Population level usage of health services, and HIV testing and care, prior to decentralization of antiretroviral therapy in Agago District in rural Northern Uganda.

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Abstract

Decentralization of ART services scaled up significantly with the country wide roll out of option B plus in Uganda. Little work has been undertaken to examine population level access to HIV care particularly in hard to reach areas in rural Africa. Most work on ART scale up has been done at health facility level which omits people not accessing healthcare in the community. This study describes health service usage, particularly HIV testing and care in 2/6 parishes of Lapono sub-county of northern Uganda, prior to introduction of ART services in Lira Kato Health Centre (a local lower-level health centre III), as part of ART decentralization.

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Implementing antiretroviral therapy in rural communities: the Lusikisiki model of decentralized HIV/AIDS care.

Martha Bedelu, Nathan Ford, Katherine Hilderbrand … (2007)

Health worker shortages are a major bottleneck to scaling up antiretroviral therapy (ART), particularly in rural areas. In Lusikisiki, a rural area of South Africa with a population of 150,000 serviced by 1 hospital and 12 clinics, Médecins Sans Frontières has been supporting a program to deliver human immunodeficiency virus (HIV) services through decentralization to primary health care clinics, task shifting (including nurse-initiated as opposed to physician-initiated treatment), and community support. This approach has allowed for a rapid scale-up of treatment with satisfactory outcomes. Although the general approach in South Africa is to provide ART through hospitals-which seriously limits access for many people, if not the majority of people-1-year outcomes in Lusikisiki are comparable in the clinics and hospital. The greater proximity and acceptability of services at the clinic level has led to a faster enrollment of people into treatment and better retention of patients in treatment (2% vs. 19% lost to follow-up). In all, 2200 people were receiving ART in Lusikisiki in 2006, which represents 95% coverage. Maintaining quality and coverage will require increased resource input from the public sector and full acceptance of creative approaches to implementation, including task shifting and community involvement.

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Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review.

Mark J. Siedner, Alexander Tsai, Alexander Lankowski … (2014)

Difficulty obtaining reliable transportation to clinic is frequently cited as a barrier to HIV care in sub-Saharan Africa (SSA). Numerous studies have sought to characterize the impact of geographic and transportation-related barriers on HIV outcomes in SSA, but to date there has been no systematic attempt to summarize these findings. In this systematic review, we summarized this body of literature. We searched for studies conducted in SSA examining the following outcomes in the HIV care continuum: (1) voluntary counseling and testing, (2) pre-antiretroviral therapy (ART) linkage to care, (3) loss to follow-up and mortality, and (4) ART adherence and/or viral suppression. We identified 34 studies containing 52 unique estimates of association between a geographic or transportation-related barrier and an HIV outcome. There was an inverse effect in 23 estimates (44 %), a null association in 26 (50 %), and a paradoxical beneficial impact in 3 (6 %). We conclude that geographic and transportation-related barriers are associated with poor outcomes across the continuum of HIV care.

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Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-Natal, South Africa

Abraham Herbst, Graham Cooke, Till Bärnighausen … (2009)

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Author and article information

Journal

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC health services research

Publisher: Springer Science and Business Media LLC

ISSN (Electronic): 1472-6963

ISSN (Print): 1472-6963

Publication date (Electronic): Nov 28 2015

Volume: 15

Affiliations

[1 ] Joint Clinical Research Centre, Kampala, Uganda. gabongomera@jcrc.org.ug.

[2 ] University of Antwerp, Antwerp, Belgium. gabongomera@jcrc.org.ug.

[3 ] Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda. skiwuwa@yahoo.com.

[4 ] University of York, York, UK. paul.revill@york.ac.uk.

[5 ] Dignitas International, Zomba, Malawi. l.chiwaula@dignitasinternational.org.

[6 ] University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe. travormabugu@yahoo.com.

[7 ] University College London, London, UK. andrew.phillips@ucl.ac.uk.

[8 ] Infectious Diseases Institute, Makerere University, Kampala, Uganda. katabira@imul.com.

[9 ] Joint Clinical Research Centre, Kampala, Uganda. vmusiime@jcrc.org.ug.

[10 ] Makerere University College of Health Sciences, Kampala, Uganda. vmusiime@jcrc.org.ug.

[11 ] Imperial College London, London, UK. c.gilks@uq.edu.au.

[12 ] School of Population Health, University of Queensland, Brisbane, Australia. c.gilks@uq.edu.au.

[13 ] Dignitas International, Zomba, Malawi. a.chan@dignitasinternational.org.

[14 ] Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada. a.chan@dignitasinternational.org.

[15 ] University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe. jhakim@mweb.co.zw.

[16 ] University of Antwerp, Antwerp, Belgium. bcoleb@itg.be.

[17 ] Joint Clinical Research Centre, Kampala, Uganda. ckityo@jcrc.org.ug.

[18 ] Medical Research Council Clinical Trials Unit at UCL, London, UK. diana.gibb@ucl.ac.uk.

[19 ] Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda. janet.seeley@mrcuganda.org.

[20 ] London School of Hygiene and Tropical Medicine, London, UK. janet.seeley@mrcuganda.org.

[21 ] Medical Research Council Clinical Trials Unit at UCL, London, UK. deborah.ford@ucl.ac.uk.

Article

Publisher Item ID: 10.1186/s12913-015-1194-4

DOI: 10.1186/s12913-015-1194-4

PMC ID: 4662831

PubMed ID: 26615587

SO-VID: e81acdcb-f15c-40fa-acfc-c8feda1ed3ea

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Population level usage of health services, and HIV testing and care, prior to decentralization of antiretroviral therapy in Agago District in rural Northern Uganda.

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Abstract

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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 11

Implementing antiretroviral therapy in rural communities: the Lusikisiki model of decentralized HIV/AIDS care.

Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review.

Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-Natal, South Africa

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Cited by 7

Most referenced authors 166