CA-IeDEA researchers have been leading IeDEA’s work examining the adoption and implementation of evidence-based policies across diverse real-world service delivery settings. Aimed at understanding whether proven interventions are reaching the populations that need them, these implementation science efforts have included:
- Examining national adoption of World Health Organization (WHO) recommendations on HIV treatment eligibility and antiretroviral regimens, including the incorporation of these recommendations in national guidelines and their introduction at clinic levels. Past research has focused on the rollout of WHO’s recommendations for universal treatment of all people living with HIV, known as “Treat All”, as well as recommendations related to same-day and rapid initiation of HIV treatment, and the roll-out of dolutegravir-based regimens for first-line ART.
- Exploring patient outcomes associated with HIV treatment eligibility expansions and guideline changes. This work has examined the timeliness of treatment initiation after the adoption of Treat All, as well as longer-term care outcomes, including retention in care and viral suppression among those initiating treatment in the era of universal treatment. Our work has also examined persistent sex- and age-based disparities in uptake of dolutegravir-based regimens after WHO’s initial safety signal on use of dolutegravir during pregnancy.
- Using mathematical modeling to estimate the health impacts of Rwanda’s Treat All policy on HIV prevalence and incidence, as well as HIV care outcomes, such as treatment initiation and viral suppression for the population overall, with stratified estimates by sex, age group, HIV acquisition risk, and urbanicity. The policy model has also been used to project HIV epidemic outcomes (HIV prevalence, HIV incidence, number of people living with HIV, new HIV infections, deaths) and care continuum outcomes (percent diagnosed, percent on ART among those diagnosed, percent virally suppressed among those on ART) under various scenarios of reduced funding for the HIV response.