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Impact of decentralisation of antiretroviral therapy services on HIV testing and care at a population level in Agago District in rural Northern Uganda: results from the Lablite population surveys

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  • George Abongomera
  • Sylvia Kiwuwa-Muyingo
  • Paul Revill
  • Levison Chiwaula
  • Travor Mabugu
  • Andrew N Phillips
  • Elly Katabira
  • Adrienne K Chan
  • Charles Gilks
  • Victor Musiime
  • James Hakim
  • Cissy Kityo
  • Robert Colebunders
  • Diana M Gibb
  • Janet Seeley
  • Deborah Ford
  • Lablite Project Team


Publication details

JournalInternational Health
DateAccepted/In press - 22 Feb 2017
DatePublished (current) - 10 Mar 2017
Issue number2
Number of pages10
Original languageEnglish


Background: We conducted unlinked cross-sectional population-based surveys in Northern Uganda before and after antiretroviral therapy (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 decentralisation, people travelled 56-76 km round-trip for ART; we aimed to evaluate changes in uptake of HIV-testing, ART coverage and access to ART following decentralisation.

Methods: A total of 2124 adults in 1351 households in two parishes closest to Lira Kato HC were interviewed using questionnaires between March and April 2013 and 2123 adults in 1229 households between January and March 2015.

Results: Adults reporting HIV-testing in the last year increased from 1077/2124 (50.7%) to 1298/2123 (61.1%) between surveys (p<0.001). ART coverage increased from 74/136 (54.4%) self-reported HIV-positive adults in 2013 to 108/133 (81.2%) in 2015 (p<0.001). Post-decentralisation, 47/108 (43.5%) of those on ART were in care at Lira Kato HC (including 37 new initiations). Most of the remainder (47/61, 77%) 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 (30/59, 51%).

Conclusions: HIV-testing and ART coverage increased after decentralisation combined with Option B+ roll-out. However, patients on ART before decentralisation were reluctant to transfer to their local facility.

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© The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details

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