TASK

Critically evaluate a current public health policy through a public health ethics framework 

[Towards Zero - An action plan towards ending HIV transmission, AIDS and HIV-related deaths in England - 2022 to 2025. Policy will be evaluated by Nancy Kass Framework]

Introduction

This essay will be focussed on evaluating the policy - Towards Zero - An action plan towards ending HIV transmission, AIDS and HIV-related deaths in England - 2022 to 2025 by using the Nancy Kass Framework. The prevalence of HIV or AIDs has been increasing on a worldwide basis (Gov 2023).

According to the recent statistics, 106,890 people were living with HIV in 2019 and 95,900 people are living with HIV in England since 2021 (Suthar et al. 2021). The essay will include a brief of the policy first, followed by other assessment criteria. The policy is about ending the transmission of HIV or AIDs, which causes a huge number of deaths per year in England.

However, there has been a massive reduction in the number of deaths and this trend has to be continued. Therefore the policy intends to complete four specific objectives. The objectives are focused on increasing equitable access and uptake of HIV prevention programmes, scale up HIV testing in line with the national guidelines, and optimize rapid access to treatment as well as retention in care followed by finally improving the life quality for people living with HIV followed by addressing stigma.

The policy based findings were good since it will lead to a reduction in the HIV transmission reduction. The essay will further evaluate the policy with Kass ethics framework and discuss whether every policy guideline was met according to the ethics framework or not. Finally, the essay will be summarized with its main findings in a conclusion section. 

Policy Explanation

In December 2021, the Department for Health and Social Care (DHSC) released a policy named as Towards Zero: HIV Action Plan for England 2022 to 2025. The main goals of this policy were to reduce HIV stigma, HIV- and AIDS-related fatalities, and HIV transmission all across the nation. 

This strategy, which has the financing of £23 million, intends to eradicate HIV infections and deaths by 2030 and reduce new HIV infections by 80% by 2025 (NHS choices 2022).

Work on four main themes—prevent (including ongoing access expansion to pre-exposure prophylaxis), test, treat, and retain—will be intensified. The DHSC also determined that in 2022, this policy would be supported by a system for monitoring and evaluation, wherein advancements achieved towards the goal will be tracked at the local, regional, and national levels. From the report of GOV.UK (2023) it could be found that there are four main objectives of this policy proposed by DHSC England.

The first objective of this strategy was to make sures that every individual has equitable access to the HIV prevention programmes. The second objective was to scale up the testing of HIV in line with the national guidelines. Third objective of the policy is to optimise the access to the treatment rapidly alongside retention in care. The fourth main objective of this study is to improve the life quality for the individual and addressing the stigma of the people living with HIV (GOV.UK 2023).  

Furthermore, the policy intends to increase the awareness, uptake and accessibility in order to reduce disparity in HIV prevention efforts made in England.  The policy further intends to use a multi-faceted approach by using HIV prevention campaigns, scaling up HIV PrEP and optimising rapid treatment as well as care services (Gov 2023).

The policy finally intends to make campaigns, biomedical interventions, distribute condoms and develop innovative methods to increase their reach towards diverse demographics. Thus, the intentions of the policy are mainly related to reducing HIV transmission, increase awareness and address the mitigation of HIV related stigma by awareness and education campaigns. The implementation of this policy involves a massive investment of more than £3.5 million.

The policy supports PrEP through financial investment, evaluation, and monitoring of frameworks. However, the policy implementation is subjected to several conditions and challenges, which affect its preferences. Preferences include a specific focus on using evidence based approaches, local authority associations, and the development of unique models. On the other hand, conditions involve setting specific standards of testing rates, evaluation and monitoring the innovation effectiveness in care delivery.

However, there are several challenges of implementing this policy. These challenges include testing rate disparities based on demographics. Addressing stigma within healthcare settings, especially among the dark people (Africans) is also another challenge. In 2019, this policy has covered 65% of the HIV testing and therefore can be stated to be a significantly popular as well as effective in addressing the gaps. However, this policy also has some strengths as well as weaknesses (Gov 2023).

