Myburgh Hanlie, Reynolds Lindsey, Hoddinott Graeme, van Aswegen Dianne, Grobbelaar Nelis, Gunst Colette, Jennings Karen, Kruger James, Louis Francoise, Mubekapi-Musadaidzwa Constance, Viljoen Lario, Wademan Dillon, Bock Peter
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.
Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Nieuwe Achtergracht 166, WV, Amsterdam, the Netherlands.
Health Policy Plan. 2021 Jun 25;36(6):923-938. doi: 10.1093/heapol/czaa094.
'Universal' access to antiretroviral treatment (ART) has become the global standard for treating people living with HIV and achieving epidemic control; yet, findings from numerous 'test and treat' trials and implementation studies in sub-Saharan Africa suggest that bringing 'universal' access to ART to scale is more complex than anticipated. Using South Africa as a case example, we describe the research priorities and foci in the literature on expanded ART access. To do so, we adapted Arksey and O'Malley's six-stage scoping review framework to describe the peer-reviewed literature and opinion pieces on expanding access to ART in South Africa between 2000 and 2017. Data collection included systematic searches of two databases and hand-searching of a sub-sample of reference lists. We used an adapted socio-ecological thematic framework to categorize data according to where it located the challenges and opportunities of expanded ART eligibility: individual/client, health worker-client relationship, clinic/community context, health systems infrastructure and/or policy context. We included 194 research articles and 23 opinion pieces, of 1512 identified, addressing expanded ART access in South Africa. The peer-reviewed literature focused on the individual and health systems infrastructure; opinion pieces focused on changing roles of individuals, communities and health services implementers. We contextualized our findings through a consultative process with a group of researchers, HIV clinicians and programme managers to consider critical knowledge gaps. Unlike the published literature, the consultative process offered particular insights into the importance of researching and intervening in the relational aspects of HIV service delivery as South Africa's HIV programme expands. An overwhelming focus on individual and health systems infrastructure factors in the published literature on expanded ART access in South Africa may skew understanding of HIV programme shortfalls away from the relational aspects of HIV services delivery and delay progress with finding ways to leverage non-medical modalities for achieving HIV epidemic control.
抗逆转录病毒治疗（ART）的“普及”已成为治疗艾滋病毒感染者和实现疫情控制的全球标准；然而，撒哈拉以南非洲众多“检测与治疗”试验及实施研究的结果表明，将ART“普及”推广至大规模实施比预期更为复杂。以南非为例，我们描述了关于扩大ART可及性的文献中的研究重点和焦点。为此，我们采用了阿克西和奥马利的六阶段范围综述框架，以描述2000年至2017年间南非关于扩大ART可及性的同行评审文献和观点文章。数据收集包括对两个数据库的系统检索以及对参考文献列表子样本的手工检索。我们使用了一个经过调整的社会生态主题框架，根据其对扩大ART资格的挑战和机遇的定位对数据进行分类：个人/服务对象、医护人员与服务对象关系、诊所/社区环境、卫生系统基础设施和/或政策环境。在1512篇已识别的文献中，我们纳入了194篇研究文章和23篇观点文章，这些文献涉及南非扩大ART可及性的问题。同行评审文献聚焦于个人和卫生系统基础设施；观点文章则关注个人、社区和卫生服务实施者角色的转变。我们通过与一组研究人员、艾滋病毒临床医生和项目管理人员的协商过程，将我们的研究结果置于具体情境中，以考虑关键的知识空白。与已发表的文献不同，协商过程特别深入地揭示了随着南非艾滋病毒项目的扩大，研究和干预艾滋病毒服务提供的关系层面的重要性。在关于南非扩大ART可及性的已发表文献中，对个人和卫生系统基础设施因素的压倒性关注可能会使对艾滋病毒项目不足的理解偏离艾滋病毒服务提供的关系层面，并延迟在寻找利用非医疗方式实现艾滋病毒疫情控制方面取得进展。
