Exploring communication of the HIV/AIDS health policy change to test-and-treat and its effect on policy implementation in selected public health facilities in Lusaka district, Zambia

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Abstract Background The World Health Organisation has promoted a shift towards the test and treat strategy to accelerate elimination of HIV/AIDS. Zambia adopted this policy change in 2017. However, communication of this policy change and its effect on policy implementation has not been documented. This study sought to explore the communication of the HIV/AIDS test and treat health policy change and how this affects practice in selected public health facilities in Lusaka district. Methods A qualitative case study was employed with purposeful sampling of policy makers, partners, National AIDS Council managers and frontline health providers in selected tertiary, secondary and primary-level health facilities in Lusaka District of Zambia. In total, 22 key informant interviews and 3 focus group discussion were conducted. Thematic inductive – deductive approach coding and data analysis were performed using NVivo pro 12 software. Results The results revealed that to communicate test and treat policy change; government relied on print media such as newspapers, IEC materials and electronic media through radios and television. The official channels of communication and feedback mechanisms for test and treat HIV health policy change were not clearly stipulated in the health facilities for reference. This created a lapse in communication which resulted in policy misinterpretation and resistance from both implementers and clients. The HIV policy changes reshaped health systems negatively as infrastructure was altered to accommodate increased service demand workload for HIV services and operational hours for HCWs. Further, policy makers seemed to be unprepared for the policy changes. Conclusion Effective health policy change communication with clear channels and open feedback mechanisms is vital for successful policy change implementation as it enhances understanding and subsequently adoption of the policy. Further, there is a need to enhance collaboration amongst policy makers, partners, implementers and the public in developing and applying communication strategies that facilitate quick adoption of health policy changes.

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