A Mixed-methods Evaluation of the Uptake of Novel Differentiated ART Delivery Models in a National Sample of Health Facilities in Uganda

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2021 Jul 22

PMID 34292984

Citations 19

Authors

Henry Zakumumpa

Kimani Makobu

Wilbrod Ntawiha

Everd Maniple

Affiliations

Soon will be listed here.

Abstract

Introduction: Since 2017, Uganda has been implementing five differentiated antiretroviral therapy (ART) delivery models to improve the quality of HIV care and to achieve health-system efficiencies. Community-based models include Community Client-Led ART Delivery and Community Drug Distribution Points. Facility-based models include Fast Track Drug Refill, Facility Based Group and Facility Based Individual Management. We set out to assess the extent of uptake of these ART delivery models and to describe barriers to uptake of either facility-based or community-based models.

Methods: Between December 2019 and February 2020, we conducted a mixed-methods study entailing a cross-sectional health facility survey (n = 116) and in-depth interviews (n = 16) with ART clinic managers in ten case-study facilities as well as six focus group discussions (56 participants) with patients enrolled in differentiated ART models. Facilities were selected based on the 10 geographic sub-regions of Uganda. Statistical analyses were performed in STATA (v13) while qualitative data were analysed by thematic approach.

Results: Most facilities 63 (57%) commenced implementation of differentiated ART delivery in 2018. Fast Track Drug Delivery was the most common facility-based model (implemented in 100 or 86% of health facilities). Community Client-Led ART Delivery was the most popular community model (63/116 or 54%). Community Drug Distribution Points had the lowest uptake with only 33 (24.88%) facilities implementing them. By ownership-type, for-profit facilities reported the lowest uptake of differentiated ART models. Barriers to enrolment in community-based models include HIV-related stigma and low enrolment of adult males in community models.

Conclusion: To the best of our knowledge this is the first study reporting national coverage of differentiated ART delivery models in Uganda. Overall, there has been a higher uptake of facility-based models. Interventions for enhancing the uptake of differentiated ART models in for-profit facilities are recommended.

Citing Articles

Impact of Differentiated Service Delivery Models on Quality of Life among People living with HIV in Uganda - A Quasi-Experimental Study.

Nasasira B, Banturaki G, Kalema N, Musaazi J, Nanvuma A, Okoboi S Res Sq. 2025; .

PMID: 39764111 PMC: 11702836. DOI: 10.21203/rs.3.rs-5443965/v1.

Feasibility and Impact of Community Pharmacy and Novel Pick-up Points for Antiretroviral Therapy Pre-exposure Prophylaxis Initiation and Continuation in Low and Middle-income Countries.

Lalla-Edward S, Venter W Curr HIV/AIDS Rep. 2024; 22(1):2.

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Costs and resource distribution of direct services for HIV in Uganda.

Ekirapa E, Jordan M, Nong T, Marton T, Balidawa H, Ssempala R BMJ Open. 2024; 14(10):e082062.

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Evaluating Antiretroviral Therapy Service Delivery Models Through Lot Quality Assurance Sampling in Central Uganda.

Mukama S, Nakawesi J, Bindeeba D, Ezajobo S, Mugisa A, Senyimba C HIV AIDS (Auckl). 2024; 16:337-354.

PMID: 39258105 PMC: 11385700. DOI: 10.2147/HIV.S475258.

Long-acting injectable antiretroviral treatment: experiences of people with HIV and their healthcare providers in Uganda.

Zakumumpa H, Alinaitwe A, Kyomuhendo M, Nakazibwe B BMC Infect Dis. 2024; 24(1):876.

PMID: 39198739 PMC: 11360315. DOI: 10.1186/s12879-024-09748-5.

References

Wilkinson L, Grimsrud A . The time is now: expedited HIV differentiated service delivery during the COVID-19 pandemic. J Int AIDS Soc. 2020; 23(5):e25503. PMC: 7203569. DOI: 10.1002/jia2.25503. View

Duncombe C, Rosenblum S, Hellmann N, Holmes C, Wilkinson L, Biot M . Reframing HIV care: putting people at the centre of antiretroviral delivery. Trop Med Int Health. 2015; 20(4):430-47. PMC: 4670701. DOI: 10.1111/tmi.12460. View

Yotebieng M, Brazier E, Addison D, Kimmel A, Cornell M, Keiser O . Research priorities to inform "Treat All" policy implementation for people living with HIV in sub-Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA). J Int AIDS Soc. 2019; 22(1):e25218. PMC: 6338103. DOI: 10.1002/jia2.25218. View

