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Impact of decentralization of Antiretroviral Therapy services on HIV testing and care at population level in Agago District in rural Northern Uganda: Results from the Lablite population surveys

Gibb, DM; Ford, D; (2017) Impact of decentralization of Antiretroviral Therapy services on HIV testing and care at population level in Agago District in rural Northern Uganda: Results from the Lablite population surveys. International Health , 9 (2) pp. 91-99. 10.1093/inthealth/ihx006. Green open access

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Abstract

BACKGROUND: We conducted unlinked cross-sectional population-based surveys in Northern Uganda before and after ART provision (including Option B+ (lifelong ART for pregnant/breast-feeding women)) at a local primary care facility (Lira Kato Health Centre (HC)).Prior to decentralization, people travelled 56-76km round-trip for ART; we aimed to evaluate changes in uptake of HIV-testing, ART coverage and access to ART following decentralization. / METHODS: 2124 adults in 1351 households in 2 parishes closest to Lira Kato HC were interviewed using questionnaires between March-April/2013; 2123 adults in 1229 households between January-March/2015. / RESULTS: Adults reporting HIV-testing in the last year increased from 1077/2124 (51%) to 1298/2123 (61%) between surveys (p<0.001). ART coverage increased from 74/136(54%) self-reported HIV-positive adults in 2013 to 108/133 (81%) in 2015 (p<0.001). Post-decentralization, 47/108(44%) of those on ART were in care at Lira Kato HC (including 37 new initiations). Most of the remainder (47/61) started ART prior to any ART provision at Lira Kato HC; the most common reason given for not accessing ART locally was concern about drug-stock-outs (30 (51%)). / CONCLUSIONS: HIV-testing and ART coverage increased after decentralization combined with Option B+ roll-out. However, patients on ART before decentralisation were reluctant to transfer to their local facility.

Type: Article
Title: Impact of decentralization of Antiretroviral Therapy services on HIV testing and care at population level in Agago District in rural Northern Uganda: Results from the Lablite population surveys
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/inthealth/ihx006
Publisher version: http://doi.org/10.1093/inthealth/ihx006
Language: English
Additional information: © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Antiretroviral therapy decentralization, Uganda, Sub-Saharan Africa, Population survey, HIV services
UCL classification: UCL
UCL > Provost and Vice Provost Offices
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
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 > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1535264
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