Assessment of the Implementation of the Treat-all Guidelines (Test and Start) in Namibia


The issue
The government of Namibia has adopted “test and start” (TnS) guidelines as national policy. As health facilities in Namibia begin operationalizing TnS policy, there are many unanswered questions about its broader effects—not only on client-level treatment outcomes, but also on the health system, including human and financial resources.


Our approach
In collaboration with the Government of Namibia, U. S. Agency for International Development/Namibia, IntraHealth International, and other partners, Project SOAR is conducting research to generate evidence on how the national rollout of the TnS guidelines and decentralization of antiretroviral treatment (ART) services affect client-level treatment outcomes, quality of ART services, and treatment costs in Namibia. The study is being conducted in five IntraHealth-supported district-level hospitals and health facilities, and five health centers (which are smaller and in closer proximity to communities compared to district-level facilities). Data are being collected on HIV testing, treatment initiation, retention, and viral load from routine clinic records, Service quality data are also being collected from client exit surveys, client in-depth interviews, and service provider focus group discussions.


The impact
The results of this study will inform the implementation and scale-up of TnS as well as efforts to decentralize ART services in Namibia and sub-Saharan Africa.