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

Abongomera, George; Chiwaula, Levison; Revill, Paul; Mabugu, Travor; Tumwesige, Edward; Nkhata, Misheck; Cataldo, Fabian; van Oosterhout, J.; Colebunders, Robert; Chan, Adrienne K.; Kityo, Cissy; Gilks, Charles; Hakim, James; Seeley, Janet; Gibb, Diana M.; Ford, Deborah

Abstract

Background 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. Methods 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). Results 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. Conclusions Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time.

Citation

Abongomera, G., Chiwaula, L., Revill, P., Mabugu, T., Tumwesige, E., Nkhata, M., …Ford, D. (2018). Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda. International Health, 10(1), 8-19. https://doi.org/10.1093/inthealth/ihx061

• Journal Article Type: Article
• Acceptance Date: Nov 28, 2017
• Online Publication Date: Jan 10, 2018
• Publication Date: Jan 10, 2018
• Deposit Date: Mar 20, 2018
• Publicly Available Date: Apr 25, 2018
• Journal: International Health
• Print ISSN: 1876-3413
• Electronic ISSN: 1876-3405
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 10
• Issue: 1
• Pages: 8-19
• DOI: https://doi.org/10.1093/inthealth/ihx061
• Public URL: https://durham-repository.worktribe.com/output/1364153