College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia.
Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
Glob Health Sci Pract. 2019 Jun 27;7(2):189-202. doi: 10.9745/GHSP-D-19-00051. Print 2019 Jun.
Sub-Saharan African correctional facilities concentrate large numbers of people who are living with HIV or at risk for HIV infection. Universal test and treat (UTT) is widely recognized as a promising approach to improve the health of individuals and a population health strategy to reduce new HIV infections. In this study, we explored the feasibility and sustainability of implementing UTT in correctional facilities in Zambia and South Africa.
Nested within a UTT implementation research study, our qualitative evaluation of feasibility and sustainability used a case-comparison design based on data from 1 Zambian and 3 South African correctional facilities. Primary data from in-depth interviews with incarcerated individuals, correctional managers, health care providers, and policy makers were supplemented by public policy documents, study documentation, and implementation memos in both countries. Thematic analysis was informed by an empirically established conceptual framework for health system analysis.
Despite different institutional profiles, we were able to successfully introduce UTT in the South Africa and Zambian correctional facilities participating in the study. A supportive policy backdrop was important to UTT implementation and establishment in both countries. However, sustainability of UTT, defined as relevant government departments' capacity to independently plan, resource, and administer quality UTT, differed. South Africa's correctional facilities had existing systems to deliver and monitor chronic HIV care and treatment, forming a "scaffolding" for sustained UTT despite some human resources shortages and poorly integrated health information systems. Notwithstanding recent improvements, Zambia's correctional health system demonstrated insufficient material and technical capacity to independently deliver quality UTT. In the correctional facilities of both countries, inmate population dynamics and their impact on HIV-related stigma were important factors in UTT service uptake.
Findings demonstrate the critical role of policy directives, health service delivery systems, adequate resourcing, and population dynamics on the feasibility and likely sustainability of UTT in corrections in Zambia and South Africa.
撒哈拉以南非洲的惩教设施集中了大量艾滋病毒感染者或有感染艾滋病毒风险的人。普遍检测和治疗（UTT）被广泛认为是改善个人健康和降低新的艾滋病毒感染的人群健康战略的一种有前途的方法。在这项研究中，我们探讨了在赞比亚和南非的惩教设施中实施 UTT 的可行性和可持续性。
在 UTT 实施研究的基础上，我们采用基于 1 个赞比亚和 3 个南非惩教设施数据的嵌套案例比较设计，对可行性和可持续性进行了定性评估。来自被监禁者、惩教管理人员、医疗保健提供者和政策制定者的深入访谈的主要数据，辅以两国的公共政策文件、研究文件和实施备忘录。主题分析是基于一个经验建立的卫生系统分析概念框架。
尽管机构情况不同，但我们成功地在参与研究的南非和赞比亚惩教设施中引入了 UTT。在这两个国家，支持性的政策背景对 UTT 的实施和建立都很重要。然而，UTT 的可持续性，即相关政府部门独立规划、资源配置和管理优质 UTT 的能力，存在差异。南非的惩教设施有提供和监测慢性艾滋病毒护理和治疗的现有系统，为持续的 UTT 提供了“支撑”，尽管存在一些人力资源短缺和健康信息系统整合不佳的问题。尽管最近有所改善，但赞比亚的惩教卫生系统表现出独立提供优质 UTT 的物质和技术能力不足。在这两个国家的惩教设施中，囚犯人口动态及其对艾滋病毒相关耻辱感的影响是 UTT 服务利用率的重要因素。
研究结果表明，政策指令、卫生服务提供系统、充足的资源和人口动态对赞比亚和南非惩教中 UTT 的可行性和可持续性具有重要作用。
