Global Healthcare Comparison Matrix and Narrative Statement

Global Healthcare Comparison Matrix and Narrative Statement

Global Health Comparison Grid Template
 

Global Healthcare Issue

HIV/AIDS

 

Description

HIV/AIDS is a (World Health Organization (WHO) priority because approximately 40.8 million people were living with HIV at the end of 2024, and 630,000 people died from HIV-related causes that year (World Health Organization [WHO], 2025). HIV is also associated with chronic conditions such as metabolic syndrome, making it an ongoing healthcare problem (Asgedom et al., 2024).

Country

United States

 

Uganda

Describe the policy in each country related to the identified healthcare issue

The Ryan White HIV/AIDS Program (RWHAP), passed in 1990, finances HIV care and support services for low-income or uninsured people with HIV, including funding for community health workers and patient navigators (Shade et al., 2021; Davoust et al., 2021). Medicaid expansion has also improved care and helped patients to reduce their viral load (Basu et al., 2025), with expansion states showing greater PrEP uptake (Hatch et al., 2025).

Uganda’s National HIV Strategic Plan (NSP) uses WHO’s treat-all approach, and prioritizes adolescent viral suppression and TB-HIV integration (Oryokot et al., 2020). It also prioritizes service delivery tailored to patient needs (Wilkinson & Grimsrud, 2020) Global Healthcare Comparison Matrix and Narrative Statement.

What are the strengths of this policy?

Strong funding, advanced diagnostics, and 77% global ART coverage influenced by PEPFAR (WHO, 2025)

Task-shifting authorizes nurses to initiate ART, which expands access amid physician shortages (Davey et al., 2023).

What are the weaknesses of this policy?

Outcomes vary by race and geography, with the rural and Deep South non-expansion states showing lower rates of suppression (McClarty et al., 2021). AIDS Drug Assistance Program (ADAP) recertification requirements often interrupt treatment (Erly et al., 2022).

Dependence on donor funding creates a large vulnerability. TB stigma persists with sex disparities (Sekandi et al., 2024). Women with disabilities have lower HIV testing utilization (Zandam et al., 2021).

Explain how the social determinants of health may impact the specified global health issue. (Be specific and provide examples)

 

In the U.S., housing instability and inadequate insurance contribute to ART non-adherence, and racial disparities persist across the care continuum (Moroko et al., 2025) Global Healthcare Comparison Matrix and Narrative Statement.

In Uganda, poverty and rural residence reduce care access, while transportation costs cause treatment interruption, and adolescent girls carry disproportionate disease risk (Moroko et al., 2025)

How has each country’ government addressed cost, quality, and access to the selected global health issue?

U.S. annual HIV treatment costs approximately $28,950 per person, with lifetime costs of $1.08 million (HIV+Hepatitis Policy Institute, 2022). Medicaid expansion improves suppression but requires FQHC capacity and navigation supports (Sommers et al., 2024).

In Uganda, HIV services are free through donor programs. Dried blood spots expand rural viral load monitoring (Simushi et al., 2023). Globally, 87% know their status, 77% are on ART, and 73% achieved suppression (WHO, 2025).

How has the identified health policy impacted the health of the global population? (Be specific and provide examples)

The President’s Emergency Plan for AIDS Relief (PEPFAR) and Global Fund contributions have reduced HIV deaths 54% since 2010, from 1.4 million in 2010, to 630,000 in 2024 (WHO, 2025).

Retention interventions improve disease outcomes (Joaquim et al., 2023). To reach 95-95-95 targets, 3.2 million more people need diagnosis and 5.2 million more need treatment (WHO, 2025).

Describe the potential impact of the identified health policy on the role of nurse in each country.

In the U.S., nurses support screening, care coordination, and telehealth follow-up for adherence (Rutledge et al., 2021).

In Uganda, nurses are the primary HIV providers through task-shifting. Nurse Initiated Management of Anti-Retroviral Therapy (NIMART) has expanded coverage but increases nursing workload (Davey et al., 2023). Nurses lead QI initiatives and integrate HIV with cervical cancer screening, but there are large training gaps (Oryokot et al., 2020; Obol et al., 2021).

