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

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Author(s)

  • George Abongomera
  • Levison Chiwaula
  • Paul Revill
  • Travor Mabugu
  • Edward Tumwesige
  • Misheck J Nkhata
  • Fabian Cataldo
  • J van Oosterhout
  • Robert Colebunders
  • Adrienne K Chan
  • Cissy Kityo
  • Charles F Gilks
  • James Hakim
  • Janet Seeley
  • Diana M Gibb
  • Deborah Ford

Department/unit(s)

Publication details

JournalInternational Health
DateAccepted/In press - 28 Nov 2017
DateE-pub ahead of print (current) - 10 Jan 2018
Number of pages12
Early online date10/01/18
Original languageEnglish

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.

Bibliographical note

©The Author(s) 2018.

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  • Journal Article

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