ArticleGlobalization and health2017
"If donors woke up tomorrow and said we can't fund you, what would we do?" A health system dynamics analysis of implementation of PMTCT option B+ in Uganda.
Article in Globalization and health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 4 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Factors influencing implementation of point-of-care tests for maternal and newborn screening and diagnosis in low-resource settings: a systematic review.BMC global and public health · 2026Pooled it
- A Systematic Review of the Methods Used in Rapid Approaches to Research and Evaluation.Evaluation review · 2025Pooled it
- Barriers and facilitators to HIV and syphilis rapid diagnostic testing in antenatal care settings in low-income and middle-income countries: a systematic review.BMJ global health · 2022Pooled it
- Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis.Family medicine and community health · 2021Pooled it
- Visualizing stigma and HIV service engagement: a participatory approach using causal loop diagrams.BMC public health · 2026Article
- Managers perspectives on the implementation of the Prevention of Mother-to-Child Transmission policy in South Africa.Journal of public health in Africa · 2026Article
- Knowledge of HIV status in a rural Ugandan population with a sustained, generalised HIV epidemic.PLOS global public health · 2026Article
- Health worker perspectives on, and health system-level facilitators and barriers to early infant male circumcision for HIV prevention in a traditionally non-circumcising community, Northeastern Uganda: a cross-sectional qualitative study.BMC health services research · 2025Article
- Use and non-adherence to antiretroviral therapy among Refugee HIV positive pregnant mothers aged 18-49 years in Kyangwali refugee camp, Western Uganda.AIDS research and therapy · 2024Article
- Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities.Global health action · 2022Review
- Identifying the implementation effect of technology transfer policy using system dynamics: a case study in Liaoning, China.The Journal of technology transfer · 2022Article
- Evolution of prevention of mother to child transmission of HIV policy in Zambia: Application of the policy triangle to understand the roles of actors, process and power.Global public health · 2022Article
- Strategies to adapt and implement health system guidelines and recommendations: a scoping review.Health research policy and systems · 2022Article
- Pursuing health systems strengthening through disease-specific programme grants: experiences in Tanzania and Sierra Leone.BMJ global health · 2021Article
- Advancing sustainable development goals through immunization: a literature review.Globalization and health · 2021Review
- Understanding the influence of health systems on women's experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa.Global public health · 2021Article
- What will it take for the Global Plan priority countries in Sub-Saharan Africa to eliminate mother-to-child transmission of HIV?BMC infectious diseases · 2019Article
- Understanding the dynamic interactions driving the sustainability of ART scale-up implementation in Uganda.Global health research and policy · 2018Article
- Assessing the level of institutionalization of donor-funded anti-retroviral therapy (ART) programs in health facilities in Uganda: implications for program sustainability.Global health action · 2018Article
- Health Provider Perspectives of Health Facility Preparedness and Organization in Implementation of Option B+ among Pregnant and Lactating Women in Central Uganda: A Qualitative Study.Journal of the International Association of Providers of AIDS CareArticle
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn October 2012 Uganda extended its prevention of mother to child HIV transmission (PMTCT) policy to Option B+, providing lifelong antiretroviral treatment for HIV positive pregnant and breastfeeding women. The rapid changes and adoptions of new PMTCT policies have not been accompanied by health systems research to explore health system preparedness to implement such programmes. The implementation of Option B+ provides many lessons which can inform the shift to 'Universal Test and Treat', a policy which many sub-Saharan African countries are preparing to adopt, despite fragile health systems.
methodsThis qualitative study of PMTCT Option B+ implementation in Uganda three years following the policy adoption, uses the health system dynamics framework to explore the impacts of this programme on ten elements of the health system. Qualitative data were gathered through rapid appraisal during in-country field work. Key informant interviews and focus group discussions (FGDs) were undertaken with the Ministry of Health, implementing partners, multilateral agencies, district management teams, facility-based health workers and community cadres. A total of 82 individual interviews and 16 focus group discussions were completed. We conducted a simple manifest analysis, using the ten elements of a health system for grouping data into categories and themes.
resultsOf the ten elements in the health system dynamics framework, context and resources (finances, infrastructure & supplies, and human resources) were the most influential in the implementation of Option B+ in Uganda. Support from international actors and implementing partners attempted to strengthen resources at district level, but had unintended consequences of creating dependence and uncertainty regarding sustainability.
conclusionsThe health system dynamics framework offers a novel approach to analysis of the effects of implementation of a new policy on critical elements of the health system. Its emphasis on relationships between system elements, population and context is helpful in unpacking impacts of and reactions to pressures on the system, which adds value beyond some previous frameworks.
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