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

Gibb, DM; Ford, D; Seeley, J; Hakim, J; Gilks, C; Kityoa, C; Chan, A; ... Abongomera, G; + view all (2018) Patient level benefits associated with decentralisation of antiretroviral therapy services to primary health facilities in Malawi and Uganda. International Health , 10 (1) pp. 8-19. 10.1093/inthealth/ihx061. Green open access

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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.

Type: Article
Title: Patient level benefits associated with decentralisation of antiretroviral therapy services to primary health facilities in Malawi and Uganda
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/inthealth/ihx061
Publisher version: http://dx.doi.org/10.1093/inthealth/ihx061
Language: English
Additional information: © 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.
Keywords: HIV services, Antiretroviral therapy, Decentralization, Patient costs, Equity, Malawi, Uganda
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > UCL SLASH
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS > SHS Faculty Office
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS > SHS Faculty Office > UCL Institute for Advanced Studies
URI: https://discovery.ucl.ac.uk/id/eprint/10039498
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