Ifakara Health Institute, Dar es Salaam, Tanzania.
Department of Population Studies, London School of Hygiene and Tropical Medicine, London, UK.
Glob Public Health. 2021 Feb;16(2):241-255. doi: 10.1080/17441692.2020.1763420. Epub 2020 May 27.
National HIV testing policies aim to increase the proportion of people living with HIV who know their status. National HIV testing policies were reviewed for each country from 2013 to 2018, and compared with WHO guidance. Three rounds of health facility surveys were conducted to assess facility level policy implementation in Karonga (Malawi), uMkhanyakude (South Africa), and Ifakara (Tanzania). A policy 'implementation' score was developed and applied to each facility by site for each round. Most HIV testing policies were explicit and aligned with WHO recommendations. Policies about service coverage, access, and quality of care were implemented in >80% of facilities per site and per round. However, linkage to care and the provision of outreach HIV testing for key populations were poorly implemented. The proportion of facilities reporting HIV test kit stock-outs in the past year reduced over the study period in all sites, but still occurred in ≥17% of facilities per site by 2017. The implementation score improved over time in Karonga and Ifakara and declined slightly in uMkhanyakude. Efforts are needed to address HIV test kit stock-outs and to improve linkage to care among people testing positive in order to reach the 90-90-90 targets.
国家艾滋病毒检测政策旨在提高艾滋病毒感染者中知晓自身感染状况的人数比例。对 2013 年至 2018 年期间各国的国家艾滋病毒检测政策进行了审查，并与世界卫生组织的指导意见进行了比较。在马拉维的卡隆加、南非的乌姆济库德和坦桑尼亚的伊法卡拉进行了三轮卫生机构调查，以评估机构一级政策执行情况。为每轮调查的每个地点制定了一个政策“执行”评分，并对每个机构进行了应用。大多数艾滋病毒检测政策是明确的，并与世界卫生组织的建议一致。关于服务覆盖范围、可及性和护理质量的政策在每个地点和每轮调查中都得到了 80%以上的机构的执行。然而，向感染者提供接触式艾滋病毒检测和联系护理的政策执行情况不佳。在过去一年中，报告艾滋病毒检测试剂盒库存不足的机构比例在所有地点均有所下降，但到 2017 年，每个地点仍有≥17%的机构报告存在这种情况。卡隆加和伊法卡拉的执行评分随着时间的推移有所提高，而乌姆济库德的评分略有下降。需要努力解决艾滋病毒检测试剂盒库存不足的问题，并改善艾滋病毒检测呈阳性者的护理衔接，以实现 90-90-90 目标。
