Health policy and planning最新文献

{"title":"Prospective policy analysis of healthcare workforce policies for effective non-communicable disease prevention and management in Meghalaya, India.","authors":"Ankur Nair, Pratheeba John, Rajeev Sadanandan","doi":"10.1093/heapol/czaf107","DOIUrl":"10.1093/heapol/czaf107","url":null,"abstract":"<p><p>This study presents a prospective policy analysis of healthcare workforce (human resources for health, HRH) reforms in Meghalaya, India, a state facing dual challenges of a rising burden of non-communicable diseases (NCDs) and persistent inequities in access to medical and public health specialists. Grounded in a health systems and social justice perspective, this study examines current HRH needs and proposed reforms, evaluating their potential to address the evolving health demands of the population, particularly among poor and marginalized groups vulnerable to NCDs. Using secondary evidence, including national surveys, epidemiological data, and government reports, the study maps workforce gaps, especially in rural and tribal regions, and highlights the physician-centric nature of HRH governance in India. The Walt and Gilson policy triangle, combined with adapted HRH evaluation frameworks, guided the analysis of policy context, content, processes, and actors. This approach identified key gaps in recruitment, rural retention, cadre structures, and specialist training for effective NCD prevention and management. A scenario analysis, using the Intuitive Logic method, developed a best-case trajectory of reform achievable through equity-oriented design, strong political will, and institutional capacity, while recognizing risks of policy stagnation. Findings indicate that achieving a socially accountable HRH system characterized by equitable distribution, transparent governance, and meaningful community engagement is critical for improving NCD outcomes and reducing health inequities, particularly by preventing financial distress among the poor. The study contributes to health policy and systems research by linking institutional design to future health system resilience, underscoring the need to embed justice, participation, and adaptability within HRH governance to effectively address present and future health challenges in low-resource contexts such as Meghalaya.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"41 Supplement_1","pages":"i58-i70"},"PeriodicalIF":3.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to do (or not to do) realist evaluations to advance theory, practice, and justice in health systems research.","authors":"Praveenkumar Aivalli, Pragati Hebbar, Chinyere Mbachu, Prashanth Nuggehalli Srinivas, Seye Abimbola, Sara Dada","doi":"10.1093/heapol/czaf080","DOIUrl":"10.1093/heapol/czaf080","url":null,"abstract":"<p><p>The realist approach seeks to understand underlying mechanisms that explain how and why complex interventions, programmes, and policies work in specific contexts, making it particularly valuable in health policy and systems research (HPSR). We draw on reflexive practice of realist evaluations from several realist evaluation practitioners and on insights from an organized session at the Eighth Health Systems Research Symposium in Nagasaki, Japan, in 2024, where we engaged a diverse group of practitioners and researchers on how to use realist approaches in HPSR. Examples from our studies, while situated in distinct contexts, highlight common challenges in applying realist methodologies including identifying and refining context-mechanism-outcome configurations. Building on these examples, we illustrate how realist evaluations, if conducted rigorously and with the purpose of advancing justice in health systems, could do so through exposing structural barriers to health justice, amplifying local voices and fostering epistemic justice in knowledge production.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"41 Supplement_1","pages":"i83-i90"},"PeriodicalIF":3.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Political economy analysis of health: a scoping review of concepts, definitions, frameworks, outcomes, and applications.","authors":"Vineetha Karuveettil, Chandrashekar Janakiram, Shewta Ramesh, Aparna Ramachandran, Manu Mathur, Balagopal Varma, Heidi Green, Denny John","doi":"10.1093/heapol/czaf096","DOIUrl":"10.1093/heapol/czaf096","url":null,"abstract":"<p><p>This review examined 28 studies to understand how political economy analysis (PEA) is conceptualized and applied in health. Definitions of political economy varied, with only 11 studies offering explicit definitions. Most commonly, political economy was framed as the study of power, interests, institutions, and ideas shaping health policy processes and outcomes. Applications ranged from analysing structural determinants of health to understanding stakeholder influence in health reforms. Across studies, 31 distinct frameworks and theories were used. Frequently employed models included Campos and Reich's Political Economy of Health Financing Reform Framework, Harris's Applied PEA, and the DFID and World Bank 'How-to' notes. Theoretical underpinnings were drawn from economics, political science, and sociology-such as historical institutionalism, stakeholder theory, and discursive institutionalism-highlighting the interdisciplinary nature of PEA. Health issues analysed through a political economy lens primarily included health financing, governance, human resources for health, and service delivery. PEA was used to explore challenges such as policy reform feasibility, institutional capacity, health workforce equity, and donor dependency. The rationale for applying PEA included uncovering the influence of actors, navigating complex political contexts, and enhancing policy implementation. Overall, PEA in health is marked by conceptual diversity and methodological pluralism. Its growing application reflects the need to understand the interplay of politics, institutions, and economics in addressing systemic health challenges.