ArticlePloS one2026
Challenges in implementing the WHO-recommended package of care for advanced HIV disease in resource-constrained settings: A mixed-methods study.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPeople diagnosed with advanced HIV disease (AHD) should be provided with the World Health Organization's (WHO) package of care to address their specific healthcare needs. Although the WHO-recommended package of care is considered feasible and effective, its implementation remains sub-optimal across many sub-Saharan African (SSA) countries. This study aimed to explore challenges in implementing the WHO-recommended package of care for advanced HIV disease in resource-constrained settings.
methodsA sequential explanatory mixed-methods study was conducted between March 1 and April 30, 2024, in the Gedeo Zone of Southern Ethiopia. The quantitative data involved extraction from medical records of 145 individuals newly diagnosed with AHD. For the qualitative inquiry, healthcare providers engaged in the HIV care continuum were purposively selected for in-depth key informant interviews. An inductive thematic analysis was conducted to identify and interpret recurrent patterns within the qualitative data. Quantitative data were analyzed using R version 4.3.3, while qualitative data were organized and managed using NVivo version 14.
resultsOnly about half (47.6%) of the newly diagnosed AHD cases underwent baseline CD4 count testing. All 145 individuals were screened for TB using the WHO four-symptom algorithm, and 78.6% underwent confirmatory GeneXpert® MTB/RIF testing. Among individuals with AHD, 92.4% received co-trimoxazole prophylaxis, and 14.5% received tuberculosis preventive therapy. Rapid ART initiation was implemented for 20.0% of individuals with AHD. All newly diagnosed individuals with AHD received tailored counseling to ensure optimal adherence. Qualitative data analysis identified three principal challenges to the implementation of the WHO-recommended package of care: structural and organizational obstacles, service delivery constraints, and patient-related concerns as expressed by healthcare workers.
conclusionsThe implementation of the WHO-recommended package of care for individuals with AHD remains inconsistent. Although adherence support is routinely offered to all newly diagnosed individuals with AHD, the delivery of other key components is frequently hindered by a range of systemic challenges. These include the unavailability or frequent stockouts of essential medications and services for managing opportunistic infections, weak referral and linkage systems, and the absence of dedicated AHD care clinics. Such challenges underscore significant gaps in the continuum of AHD care and highlight the pressing need for targeted, system-level interventions to ensure comprehensive service delivery.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.