Explain how global health issues impact local healthcare organizations and policies in both countries. (Be specific and provide examples)

In the U.S., global rapid-ART initiatives have influenced hospital policies supporting same-day treatment starts

In Uganda, the National HIV and AIDS Strategic Plan (NSP) addresses global targets locally and facilities align with PEPFAR reporting. The system develops HIV estimates using Spectrum and Naomi tools (Eaton et al., 2021).

General Notes/Comments

 

 

 

Part 2: Plan for Social Change

 

Advocacy for Global Health

As a nurse leader, I would advocate for three strategies: 1) Routine screening to identify housing instability and insurance gaps (Moroko et al., 2025); 2) Protocols for treat-all service delivery (Wilkinson & Grimsrud, 2020); and 3) Nurse-led case management models that improve service uptake (El-Bassel et al., 2022).

Impact on Local Practice

I would support nurse-led discharge planning to address social barriers, and screening for housing and insurance before discharge, then use referrals to assistance programs. Evidence shows nurse-led interventions improve adherence (El-Bassel et al., 2022). I would advocate for telehealth follow-up for patients with transportation barriers (Rutledge et al., 2021) and work with community organizations that provide housing and food supports.

Social Change

By applying strategies used globally, like task-shifting and QI frameworks we can provide better, more equitable care. By advocating for nurses to initiate PrEP we would be using the effective examples of scope expansions that have increased access in resource-limited settings (Davey et al., 2023). Applying Uganda’s QI methods here would show how global learning can create local change (Oryokot et al., 2020).

References

Asgedom, Y., Kebede, T., Gebrekidan, A., Koyira, M., Azeze, G., Lombebo, A., Legesse, B., & Kassie, G. (2024). Prevalence of metabolic syndrome among people living with human immunodeficiency virus in sub-Saharan Africa: A systematic review and meta-analysis. Scientific Reports, 14(1), Article 12021. https://doi.org/10.1038/s41598-024-62497-y

Basu, S., Phillips, R., & Hoang, H. (2025). Impact of community health center losses on county-level mortality: A natural experiment in the United States, 2011–2019.
Health Services Research, 60
(5), Article e14648. https://doi.org/10.1111/1475-6773.14648

Davey, D., Wilkinson, L., Grimsrud, A., Nelson, A., Gray, A., Raphael, Y., Stein, D., & Bekker, L.-G. (2023). Urgent appeal to allow all professional nurses and midwives to prescribe pre-exposure prophylaxis (PrEP) in South Africa.
South African Medical Journal
, 113(8), 12–16. https://doi.org/10.7196/samj.2023.v113i8.1191

Eaton, J., Dwyer-Lindgren, L., Gutreuter, S., O’Driscoll, M., Stevens, O., Bajaj, S., Brazeau, N., Teng, Y., Fellows, I., Rumero, J., Francis, S., Ogungbenro, K., & Shiraishi, R. (2021). Naomi: A new modelling tool for estimating HIV epidemic indicators at the district level in sub-Saharan Africa.
Journal of the International AIDS Society, 24
(S5), Article e25788. https://doi.org/10.1002/jia2.25788

El-Bassel, N., McCrimmon, T., Wu, E., Chang, M., Terlikbayeva, A., Hunt, T., Primbetova, S., & Gilbert, L. (2022). Effectiveness of an intervention to improve HIV service delivery for people who inject drugs in Kazakhstan.
JAMA Network Open, 5(
12), Article e2244734. https://doi.org/10.1001/jamanetworkopen.2022.44734

Erly, S., Khosropour, C., Hajat, A., Sharma, M., Reuer, J., Grimm, M., Herbeck, J., & Dombrowski, J. (2022). Characterization of the population affected by the 6-month recertification criterion of the Ryan White HIV/AIDS Program’s AIDS Drug Assistance Program in Washington State, 2017–2019.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 89
(1), 27–33. https://doi.org/10.1097/qai.0000000000002824

