ArticleGlobal health, science and practice2019
"It's Not Like Taking Chocolates": Factors Influencing the Feasibility and Sustainability of Universal Test and Treat in Correctional Health Systems in Zambia and South Africa.
Article in Global health, science and practice, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Transitional community adherence support for people leaving incarceration in South Africa: a pragmatic, open-label, randomised controlled trial.The lancet. HIV · 2024Trial
- How has the concept of health system software been used in health policy and systems research? A scoping review.Health policy and planning · 2025Article
- Assessing the preparedness of primary healthcare facilities for the implementation of universal test and treat in uThukela District, South Africa: a cross-sectional study.BMJ public health · 2025Article
- Toward Equitable Health Care: Bridging the Gap in the Health of Incarcerated Individuals in Africa.Public health challenges · 2024Article
- Experiences of Justice-Involved People Transitioning to HIV Care in the Community After Prison Release in Lusaka, Zambia: A Qualitative Study.Global health, science and practice · 2023Article
- Tuberculosis control at a South African correctional centre: Diagnosis, treatment and strain characterisation.PloS one · 2022Observational
- Costs of implementing universal test and treat in three correctional facilities in South Africa and Zambia.PloS one · 2022Article
- Preferences for transitional HIV care among people living with HIV recently released from prison in Zambia: a discrete choice experiment.Journal of the International AIDS Society · 2021Article
- Prisoners' access to HIV services in southern Malawi: a cross-sectional mixed methods study.BMC public health · 2021Article
- Addressing Common Mental Health Disorders Among Incarcerated People Living with HIV: Insights from Implementation Science for Service Integration and Delivery.Current HIV/AIDS reports · 2020Review
- HIV prevalence and the cascade of care in five South African correctional facilities.PloS one · 2020Article
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSub-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.
methodsNested 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.
resultsDespite 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.
conclusionFindings 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.
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