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Jonas, Anna 2024-05-28T13:55:19Z 2024-05-28T13:55:19Z 2024 http://hdl.handle.net/11070/3843 A dissertation submitted in fulfilment of the requirements for the degree of doctor of philosophy in public health Namibia started with the implementation of the Human Immunodeficiency Virus (HIV) Test and Treat strategy in July 2016 as a pilot phase in three high-volume sites in the Zambezi, Ohangwena, and Khomas regions. In 2017, the strategy was expanded to all the regions in the country. The HIV Test and Treat strategy is envisaged to serve as treatment and as prevention based on scientific evidence that supports the use of Antiretroviral Therapy (ART) treatment for the prevention of HIV. The study aims to develop an operational framework based on the assessment and identification of pitfalls in the current HIV Test and Treat strategy implemented in Namibia, specifically Windhoek. The researcher used a concurrent mixed-method design with retrospective and cross-sectional quantitative data collected from the electronic patient system as well as from patients attending ART clinics in Windhoek. A qualitative design was used to explore the views of the HCWs and managers on the implementation of HIV Test and Treat. Also employed were the systems and resource-based theories on which the study was anchored. The study was subdivided into four phases. The situational analysis in Phase I consisted of both qualitative and quantitative data collection approaches. The first quantitative part was conducted by retrospectively analyzing patients’ outcomes in terms of retention in care and viral load suppression of patients who initiated ART due to WHO clinical stage and patients who initiated ART due to HIV Test and Treat strategy. An abstraction tool was used to retrospectively abstract data from the electronic patient monitoring system (ePMS) by following a cohort of patients that initiated ART between 2010- 2016 before the HIV Test and Treat implementation as well as patients that started ART between 2017-2018. About 17,570 adult patient records were included in the study of which 2,399 were allocated to HIV Test and Treat, and 15,171 were assigned to the WHO clinical stage arm. Moreover, three hundred and eighty-five (385) patients above the age of eighteen (18) years collecting their treatment at different facilities in the Khomas region completed a structured questionnaire to obtain information on factors associated with HIV Test and Treat. Quantitative data analysis was performed using STATA version fourteen (14). In addition, to describe and analyze factors associated with HIV Test and Treat, Key informant interviews (KIIs) were conducted with nine (9) Healthcare workers (HCWs) as well as nine (9) KIIs inclusive of II policymakers and program managers. The data were collected through in-depth interviews and the NVIVO version ten (10) was used for analysis. The findings were that HIV Test and Treat strategy is reaching its objectives. However, the implementation of the strategy had challenges such as lack of space, insufficient health care workers, medicine stock out, and lack of training for the HCWs. Also, viral load suppression (VLS) was associated with the regimens that the patient was taking and the patient’s status on ART. The study's quantitative and qualitative findings informed the conceptual framework developed in Phase II. Amongst the findings that informed the conceptual framework is the fact that overall, 31.8% of the patients were lost to follow-up, while retention in care was 57.6% amongst the patients that initiated ART due to HIV Test and Treat compared to 43.1% amongst the patients in the WHO clinical stage category (Table 4.3). This, therefore, requires more resources in order to conduct patient tracing as well as to do continuous adherence counseling. In addition, about 38.10% (Table 4. 28) of the patients recommended fewer clinic visits which will require sufficient ARV storage at facilities that was mentioned as not enough during HCWs interview (006). The researcher used the systems theory, resource-based theory, and central concepts to guide the development of the conceptual framework. Phase III developed and described the operational framework to facilitate the implementation of the HIV Test and Treat strategy in Windhoek using the main findings from Phase I. The framework was described in terms of its goal, purpose, structure, and assumptions. The key attributes of the framework are that it is made up of interrelated and interlinked components that are derived from the systems theory, resource-based theory, the logic model, and the six steps of Dickoff’s orientation theory. Lastly, the researcher developed the guidelines to operationalize the framework based on the central concepts and the theories used to guide the development of the framework in Phase IV. Peer evaluation of the framework was conducted in terms of its clarity, simplicity, generality, accessibility, importance and it was found to be compliant (Chapter 6, 6.9). The guidelines provide a detailed plan for the implementation of the framework en University of Namibia HIV Test and treat Antiretroviral Therapy (ART) Operational framework Patient outcomes Retention in care Viral load suppression WHO clinical stage Evaluation of HIV test and treat strategy in Windhoek, Namibia: Development of an operational framework Thesisopen.access