ArticleJournal of the International AIDS Society2017
Identifying gaps in HIV service delivery across the diagnosis-to-treatment cascade: findings from health facility surveys in six sub-Saharan countries.
Article in Journal of the International AIDS Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 1 of them a synthesis that pooled it.
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Who cites it
39 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.
- Implementation determinants of rapid diagnostic tests for fever management in sub-Saharan Africa: a mixed-studies systematic review.Nature communications · 2026Pooled it
- HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care.F1000Research · 2018Trial
- Article
- Scaling Up HIV Self-Testing in Africa: Insights From National Programmatic Data in Eight Countries.Journal of the International AIDS Society · 2026Article
- Unmet patient needs and information gaps in fertility counseling for persons living with HIV/AIDS: Evidence from Ghana.PLOS global public health · 2026Article
- Using positive deviance to enhance HIV care retention in South Africa: development of a compassion-focused program to improve the staff and patient experience.BMC global and public health · 2025Article
- Quality of Caregiver-Adolescent Relationship on HIV, Herpes Simplex Virus Type-2, and on Pregnancy Among Young Women in South Africa Enrolled in HIV Prevention Trials Network 068.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2025Article
- Using Positive Deviance to Enhance HIV Care Retention in South Africa: Development of a Compassion-Focused Programme to Improve the Staff and Patient Experience.Research square · 2024Article
- "I only seek treatment when I am ill": experiences of hypertension and diabetes care among adults living with HIV in urban Tanzania.BMC health services research · 2024Article
- Perceptions of women enrolled in a cardiovascular disease screening and prevention in HIV study.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2023Article
- Strengthening HIV and HIV co-morbidity care in low- and middle-income countries: insights from behavioural economics to improve healthcare worker behaviour.Journal of the International AIDS Society · 2023Article
- Article
- Article
- Nurses at the frontline of public health emergency preparedness and response: lessons learned from the HIV/AIDS pandemic and emerging infectious disease outbreaks.The Lancet. Infectious diseases · 2021Review
- The Shinyanga Patient: A Patient's Journey through HIV Treatment Cascade in Rural Tanzania.International journal of environmental research and public health · 2021Article
- Individual- and Facility-Level Factors Associated with Facility Testing among Men in Malawi: Findings from a Representative Community Survey.Diagnostics (Basel, Switzerland) · 2021Article
- HIV cure research in the time of COVID-19 - Antiretroviral therapy treatment interruption trials: A discussion paper.Journal of virus eradication · 2021Article
- Investigating the implementation of differentiated HIV services and implications for pregnant and postpartum women: A mixed methods multi-country study.Global public health · 2021Article
- Influence of evolving HIV treatment guidance on CD4 counts and viral load monitoring: A mixed-methods study in three African countries.Global public health · 2021Article
- Gaps and Opportunities in HIV Service Delivery in High Volume HIV Care Centers in Liberia: Lessons From the Field.Annals of global health · 2021Review
Corrections and comments
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Authors and funding
17 authors at 9 institutions in 6 countries.
Funding
Abstract
introductionDespite the rollout of antiretroviral therapy (ART), challenges remain in ensuring timely access to care and treatment for people living with HIV. As part of a multi-country study to investigate HIV mortality, we conducted health facility surveys within 10 health and demographic surveillance system sites across six countries in Eastern and Southern Africa to investigate clinic-level factors influencing (i) use of HIV testing services, (ii) use of HIV care and treatment and (iii) patient retention on ART.
methodsHealth facilities (
resultsThe number of facilities surveyed ranged from six in Malawi to 36 in Zimbabwe. Eighty percent were government-run; 73% were lower-level facilities and 17% were district/referral hospitals. Client load varied widely, from less than one up to 65 HIV testing clients per provider per week. Most facilities (>80%) delivered services or interventions that would support patient retention in care such as delivering free services, offering PMTCT within antenatal care, pre-ART monitoring and adherence counselling. Many facilities under-delivered in several areas, however, such as targeted testing for high-risk groups (21%) and mobile testing (36%). There were also intra-site and inter-site differences, including in the delivery of Option B+ (ranging from 6% in Kisumu to 93% in Kyamulibwa), and nurse-led ART initiation (ranging from 50% in Kisesa to 100% in Karonga and Agincourt). Only facilities in Malawi did not require additional lab tests for ART initiation. Stock-outs of HIV test kits and antiretroviral drugs were particularly common in Tanzania.
conclusionWe identified a high standard of health facility performance in delivering strategies that may support progression through the continuum of HIV care. HIV testing policy and practice was particularly weak. Inter- and intra-country differences in quality and coverage represent opportunities to improve the delivery of comprehensive services to people living with HIV.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.