adult HIV clients on antiretroviral treatment Northwest Ethiopia

Asrade¹,

Moges

Meseret

et al. 2022

PLoS ONE

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“…There was greater satisfaction reported on items representing individual interactions with practitioners, however, clients also reported reduced ability to access the services they need, or to spend sufficient time with their providers. This is consistent with our previous publication that shows a significant reduction of clinical time between before treat all and after treat all [15]. This may be due to increased demands on providers time, or the use of communitybased ART delivery strategies.…”

Section: Plos Onesupporting

confidence: 92%

“…We also captured data on adult ART clients or who had received a confirmed HIV-positive diagnosis after 1 April of the corresponding year and subsequently initiated ART. The list of facilities can be found elsewhere [15]. Baseline retrospective data collection took place between June-August 2017; endline occurred between June-August 2018.…”

Section: Study Site and Designmentioning

confidence: 99%

Effects of the implementation of the HIV Treat All guidelines on key ART treatment outcomes in Namibia

Burnett-Zieman

Stoman

et al. 2020

PLoS ONE

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Background This study aimed to help the Namibian government understand the impact of Treat All implementation (started on April 1, 2017) on key antiretroviral therapy (ART) outcomes, and how this transition impacts progress toward the UNAIDS’s 90-90-90 HIV targets. Methods We collected clinical records from two separate cohorts (before and after treat-all) of ART patients in 10 high- and medium-volume facilities in 6 northern Namibia districts. Each cohort contains 12-month data on patients’ scheduled appointments and visits, health status, and viral load results. We also measured patients’ wait time and perceptions of service quality using exit interviews with 300 randomly selected patients (per round). We compared ART outcomes of the two cohorts: ART initiation within 7 days from diagnosis, loss to follow-up (LTFU), missed scheduled appointments for at least 30 days, and viral suppression using unadjusted and adjusted analyses. Results Among new ART clients (on ART for less than 3 months or had not yet initiated treatment as of the start date for the ART record review period), rapid ART initiation (within 7 days from diagnosis) was 5.2 times higher after Treat All than that among clients assessed before the policy took effect [AOR: 5.2 (3.8–6.9)]. However, LTFU was higher after Treat All roll-out compared to before Treat All [AOR: 1.9 (1.3–2.8)]. Established ART clients (on ART treatment for at least three months at the start date of the ART record review period) had over 3 times greater odds of achieving viral suppression after Treat All roll-out compared to established ART clients assessed before Treat All [AOR: 3.1 (1.6–5.9)]. Conclusions and recommendations The findings indicate positive effect of the “Treat All” implementation on ART initiation and viral suppression, and negative effect on LTFU. Additionally, by April 2018, Namibia seems to have reached the UNAIDS’s 90-90-90 targets.

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“…Namibia is one of the major economies within the Southern African Development Community (SADC) region of Africa. In 2006, the government implemented a comprehensive package of reforms aimed at enhancing service delivery, which included the establishment of a national service delivery strategy, the institutionalisation of a comprehensive monitoring and evaluation system for service delivery, and the development of a framework for public-private partnerships (Helao 2015;Schutte et al 2020). However, the effectiveness of the various reforms has not materialized in terms of service delivery.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, it is where the most basic needs of the people are provided. Therefore, various policy directives are put in place to guide and ensure service delivery by the Town Councils (Schutte et al 2020). These include the provisions in the Local Authority Act, section 30, and the Regional Council Act, section 28, which emphasised the need for local and regional government to ensure the provision of services to local-regional communities in a sustainable manner, and that services must be provided impartially, fairly, equitably, and without bias (Helao 2015;Kamwanyah et al 2021).…”

Section: Introductionmentioning

confidence: 99%

Leadership and Service Delivery in Times of Change

Atiku,

Kurana,

Ganiyu

2023

Administrative Sciences

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There has been a growing concern for excellent service delivery in the public sector. The challenges that are hindering service delivery in Town Councils have been attributed to political interference in appointments and ineffective leadership. The residents in the Town Council have been experiencing power outages and water shortages. The livelihoods of the residents and business operations have been hindered by these difficulties. This study investigates the influence of leadership on service delivery in a Town Council in Namibia. A qualitative research approach was adopted to analyse the influence of leadership practices on service delivery in times of change. A total of ten participants were sampled from a population of 117 staff members using a purposive sampling. Face-to-face interviews were conducted using a semi-structured interview guide. Participants views were tape recorded, transcribed into Microsoft Word, and analysed using thematic analysis via NVivo 12. The results showed that logistical difficulties, political interference, lack of human resources, and financial constraints, are the challenges hampering service delivery in the Town Council. The need for managers and supervisors to inspire, coach, mentor, and motivate their subordinates to enhance service delivery using a transformational leadership style is evident in the results. Therefore, the Town Council should prioritise budgeting, foster public-private partnerships, promote innovation, and ensure stakeholder engagement to enhance service delivery in the Town Council.

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The short-term effects of the implementation of the "Treat All" guidelines on ART service delivery costs in Namibia

Cited by 5 publications

References 20 publications

Uptake of appointment spacing model of care and associated factors among stable adult HIV clients on antiretroviral treatment Northwest Ethiopia

Uptake of appointment spacing model of care and associated factors among stable adult HIV clients on antiretroviral treatment Northwest Ethiopia

Effects of the implementation of the HIV Treat All guidelines on key ART treatment outcomes in Namibia

Leadership and Service Delivery in Times of Change

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