title: A comparative analysis of national HIV policies in six African countries with generalized epidemics.
abstract: OBJECTIVE
  To compare national human immunodeficiency virus (HIV) policies influencing access to HIV testing and treatment services in six sub-Saharan African countries.
  
  
  METHODS
  We reviewed HIV policies as part of a multi-country study on adult mortality in sub-Saharan Africa. A policy extraction tool was developed and used to review national HIV policy documents and guidelines published in Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zimbabwe between 2003 and 2013. Key informant interviews helped to fill gaps in findings. National policies were categorized according to whether they explicitly or implicitly adhered to 54 policy indicators, identified through literature and expert reviews. We also compared the national policies with World Health Organization (WHO) guidance.
  
  
  RESULTS
  There was wide variation in policies between countries; each country was progressive in some areas and not in others. Malawi was particularly advanced in promoting rapid initiation of antiretroviral therapy. However, no country had a consistently enabling policy context expected to increase access to care and prevent attrition. Countries went beyond WHO guidance in certain areas and key informants reported that practice often surpassed policy.
  
  
  CONCLUSIONS
  Evaluating the impact of policy differences on access to care and health outcomes among people living with HIV is challenging. Certain policies will exert more influence than others and official policies are not always implemented. Future research should assess the extent of policy implementation and link these findings with HIV outcomes.
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, England .
authors.forename: Kathryn
authors.initials: K
authors.lastname: Church
authors.affiliation: Makerere University School of Public Health, Kampala, Uganda .
authors.forename: Francis
authors.initials: F
authors.lastname: Kiweewa
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, England .
authors.forename: Aisha
authors.initials: A
authors.lastname: Dasgupta
authors.affiliation: Ifakara Health Institute, Ifakara, United Republic of Tanzania .
authors.forename: Mary
authors.initials: M
authors.lastname: Mwangome
authors.affiliation: Manicaland HIV/STD Prevention Project, Harare, Zimbabwe .
authors.forename: Edith
authors.initials: E
authors.lastname: Mpandaguta
authors.affiliation: Agincourt, Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa .
authors.forename: Francesc Xavier
authors.initials: FX
authors.lastname: Gómez-Olivé
authors.affiliation: African Population Health Research Center, Nairobi, Kenya .
authors.forename: Samuel
authors.initials: S
authors.lastname: Oti
authors.affiliation: London School of Hygiene & Tropical Medicine, London, England .
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, England .
authors.forename: Alison
authors.initials: A
authors.lastname: Wringe
authors.affiliation: Ifakara Health Institute, Ifakara, United Republic of Tanzania .
authors.forename: Eveline
authors.initials: E
authors.lastname: Geubbels
authors.affiliation: London School of Hygiene & Tropical Medicine, London, England .
authors.forename: Amelia
authors.initials: A
authors.lastname: Crampin
authors.affiliation: MRC/UVRI Uganda Research Unit on HIV/AIDS, Entebbe, Uganda .
authors.forename: Jessica
authors.initials: J
authors.lastname: Nakiyingi-Miiro
authors.affiliation: World Health Organization, Geneva, Switzerland .
authors.forename: Chika
authors.initials: C
authors.lastname: Hayashi
authors.affiliation: Consultant, Nairobi, Kenya .
authors.forename: Muthoni
authors.initials: M
authors.lastname: Njage
authors.affiliation: Agincourt, Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa .
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Wagner
authors.affiliation: Ministry of Health, Kampala, Uganda .
authors.forename: Alex Riolexus
authors.initials: AR
authors.lastname: Ario
authors.affiliation: Ministry of Health, Lilongwe, Malawi .
authors.forename: Simon D
authors.initials: SD
authors.lastname: Makombe
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe .
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, England .
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D003906:Developing Countries; D058872:Epidemics; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006293:Health Promotion / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D057766:Policy; D014944:World Health Organization
chemical_list: D044966:Anti-Retroviral Agents