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The Lablite project: A cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe

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The Lablite project : A cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe. / Chan, Adrienne K; Ford, Deborah; Namata, Harriet; Muzambi, Margaret; Nkhata, Misheck J; Abongomera, George; Mambule, Ivan; South, Annabelle; Revill, Paul; Grundy, Caroline; Mabugu, Travor; Chiwaula, Levison; Cataldo, Fabian; Hakim, James; Seeley, Janet; Kityo, Cissy; Reid, Andrew; Katabira, Elly; Sodhi, Sumeet; Gilks, Charles F; Gibb, Diana M.

In: BMC Health Services Research, Vol. 14, 19.08.2014.

Research output: Contribution to journalArticle

Harvard

Chan, AK, Ford, D, Namata, H, Muzambi, M, Nkhata, MJ, Abongomera, G, Mambule, I, South, A, Revill, P, Grundy, C, Mabugu, T, Chiwaula, L, Cataldo, F, Hakim, J, Seeley, J, Kityo, C, Reid, A, Katabira, E, Sodhi, S, Gilks, CF & Gibb, DM 2014, 'The Lablite project: A cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe', BMC Health Services Research, vol. 14. https://doi.org/10.1186/1472-6963-14-352

APA

Chan, A. K., Ford, D., Namata, H., Muzambi, M., Nkhata, M. J., Abongomera, G., ... Gibb, D. M. (2014). The Lablite project: A cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe. BMC Health Services Research, 14. https://doi.org/10.1186/1472-6963-14-352

Vancouver

Chan AK, Ford D, Namata H, Muzambi M, Nkhata MJ, Abongomera G et al. The Lablite project: A cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe. BMC Health Services Research. 2014 Aug 19;14. https://doi.org/10.1186/1472-6963-14-352

Author

Chan, Adrienne K ; Ford, Deborah ; Namata, Harriet ; Muzambi, Margaret ; Nkhata, Misheck J ; Abongomera, George ; Mambule, Ivan ; South, Annabelle ; Revill, Paul ; Grundy, Caroline ; Mabugu, Travor ; Chiwaula, Levison ; Cataldo, Fabian ; Hakim, James ; Seeley, Janet ; Kityo, Cissy ; Reid, Andrew ; Katabira, Elly ; Sodhi, Sumeet ; Gilks, Charles F ; Gibb, Diana M. / The Lablite project : A cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe. In: BMC Health Services Research. 2014 ; Vol. 14.

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@article{f590b7e7c4f14f22bf3b682f1a6d3591,
title = "The Lablite project: A cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe",
abstract = "BACKGROUND: In sub-Saharan Africa antiretroviral therapy (ART) is being decentralized from tertiary/secondary care facilities to primary care. The Lablite project supports effective decentralization in 3 countries. It began with a cross-sectional survey to describe HIV and ART services.METHODS: 81 purposively sampled health facilities in Malawi, Uganda and Zimbabwe were surveyed.RESULTS: The lowest level primary health centres comprised 16/20, 21/39 and 16/22 facilities included in Malawi, Uganda and Zimbabwe respectively. In Malawi and Uganda most primary health facilities had at least 1 medical assistant/clinical officer, with average 2.5 and 4 nurses/midwives for median catchment populations of 29,275 and 9,000 respectively. Primary health facilities in Zimbabwe were run by nurses/midwives, with average 6 for a median catchment population of 8,616. All primary health facilities provided HIV testing and counselling, 50/53 (94{\%}) cotrimoxazole preventive therapy (CPT), 52/53 (98{\%}) prevention of mother-to-child transmission of HIV (PMTCT) and 30/53 (57{\%}) ART management (1/30 post ART-initiation follow-up only). All secondary and tertiary-level facilities provided HIV and ART services. In total, 58/81 had ART provision. Stock-outs during the 3 months prior to survey occurred across facility levels for HIV test-kits in 55{\%}, 26{\%} and 9{\%} facilities in Malawi, Uganda and Zimbabwe respectively; for CPT in 58{\%}, 32{\%} and 9{\%} and for PMTCT drugs in 26{\%}, 10{\%} and 0{\%} of facilities (excluding facilities where patients were referred out for either drug). Across all countries, in facilities with ART stored on-site, adult ART stock-outs were reported in 3/44 (7{\%}) facilities compared with 10/43 (23{\%}) facility stock-outs of paediatric ART. Laboratory services at primary health facilities were limited: CD4 was used for ART initiation in 4/9, 5/6 and 13/14 in Malawi, Uganda and Zimbabwe respectively, but frequently only in selected patients. Routine viral load monitoring was not used; 6/58 (10{\%}) facilities with ART provision accessed centralised viral loads for selected patients.CONCLUSIONS: Although coverage of HIV testing, PMTCT and cotrimoxazole prophylaxis was high in all countries, decentralization of ART services was variable and incomplete. Challenges of staffing and stock management were evident. Laboratory testing for toxicity and treatment effectiveness monitoring was not available in most primary level facilities.",
author = "Chan, {Adrienne K} and Deborah Ford and Harriet Namata and Margaret Muzambi and Nkhata, {Misheck J} and George Abongomera and Ivan Mambule and Annabelle South and Paul Revill and Caroline Grundy and Travor Mabugu and Levison Chiwaula and Fabian Cataldo and James Hakim and Janet Seeley and Cissy Kityo and Andrew Reid and Elly Katabira and Sumeet Sodhi and Gilks, {Charles F} and Gibb, {Diana M}",
year = "2014",
month = "8",
day = "19",
doi = "10.1186/1472-6963-14-352",
language = "English",
volume = "14",
journal = "BMC Health Services Research",
issn = "1472-6963",
publisher = "BioMed Central",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - The Lablite project