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"41 Supplement_1","pages":"i91-i110"},"PeriodicalIF":3.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A river, frontline families, and the double-edged sword of community participation: how nutrition interventions are shaped at the village level in Dhubri, India.","authors":"J R Jith, S Dash, R Bedamatta","doi":"10.1093/heapol/czag011","DOIUrl":"10.1093/heapol/czag011","url":null,"abstract":"<p><p>This paper explores how top-down health interventions engage with and reshape communities at the village level, focusing on nutrition interventions as tracers to examine the functioning of local health systems. Drawing on 28 in-depth interviews and 6 focus group discussions conducted in Dhubri district, Assam, the study investigates how such interventions are delivered through a health system constituted of both formal structures and informal arrangements, deeply influenced by the ecology of the Brahmaputra River. Using an exploratory qualitative approach, the study surfaces five key themes. First, seasonal disruptions linked to the river significantly affect service continuity, revealing the inadequacy of existing policies to respond to environmental vulnerability. Second, the creation of 'frontline families'-where the personal lives and unpaid labour of frontline health workers' households are drawn into service delivery-reflects systemic dependence on invisible support. Third, community participation emerges as a double-edged sword, simultaneously enabling programme reach and generating unrealistic demands and burdens on frontline actors. Fourth, informal spaces and interpersonal relationships underpin much of the operational success of interventions, compensating for gaps in formal governance and infrastructure. Finally, symbolic campaigns, detached from local material realities, often foster alienation rather than awareness. The findings call for a rethinking of intervention design and delivery that take account of embedded social, ecological, and institutional realities. The paper argues that building just and sustainable health systems requires recognising and supporting the informal, relational, and contextual dimensions that currently remain overlooked in dominant policy frameworks.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"41 Supplement_1","pages":"i71-i82"},"PeriodicalIF":3.5,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored video-based lifestyle intervention for overweight or obese adults in Phnom Penh, Cambodia: a pilot cluster randomized controlled trial.","authors":"Youngran Yang, Sreypov Yuth, Oknam Hwang, Virya Koy","doi":"10.1093/heapol/czag047","DOIUrl":"10.1093/heapol/czag047","url":null,"abstract":"<p><p>Physical activity plays a crucial role in preventing and managing obesity and its related comorbidities, with minimal side effects. Similarly, consuming a balanced diet is essential for maintaining good health and adequate nutrition. However, most adults fail to meet population-based dietary and physical activity guidelines. In this pilot cluster-randomized controlled trial, we aimed to evaluate the effectiveness of a video-based physical activity and dietary intervention among adults aged 30-59 years in Phnom Penh, Cambodia. A total of 63 adults participated in the 12-week program, with 31 assigned to the intervention group and 32 to the control group. The intervention group received a video-based program delivered via Telegram and YouTube, complemented by a 2-h in-person session focusing on technical orientation and safety training. Standard care was provided to both the intervention and control groups and consisted of a single 60-min in-person lifestyle education session and a printed booklet commonly used in Cambodian health center settings. The intervention group demonstrated greater improvements in physical activity adherence, healthy eating adherence, exercise self-efficacy, healthy eating self-efficacy, systolic blood pressure, body weight, body mass index, waist circumference, fasting blood glucose, and high-density lipoprotein cholesterol levels compared with the control group (P < .05). Given its high accessibility and ease of implementation, video-based content appears to be an effective approach and policy for improving health behaviors, even in resource-limited settings. These findings support the use of video and digital platforms as potential strategies and evidence-based policy for preventing and managing non-communicable diseases in low-resource settings. Trial registration ISRCTN11839050 (retrospectively registered).</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1004-1017"},"PeriodicalIF":3.5,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the progress in implementing population-based policies to reduce the burden of noncommunicable diseases in Eastern Europe and Central Asia, 2010-2024.","authors":"Anastasiya Dumcheva, Tiina Laatikainen, Ivo Rakovac, Jaakko Nevalainen, Pekka Nuorti","doi":"10.1093/heapol/czag055","DOIUrl":"10.1093/heapol/czag055","url":null,"abstract":"<p><p>Premature mortality from noncommunicable diseases (NCDs) remains high in twelve Eastern Europe and Central Asia (EECA) countries-Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan. Although WHO-recommended 'Best Buys' offer effective strategies to reduce NCDs, their implementation in EECA remains poorly documented. We conducted a cross-country, retrospective analysis of the adoption and implementation