The strengths lie in the comprehensive approach in covering testing, treatment, prevention and well-being. A specific focus on evidence-based strategies, innovative approaches and collaboration adds to the strength of the policy.Furthermore, the policy has been evaluated using the Nancy Kass ethics framework in the following section. 

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Ethical Framework

An ethical framework is a set of ethical guidelines that provide direction and structure for deciding what is morally right or wrong. When deciding what kind of conduct could result in the greatest moral end, ethical frameworks are helpful viewpoints (van Bruchemet al. 2020).  There are several ethical frameworks available, and the one chosen will rely on the values and beliefs of the individual.The purpose of an ethical framework is to assess whether the policy and its guidelines align with ethical values and principles.

Evaluating public health policies is importance since it helps an individual to understand the efficacy, effectiveness and intervention equity aimed at the improvement of population health (Mastroianni et al. 2019). Moreover, effectiveness assessment includes impact on health outcomes, identification of best practices and challenges associated with the policy.

Equity and social justice were observed to be associated with the policy and therefore it has to be evaluated too in order to understand the impact of the policy on reducing disparity.

While evaluating a policy by using an ethical framework, a few of the most important ethical factors that need to be included are avoiding conflicts of interest, upholding one's objectivity, preserving justice, openness, full disclosure, privacy, and secrecy, as well as respect, responsibility, accountability, empowerment, along with sustainability (Akrami et al. 2018).

In the context of evaluating public health intervention by using ethical framework, can aid those working in public health in recognising and addressing moral dilemmas. They can also assist people in making more ethical judgements by providing them with better information.

In this research, the selected ethical framework for this public health policy evaluation is Nancy Kass framework (Morain et al. 2019). The ethical framework was selected to evaluate the policy since it includes social value, scientific validity, fair subject selection, favourable risk benefit ratio, independent review and informed consent-based assessment for policies.  

From the research of Kass (2001), it was found that this is not a code of ethics for professionals; one would normally deal with broad standards and expectations of professional conduct, and one would most likely come from a professional association. As an analytical tool, however, this one is meant to assist public health professionals in thinking through the ethical implications of suggested interventions, policy recommendations, research projects, and programmes.

This ethical framework contains a total of 6-steps such as “What are the public health goals of the proposed program?”, “How effective is the program in achieving its stated goals?”, “What are the known or potential burdens of the program?”, “Can burdens be minimized? Are there alternative approaches?”, “Is the program implemented fairly?”, and “How can the benefits and burdens of a program be fairly balanced?” (Omer2013).

It has also been very evident that the professionals who are associated with the public health must go through all the steps of this ethics framework of analysis comprehensively to assure the public about the integrity of the selected public health policy that are analysed with the help of this tool. Therefore, in this context the selection of this framework for the current policy assessment can be stated to be justified. 

Applying the Ethical Framework to the Chosen Policy

In this section, the comprehensive analysis will be done by analysing the selected policy that is “Towards Zero - An action plan towards ending HIV transmission, AIDS and HIV-related deaths in England - 2022 to 2025” with the help of the selected ethical framework which is Kass-6 step framework of evaluation.

From the above-mentionedsections, it could be found that the selected ethical framework of Nancy Kass has 6 specific steps. By using those steps and relating with the selected public health policy a comprehensive evaluation has been done and mentioned below. 

Step 1. What are the public health goals of the proposed program?

Answer – The "Towards Zero" policyselected in this context has been focused to endthe transmission of HIV in England and this policy has been very ambitious. Furthermore, this policy aimed toeradicate new transmissions of HIV cases, and decrease the overall death rates related to HIV, and AIDS, along with improving the public health of England from 2022 to 2025.

