Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda.


Abongomera, G; Chiwaula, L; Revill, P; Mabugu, T; Tumwesige, E; Nkhata, M; Cataldo, F; van Oosterhout, J; Colebunders, R; Chan, AK; Kityo, C; Gilks, C; Hakim, J; Seeley, J; Gibb, DM; Ford, D; (2018) Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda. Int Health. ISSN 1876-3405 DOI: https://doi.org/10.1093/inthealth/ihx061

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Abstract

The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities ('hubs') and lower-level health facilities ('spokes') in Phalombe district, Malawi and in Kalungu district, Uganda. We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46). In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1-Q2); patients at spokes were poorer than at a hub (57% vs 23% in Q1-Q2; p<0.001). In Uganda, 7% of patients mapped to Q1-Q2; patients at the rural spoke were poorer than at the two peri-urban facilities (15% vs 4% in Q1-Q2; p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30-120) in Malawi and 30 min (IQR 20-60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs. Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
PubMed ID: 29329396
URI: http://researchonline.lshtm.ac.uk/id/eprint/4646121

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