Zakumumpa H, Bennett S, Ssengooba F . Accounting for variations in ART program sustainability outcomes in health facilities in Uganda: a comparative case study analysis. BMC Health Serv Res. 2016; 16(1):584. PMC: 5070310. DOI: 10.1186/s12913-016-1833-4. View

Sengupta S, Banks B, Jonas D, Miles M, Smith G . HIV interventions to reduce HIV/AIDS stigma: a systematic review. AIDS Behav. 2010; 15(6):1075-87. PMC: 3128169. DOI: 10.1007/s10461-010-9847-0. View

Sharer M, Davis N, Makina N, Duffy M, Eagan S . Differentiated Antiretroviral Therapy Delivery: Implementation Barriers and Enablers in South Africa. J Assoc Nurses AIDS Care. 2019; 30(5):511-520. PMC: 6738628. DOI: 10.1097/JNC.0000000000000062. View

Gilson L, Hanson K, Sheikh K, Agyepong I, Ssengooba F, Bennett S . Building the field of health policy and systems research: social science matters. PLoS Med. 2011; 8(8):e1001079. PMC: 3160340. DOI: 10.1371/journal.pmed.1001079. View

Rabkin M, Strauss M, Mantell J, Mapingure M, Masvawure T, Lamb M . Optimizing differentiated treatment models for people living with HIV in urban Zimbabwe: Findings from a mixed methods study. PLoS One. 2020; 15(1):e0228148. PMC: 6986745. DOI: 10.1371/journal.pone.0228148. View

Li A, Fung K, Maticka-Tyndale E, Wong J . Effects Of HIV stigma reduction interventions in diasporic communities: insights from the CHAMP study. AIDS Care. 2017; 30(6):739-745. DOI: 10.1080/09540121.2017.1391982. View

10.

Olivier J, Tsimpo C, Gemignani R, Shojo M, Coulombe H, Dimmock F . Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction. Lancet. 2015; 386(10005):1765-75. DOI: 10.1016/S0140-6736(15)60251-3. View

11.

Zakumumpa H, Taiwo M, Muganzi A, Ssengooba F . Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda. Hum Resour Health. 2016; 14(1):63. PMC: 5070071. DOI: 10.1186/s12960-016-0160-5. View

12.

Adjetey V, Obiri-Yeboah D, Dornoo B . Differentiated service delivery: a qualitative study of people living with HIV and accessing care in a tertiary facility in Ghana. BMC Health Serv Res. 2019; 19(1):95. PMC: 6360720. DOI: 10.1186/s12913-019-3878-7. View

13.

Levesque J, Harris M, Russell G . Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013; 12:18. PMC: 3610159. DOI: 10.1186/1475-9276-12-18. View

14.

Prust M, Banda C, Nyirenda R, Chimbwandira F, Kalua T, Jahn A . Multi-month prescriptions, fast-track refills, and community ART groups: results from a process evaluation in Malawi on using differentiated models of care to achieve national HIV treatment goals. J Int AIDS Soc. 2017; 20(Suppl 4):21650. PMC: 5577715. DOI: 10.7448/IAS.20.5.21650. View

15.

Zakumumpa H, Rujumba J, Kwiringira J, Katureebe C, Spicer N . Understanding implementation barriers in the national scale-up of differentiated ART delivery in Uganda. BMC Health Serv Res. 2020; 20(1):222. PMC: 7077133. DOI: 10.1186/s12913-020-5069-y. View

16.

Golin R, Godfrey C, Firth J, Lee L, Minior T, Phelps B . PEPFAR's response to the convergence of the HIV and COVID-19 pandemics in Sub-Saharan Africa. J Int AIDS Soc. 2020; 23(8):e25587. PMC: 7405155. DOI: 10.1002/jia2.25587. View

17.

Pope C, Mays N . Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ. 1995; 311(6996):42-5. PMC: 2550091. DOI: 10.1136/bmj.311.6996.42. View

18.

Ford N, Geng E, Ellman T, Orrell C, Ehrenkranz P, Sikazwe I . Emerging priorities for HIV service delivery. PLoS Med. 2020; 17(2):e1003028. PMC: 7021280. DOI: 10.1371/journal.pmed.1003028. View

19.

Widmer M, Betran A, Merialdi M, Requejo J, Karpf T . The role of faith-based organizations in maternal and newborn health care in Africa. Int J Gynaecol Obstet. 2011; 114(3):218-22. DOI: 10.1016/j.ijgo.2011.03.015. View

20.

Reidy W, Rabkin M, Syowai M, Schaaf A, El-Sadr W . Patient-level and program-level monitoring and evaluation of differentiated service delivery for HIV: a pragmatic and parsimonious approach is needed. AIDS. 2017; 32(3):399-401. PMC: 5768233. DOI: 10.1097/QAD.0000000000001723. View