Furthermore, to achieve the objectives of the policy, additional goals there have been takenwhere focused to Early detection and treatment, which are associated with direct reduction of mortality associated with HIV as well as morbidity. If the disease is diagnosed at early stage, life span can be increased and immediately mortality can be reduced. Optimizing treatment access further reduces disparity in access to healthcare sectors (Bhaskaran et al. 2021).

People from all sections from the society will get access to every healthcare service at an early stage. Finally, providing holistic support and ensuring well-being of the people can be stated to be beneficial in reducing morbidity and mortality associated with the disease. 

Overall, the ultimate goal of this policy could be stated as commendable, since it focus to achieve maximum public health improvement by achieving zero new HIV transmissions, cases of AIDS and maximum reduction of each HIV associated deaths. This reflects that this policy as comprehensive oneto address the public health issue directly and improving overall public health outcomes.

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Step 2. How effective is the program in achieving its stated goals?

Answer – The program aims at achieving 90% testing rates in order to reduce HIV transmission. A specific focus on investing in HIV PrEP as well as improving access for specific populations is also a necessary step. Efforts for reduction for missed testing opportunities in high prevalence regions were aimed to address later HIV diagnosis (Otto et al. 2021).

The program has been observed to be effective in increasing access to treatment. It has been seen that, the policy aims to identify and develop widespread testing, early diagnosis of HIV, along with initiating prompt treatment process, and comprehensively supportthe services for treating the HIV patients.

The logic model of this policy aligns with various scientific evidence that indicated about early detection and treatment in the cases of HIV, to reduce viral loads and successful prevention of the virus transmission (Smith et al. 2013). The research done on   Treatment as Prevention (TasP) and Pre-Exposure Prophylaxis (PrEP) have been found to provide strong empirical foundation for this step. 

Step 3.What are the known or potential burdens of the program?

Answer –The potential burdens regarding privacy and confidentiality risk reduction includes testing data security, autonomy and liberty risks are associated with consent issues and justice risks are related to disparities in testing. Stigmatization is also a major burden of the program since it might face challenges in addressing discrimination of groups to participate in the program (Hiv 2020). Informed consent is a specific mitigation strategy to ensure testing and notification of partners on what test is to be conducted to reduce HIV transmission.

This policy has foundfocusing to maintain the confidentiality and privacy of the individuals undergoing HIV testing, hey that increase the robustness of the privacy protection aspect of the policy. From the autonomy and liberty perspective, this policy indicated that autonomy and voluntary testing would be promotedthat overall maintain the ethics from the autonomy aspect. One of the major goals of this policy was toensure equitable access of the services in the nation that insured about the justice ethical principle. 

Step 4. Can burdens be minimized? Are there alternative approaches?

Answer – The burdens can be minimised by increasing the reach of policy to a larger section of the society. By implementing as well as communicating anonymous testing options and maintaining the privacy, this policy could be a robust oneto minimise cancel associated with privacy and confidentiality. Moreover, by giving priorityto the voluntary testing and voluntary treatment processes bygivingrespect to the persons autonomy this policy successfully minimises the risk of ethical violations.

Furthermore, by ensuring the justice ethics, hey by providing the service access to every individual in equitable manner this policy could be successfully minimise the battle of the disease in the nation. From the aspect of alternative strategies, it could be stated that this policy focused on community-based testing along with decentralization of healthcare services which might be successful in minimisingthe burden of the disease and improving the effectiveness of the policy. 

Step 5. Is the program implemented fairly?

Answer – The programs has been implemented fairly. None of the groups face any burden and the program will decrease inequalities by reducing disparity. The program should be universal in reducing the prevalence of HIV on a worldwide basis and not only on England (van Sighem and van der Valk 2022).  The programs will be better implemented if restrictive measures are proposed.

Furthermore, it could be added thatto ensure fair implementation, this policy giving priority to equitable distribution of benefitsthat involves strategic development to ensure equitable access to diagnosis and services of treatment to the population.