HIV+Hepatitis Policy Institute. (2022). U.S. PrEP cost analysis final report.
RTI International.
https://hivhep.org/wp-content/uploads/2022/11/PrEP_Cost_Final_Report_21November2022.pdf

Joaquim, L., Miranda, M., Pimentel, V., Martins, M., Nhampossa, T., Abecasis, A., Camacho, R., Viegas, S., & Pingarilho, M. (2023). Retention in care and virological failure among adult HIV-positive patients on first-line antiretroviral treatment in Maputo, Mozambique.
Viruses, 15
(10), Article 1978. https://doi.org/10.3390/v15101978

McClarty, L., Blanchard, J., & Becker, M. (2021). Leaving no one behind? An equity analysis of the HIV care cascade among a cohort of people living with HIV in Manitoba, Canada.
BMC

Public Health, 21
(1), Article 316. https://doi.org/10.1186/s12889-021-10225-w

Moroko, K., Rensburg, Z., & Jacobs, W. (2025). Experiences of nurses in patient adherence to antiretroviral therapy in Mpumalanga, South Africa.
African Journal of Primary Health Care & Family Medicine, 17
(1), Article 4841. https://doi.org/10.4102/phcfm.v17i1.4841

Oryokot, B., Miya, Y., Logose, B., Ajambo, E., Oluka, A., Odoi, C., Alege, J., & Mugisha, K. (2020). Interventions to improve HIV viral load suppression among the adolescents: Evidence of improvement science through a quality improvement approach in Eastern Uganda.
World Journal of AIDS, 10
(2), 94–106. https://doi.org/10.4236/wja.2020.102008

Rutledge, C., O’Rourke, J., Mason, A., Chike-Harris, K., Behnke, L., Melhado, L., Downes, L., & Gustin, T. (2021). Telehealth competencies for nursing education and practice.
Nurse Educator, 46
(5), 300–305. https://doi.org/10.1097/nne.0000000000000988

Sekandi, J., Quach, T., Olum, R., Nakkonde, D., Farist, L., Obiekwe, R., Turyahabwe, S., & Buregyeya, E. (2024). Stigma and associated sex disparities among patients with tuberculosis in Uganda: A cross-sectional study.
Therapeutic Advances in Infectious Disease, 11
, Article 20499361241305517. https://doi.org/10.1177/20499361241305517

Shade, S., Marseille, E., Kirby, V., Chakravarty, D., Steward, W., Koester, K., Storholm, E., & Myers, J. (2021). Health information technology interventions and engagement in HIV care and achievement of viral suppression in publicly funded settings in the US: A cost-effectiveness analysis.
PLOS Medicine, 18
(4), Article e1003389. https://doi.org/10.1371/journal.pmed.1003389

Simushi, P., Kalunga, M., Mwakyoma, T., Mwewa, M., Muchaili, L., Hazeemba, N., Ndhlovu, Z., & Kasonka, L. (2023). Verification of dried blood spot as a sample type for HIV viral load and early infant diagnosis on Hologic Panther in Zambia.
BMC Research Notes, 16
(1), Article 145. https://doi.org/10.1186/s13104-023-06344-9

Sommers, B., Gullett, L., & Hornstein, S. (2024). Medicaid’s edge case—Potential expansion and work requirements in Mississippi.
JAMA Health Forum, 5
(10), Article e244523. https://doi.org/10.1001/jamahealthforum.2024.4523

Wilkinson, L., & Grimsrud, A. (2020). The time is now: Expedited HIV differentiated service delivery during the COVID-19 pandemic.
Journal of the International AIDS Society, 23
(5), Article e25503. https://doi.org/10.1002/jia2.25503

World Health Organization. (2025).
HIV data and statistics.
https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategic-information/hiv-data-and-statistics

Zandam, H., Akobirshoev, I., Nandakumar, A., & Mitra, M. (2021). Utilization of HIV testing and counselling services by women with disabilities during antenatal care in Uganda: Analysis of 2016 demographic and health survey.
BMC Public Health, 21
(1), Article 1848. https://doi.org/10.1186/s12889-021-12045-4 Global Healthcare Comparison Matrix and Narrative Statement