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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

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


Authors

George Abongomera

Levison Chiwaula

Paul Revill

Travor Mabugu

Edward Tumwesige

Misheck Nkhata

Fabian Cataldo

J. van Oosterhout

Robert Colebunders

Adrienne K. Chan

Cissy Kityo

Charles Gilks

James Hakim

Janet Seeley

Diana M. Gibb

Deborah Ford



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

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Publisher Licence URL
http://creativecommons.org/licenses/by/4.0/

Copyright Statement
© The Author(s) 2018. Published by Oxford University Press Royal Society of Tropical Medicine and Hygiene.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.





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