To attain this, a comprehensive and concerted efforthave been needed to fill the existing gaps in health access and outcomes and therefore the policy is successfulto prevent theexacerbationof health inequalities. In addition, it could be added that in the implementation process of the policy to target specific population who have higher rate of HIV compared to othersis vital, however it requires a careful approach to avoid overall stereotypes, that were evident in this policy. 

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Step 6. How can the benefits and burdens of a program be fairly balanced?

Answer – This is the last step ofthe 6- step ethical framework selected to evaluate the policy. This step entails that a balance will be automatically obtained where a higher burden associated with the program will produce higher benefits for the associated public. By evaluating the policy, it was seen that to balance the benefits and burdens of the program, a democratic process has been involved in this policy to involve a white array of stakeholders.

This policy has taken an inclusive approach that not only facilitate ongoing evaluation, but alsoenablea wide range of population of the nation to take part in making the policy successful. In addition, this policy incorporated procedural justice mechanism, that has been significant to maintain the nature and responsiveness of the policy that make this policy an ethical one and might help this policy to become successful by fulfillingthe objectives.

Discussion

Through the utilization of independent assessments, stakeholder participation, and solutions based on evidence, the National HIV Prevention Programme shows its dedication to ethical considerations. The focus on improving partner notification, reducing late diagnosis probabilities, increasing testing rates, maximizing PrEP availability, and boosting the quality of life for HIV-positive individuals is consistent with the moral principles of beneficence, equality, and autonomy respect (Nichols and van der Valk 2021).

The paper outlines mitigation techniques and attracts attention to possible risks, including privacy problems and discrepancies in testing, in order to determine if the implementation has produced more benefit than damage. The success associated with this program has been observed to be not so focussed since it the harmful effects or undesirable impacts of this program has not been discussed.

According to Hanum et al. (2020), it has been observed that the success of this policy is dependent on how the people’s quality of life is affected. If the quality of life of the people  were observed to have been affected, changes will be necessary in the policy. Thus, it can be said that the ethical integrity of the program is significant in order to complete all the objectives as well as reach the aim of the programme. Depending on the population requirements, policy change is necessary. 

The "Towards Zero" policy for ending HIV transmission in England from 2022 to 2025has been very effective as per the evolution done on the basis of ethical framework. By prioritising equitable distributionof the services and intervention to the common population this policy insured universal access that ultimately promoted the inclusivity and person centered approach used in healthcare sector to improve the patient outcomes (Lathouraet al. 2020).  

Furthermore, by actively implementing the steps required to address existing gaps this policy have been very proactive to overcome the discrimination and protecting the principles of justice in the healthcare sector (Varkey 2021). Furthermore, the approach taken in the policy acknowledged the unique requirement of target population by respecting the dignity which is essential from the aspect of healthcare ethics (Varkey 2021).

In addition to these, the commitment of the policy to stay compliant to a democratic process by involving the wide arrays of stakeholders and ensuring their active participation, this policy promoted the concept of transparency and accountability. Overall, from ethical aspect this policy, could be stated as a sound one.

Conclusion

On a concluding note, it can be stated that this article utilized the Nancy Kass Framework to assess the National HIV Prevention Programme in England. "Towards Zero," , which is the strategy to reduce HIV transmission. The policy concentrates on the important objective of preventing HIV infection and deaths from AIDS. This policy also lays forth certain goals with an emphasis on treatment, prevention, testing, and enhancing the quality of life for HIV-positive individuals.

The program's conformity with the ethical precepts of beneficence, fairness, and respect for autonomy is highlighted by the ethical evaluation conducted using the Kass framework. The comprehensive approach and evidence-based tactics employed by the policy are noteworthy; nevertheless, ongoing focus is necessary to address possible difficulties related to privacy, autonomy, and justice.

Reducing inequities, reducing stigma, and ensuring ongoing ethical review should be given top priority in future modifications in order to preserve the program's effectiveness and ethical integrity. 

 

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