of population-level NCD 'Best Buys' interventions targeting tobacco, alcohol, diet, and physical activity across EECA from 2010 (or earliest available year) to 2024 (or latest available year), aiming to identify progress, gaps, and priorities for action. Data were sourced from WHO NCD Country Capacity Surveys and other global databases and monitoring reports. A scoring system (0-1) captured implementation status, and spider charts and summary tables visualized trends over time. Tobacco control showed the most progress, with widespread adoption of taxation and graphic warnings. However, the implementation of smoke-free laws, cessation support, and media campaigns was inconsistent. Alcohol policies varied: most countries increased taxes and banned advertising, but gaps persisted in sales restrictions, health warnings, and treatment services. Adoption of nutrition policies remained inconsistent, with substantial gaps in food reformulation, labelling, fiscal tools, and education. Physical activity campaigns were common, but integration into healthcare systems was poorly documented. Disparities in implementation were observed across and within countries, in terms of the number and combination of 'Best Buys' strategies adopted. Despite some progress, major gaps remain in the implementation of population-level NCD 'Best Buys' across EECA. Greater prioritization of cost-effective tobacco, alcohol, nutrition, and physical activity strategies is needed. Subregional and country-level analyses of NCD 'Best Buys' implementation over time can help policymakers identify progress and gaps, guiding targeted, evidence-informed action to address shared behavioural risks and thereby prevent many NCDs and contribute to equitable and sustainable health outcomes.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"942-954"},"PeriodicalIF":3.5,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the formulation of non-communicable disease policies in Nepal: a qualitative study.","authors":"Anju Vaidya, Padam Simkhada, Edwin van Teijlingen, Andrew Chee Keng Lee","doi":"10.1093/heapol/czag048","DOIUrl":"10.1093/heapol/czag048","url":null,"abstract":"<p><p>Few policies have focused specifically on the growing burden of non-communicable diseases (NCDs) in low- and middle-income countries. Health policy formulation plays a vital role in the allocation of resources to implement effective interventions and reforms; hence, a nuanced understanding of the health policy formulation process is essential. However, there is limited evidence about the process through which NCD policies were formulated in Nepal. This study used Kingdon's multiple streams framework to explore how NCDs were recognized and prioritized, how policy alternatives were decided, how policy windows were opened, and which contextual factors influenced the policy formulation process. A qualitative case study approach was applied to gain a comprehensive understanding of the formulation of major NCD-related policies in Nepal. Semi-structured interviews were conducted with 12 key stakeholders and policy documents were analyzed using framework analysis. The NCDs were gradually recognized and prioritized through the convergence of global and local evidence, sustained advocacy, and international commitments. Policymakers encountered several challenges, such as competing health priorities, the chronic nature of NCDs, donor preferences for communicable diseases, financial constraints, and multisectoral complexities of NCDs. The Package of Essential Non-communicable diseases interventions were adopted as a policy alternative, informed by global evidence, World Health Organization recommendations, and lessons from other countries. While coordinated efforts by stakeholders brought the problem, policy, and politics streams together, the role of policy entrepreneurs was found to be less relevant in Nepal's context. The findings highlight the need to consider external influences while conducting similar studies in low- and middle-income countries. Further research is needed on strategies to address persistent structural and financial challenges in NCD policy formulation.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"955-966"},"PeriodicalIF":3.5,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pervasiveness of racism in healthcare facilities in Latin America: a scoping review.","authors":"Arachu Castro, Martha Silva, Eva Silvestre","doi":"10.1093/heapol/czag050","DOIUrl":"10.1093/heapol/czag050","url":null,"abstract":"<p><p>Racism in healthcare facilities across Latin America systematically affects Indigenous, Afrodescendant, and migrant populations. Yet, no comprehensive synthesis has mapped its scope across different populations, healthcare settings, and countries in the region. This scoping review followed PRISMA guidelines and searched PubMed, EBSCOhost, and EMBASE for peer-reviewed studies published between January 2015 and June 2025. We included studies addressing racism in healthcare facilities where clinical encounters between populations and healthcare workers occur. Data were charted using AI-assisted tools and analyzed thematically. We retained 70 studies from 15 countries, predominantly Brazil (n = 30) and Mexico (n = 14). Racism manifested through three interconnected forms: institutional racism (policies restricting access, absence of data reflecting ethnic identification and racialization processes, resource inequities), personally mediated racism (verbal abuse, physical mistreatment, denial of culturally appropriate care), and internalized racism (self-devaluation, acceptance of mistreatment). These forms of discrimination pervade multiple medical fields, including maternal and reproductive health, mental health services, dental