The impact of PEPFAR transition on HIV service delivery at health facilities in Uganda


Autoři: Jess Alan Wilhelm aff001;  Mary Qiu aff001;  Ligia Paina aff001;  Elizabeth Colantuoni aff002;  Moses Mukuru aff003;  Freddie Ssengooba aff003;  Sara Bennett aff001
Působiště autorů: Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, United States of America aff001;  Johns Hopkins University, Bloomberg School of Public Health, Department of Biostatistics, Baltimore, Maryland, United States of America aff002;  Makerere University, School of Public Health, Department of Health Policy, Planning & Management, Kampala, Uganda aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223426

Souhrn

Background

Since 2004, the President’s Emergency Plan for AIDS Relief (PEPFAR) has played a large role in Uganda’s HIV/AIDS response. To better target resources to high burden regions and facilities, PEPFAR planned to withdraw from 29% of previously-supported health facilities in Uganda between 2015 and 2017.

Methods

We conducted a cross-sectional survey of 226 PEPFAR-supported health facilities in Uganda in mid-2017. The survey gathered information on availability, perceived quality, and access to HIV services before and after transition. We compare responses for facilities transitioned to those maintained on PEPFAR, accounting for survey design. We also extracted data from DHIS2 for the period October 2013–December 2017 on the number of HIV tests and counseling (HTC), number of patients on antiretroviral therapy (Current on ART), and retention on first-line ART (Retention) at 12 months. Using mixed effect models, we compare trends in service volume around the transition period.

Results

There were 206 facilities that reported transition and 20 that reported maintenance on PEPFAR. Some facilities reporting transition may have been in a gap between implementing partners. The median transition date was September 2016, nine months prior to the survey. Transition facilities were more likely to discontinue HIV outreach following transition (51.6% vs. 1.4%, p<0.001) and to report declines in HIV care access (43.5% vs. 3.1%, p<0.001) and quality (35.6% vs. 0%, p<0.001). However, transition facilities did not differ in their trends in HIV service volume relative to maintenance facilities.

Conclusions

Transition from PEPFAR resulted in facilities reporting worsening patient access and service quality for HIV care, but there is insufficient evidence to suggest negative impacts on volume of HIV services. Facility respondents’ perceptions about access and quality may be overly pessimistic, or they may signal forthcoming impacts. Unrelated to transition, declining retention on ART in Uganda is a cause for concern.

Klíčová slova:

AIDS – Antiretroviral therapy – Health services administration and management – HIV – HIV prevention – Seasonal variations – Surveys – Uganda


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