T2 - A cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe

AU - Chan, Adrienne K

AU - Ford, Deborah

AU - Namata, Harriet

AU - Muzambi, Margaret

AU - Nkhata, Misheck J

AU - Abongomera, George

AU - Mambule, Ivan

AU - South, Annabelle

AU - Revill, Paul

AU - Grundy, Caroline

AU - Mabugu, Travor

AU - Chiwaula, Levison

AU - Cataldo, Fabian

AU - Hakim, James

AU - Seeley, Janet

AU - Kityo, Cissy

AU - Reid, Andrew

AU - Katabira, Elly

AU - Sodhi, Sumeet

AU - Gilks, Charles F

AU - Gibb, Diana M

PY - 2014/8/19

Y1 - 2014/8/19

N2 - BACKGROUND: In sub-Saharan Africa antiretroviral therapy (ART) is being decentralized from tertiary/secondary care facilities to primary care. The Lablite project supports effective decentralization in 3 countries. It began with a cross-sectional survey to describe HIV and ART services.METHODS: 81 purposively sampled health facilities in Malawi, Uganda and Zimbabwe were surveyed.RESULTS: The lowest level primary health centres comprised 16/20, 21/39 and 16/22 facilities included in Malawi, Uganda and Zimbabwe respectively. In Malawi and Uganda most primary health facilities had at least 1 medical assistant/clinical officer, with average 2.5 and 4 nurses/midwives for median catchment populations of 29,275 and 9,000 respectively. Primary health facilities in Zimbabwe were run by nurses/midwives, with average 6 for a median catchment population of 8,616. All primary health facilities provided HIV testing and counselling, 50/53 (94%) cotrimoxazole preventive therapy (CPT), 52/53 (98%) prevention of mother-to-child transmission of HIV (PMTCT) and 30/53 (57%) ART management (1/30 post ART-initiation follow-up only). All secondary and tertiary-level facilities provided HIV and ART services. In total, 58/81 had ART provision. Stock-outs during the 3 months prior to survey occurred across facility levels for HIV test-kits in 55%, 26% and 9% facilities in Malawi, Uganda and Zimbabwe respectively; for CPT in 58%, 32% and 9% and for PMTCT drugs in 26%, 10% and 0% of facilities (excluding facilities where patients were referred out for either drug). Across all countries, in facilities with ART stored on-site, adult ART stock-outs were reported in 3/44 (7%) facilities compared with 10/43 (23%) facility stock-outs of paediatric ART. Laboratory services at primary health facilities were limited: CD4 was used for ART initiation in 4/9, 5/6 and 13/14 in Malawi, Uganda and Zimbabwe respectively, but frequently only in selected patients. Routine viral load monitoring was not used; 6/58 (10%) facilities with ART provision accessed centralised viral loads for selected patients.CONCLUSIONS: Although coverage of HIV testing, PMTCT and cotrimoxazole prophylaxis was high in all countries, decentralization of ART services was variable and incomplete. Challenges of staffing and stock management were evident. Laboratory testing for toxicity and treatment effectiveness monitoring was not available in most primary level facilities.

AB - BACKGROUND: In sub-Saharan Africa antiretroviral therapy (ART) is being decentralized from tertiary/secondary care facilities to primary care. The Lablite project supports effective decentralization in 3 countries. It began with a cross-sectional survey to describe HIV and ART services.METHODS: 81 purposively sampled health facilities in Malawi, Uganda and Zimbabwe were surveyed.RESULTS: The lowest level primary health centres comprised 16/20, 21/39 and 16/22 facilities included in Malawi, Uganda and Zimbabwe respectively. In Malawi and Uganda most primary health facilities had at least 1 medical assistant/clinical officer, with average 2.5 and 4 nurses/midwives for median catchment populations of 29,275 and 9,000 respectively. Primary health facilities in Zimbabwe were run by nurses/midwives, with average 6 for a median catchment population of 8,616. All primary health facilities provided HIV testing and counselling, 50/53 (94%) cotrimoxazole preventive therapy (CPT), 52/53 (98%) prevention of mother-to-child transmission of HIV (PMTCT) and 30/53 (57%) ART management (1/30 post ART-initiation follow-up only). All secondary and tertiary-level facilities provided HIV and ART services. In total, 58/81 had ART provision. Stock-outs during the 3 months prior to survey occurred across facility levels for HIV test-kits in 55%, 26% and 9% facilities in Malawi, Uganda and Zimbabwe respectively; for CPT in 58%, 32% and 9% and for PMTCT drugs in 26%, 10% and 0% of facilities (excluding facilities where patients were referred out for either drug). Across all countries, in facilities with ART stored on-site, adult ART stock-outs were reported in 3/44 (7%) facilities compared with 10/43 (23%) facility stock-outs of paediatric ART. Laboratory services at primary health facilities were limited: CD4 was used for ART initiation in 4/9, 5/6 and 13/14 in Malawi, Uganda and Zimbabwe respectively, but frequently only in selected patients. Routine viral load monitoring was not used; 6/58 (10%) facilities with ART provision accessed centralised viral loads for selected patients.CONCLUSIONS: Although coverage of HIV testing, PMTCT and cotrimoxazole prophylaxis was high in all countries, decentralization of ART services was variable and incomplete. Challenges of staffing and stock management were evident. Laboratory testing for toxicity and treatment effectiveness monitoring was not available in most primary level facilities.

U2 - 10.1186/1472-6963-14-352

DO - 10.1186/1472-6963-14-352

M3 - Article

VL - 14

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

ER -