care, chronic disease management, infectious disease treatment, and emergency care. Racialized populations experience delayed diagnoses, inadequate treatment protocols, and systematic exclusion from preventive care. Language barriers, cultural dismissal, and discriminatory triage decisions compound these inequities. Intersectional marginalization based on gender, class, migration status, and sexuality amplifies these effects, producing multiplicative rather than additive health impacts. Achieving health equity requires dismantling institutional racism through meaningful community participation in healthcare governance, mandatory collection of ethno-local data-population descriptors reflecting local ethnic identification and racialization processes-integration of anti-racist and decolonial frameworks in medical education, legal accountability mechanisms, and recognition of racism as a fundamental determinant of health. Interventions targeting only individual bias will fail without addressing structural transformation.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1018-1042"},"PeriodicalIF":3.5,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does dosage matter? Effects of results-based financing layered on top of less comprehensive direct facility financing in Tanzania.","authors":"Eskindir Loha, Vincent Somville, Jo Borghi, Peter Binyaruka, Ottar Mæstad","doi":"10.1093/heapol/czag058","DOIUrl":"10.1093/heapol/czag058","url":null,"abstract":"<p><p>Performance-based financing at health facility level has improved service delivery in many low- and middle-income countries. However, the high costs of implementing such schemes have prompted interest in less complex forms of direct health facility financing. This paper measures the effects of layering a full-blown performance-based financing scheme (results-based financing, RBF) on top of a less comprehensive direct financing scheme in Tanzania. This enables us to assess whether implementing a less comprehensive scheme exhausted the potential for financing reforms to improve service delivery, or whether there are significant gains from adding more resources and incentives to the scheme. We estimated the effects of RBF using a difference-in-differences approach. Over 4 years, we tracked 150 health facilities and more than 3000 households, equally divided between eight districts that implemented both schemes and six districts that implemented only the less comprehensive scheme. Strong positive trends were observed for most outcomes in both groups of districts. At the same time, RBF had positive and statistically significant effects on 14 of 24 directly incentivized outcomes and on 22 of 47 other outcomes, including on service coverage (e.g. prenatal and vaccination services), service quality (e.g. content of care for antenatal and delivery services, drug availability, communication, and responsiveness), and patient satisfaction. A negative effect was estimated for one outcome only (use of family planning method). Statistically significant effects of RBF ranged from -4.3 to 16.2 percentage points (average: 8.7 pp). Analysis of intermediary outcomes revealed that RBF had a positive effect on health worker job satisfaction. We conclude that dosage matters: comprehensive direct financing schemes-with more resources and incentives-can significantly improve service delivery beyond what is achieved by less comprehensive ones.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"988-1003"},"PeriodicalIF":3.5,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147928764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic burden of depressive disorders and HIV for people living with HIV in Uganda.","authors":"Patrick V Katana, Ian Ross, Barbra Elsa Kiconco, Patrick Tenywa, Melissa Neuman, Wilber Ssembajjwe, Isaac Sekitoleko, Kenneth Roger Katumba, Eugene Kinyanda, Yoko V Laurence, Giulia Greco","doi":"10.1093/heapol/czag054","DOIUrl":"10.1093/heapol/czag054","url":null,"abstract":"<p><p>Between 8%-39% of people living with HIV (PLWH) in sub-Saharan Africa have a depressive disorder (DD). Despite considerable gains in the treatment of PLWH, DD is increasingly recognised as a threat to successful treatment and prevention. PLWH incur higher health-related costs than the general population due to chronic care management needs. We aimed to estimate the combined economic burden of DD and HIV amongst PLWH and explore their mechanisms of coping with high-of-pocket health expenditure. This was a cost of illness study nested in a cluster-randomized trial that assessed the effectiveness of integrating treatment of DD into routine HIV care in Uganda (HIV+D trial). The study used cross-sectional data collected from 1115 PLWH across both trial arms at baseline, using the 9-item Patient Health Questionnaire (PHQ-9) to measure DD and a structured cost questionnaire. The mean monthly economic cost of HIV and DD amongst n = 486 participants reporting at least one non-zero cost item was United States Dollars (USD) 11.72 (2022 prices), while the mean across the whole sample (including zeroes) was USD 5.05. Mean monthly out-of-pocket expenditure amongst participants reporting at least one non-zero item was USD 7.22, which is 4% of average monthly household income. It was USD 3.11 in the sample as a whole. Moderate DD symptoms (PHQ-9 between 15-19) and severe symptoms (PHQ-9 ≥ 20) were reported by 30% and 5% of respondents respectively, with the remainder experiencing mild symptoms. Social protection mechanisms combined with the integration of the management of DD into routine HIV care could help alleviate this burden.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"979-987"},"PeriodicalIF":3.5,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}