"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

Topp, Stephanie M., Chetty-Makkan, Candice, Smith, Helene J., Chimoyi, Lucy, Hoffmann, Christopher J., Fielding, Katherine, Reid, Stewart E., Olivier, Abraham J., Hausler, Harry, Herce, Michael E., and Charalambous, Salome (2019) "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. Global Health: Science and Practice, 7 (2). pp. 189-202.

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Abstract

Background: Sub-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.

Methods: Nested 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.

Results: Despite 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.

Conclusion: Findings 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.

Item ID: 58793
Item Type: Article (Research - C1)
ISSN: 2169-575X
Copyright Information: © Topp et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-19-00051
Funders: DFID and SIDA-funded Evidence for HIV Prevention in Southern Africa (EHPSA)
Projects and Grants: EHPSA program: Grant Number: MMM/EHPSA/AURUM/05150013
Date Deposited: 04 Jul 2019 23:46
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110309 Infectious Diseases @ 10%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111708 Health and Community Services @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 40%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920599 Specific Population Health (excl. Indigenous Health) not elsewhere classified @ 25%
92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 25%
92 HEALTH > 9202 Health and Support Services > 920207 Health Policy Evaluation @ 50%
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