#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

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: https://doi.org/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 – Health services administration and management – HIV prevention – Seasonal variations – Surveys – Uganda


Zdroje

1. Ministy of Health. National Health Expenditure Uganda 2017. Kampala, Uganda: Ministry of Health; 2018.

2. UNAIDS. 90-90-90: An ambitious treatment target to help end the AIDS epidemic: UNAIDS; 2014 [Available from: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf.

3. PEPFAR. Uganda Country Operational Plan (COP) 2015 Strategic Direction Summary. 2015 September 1, 2015.

4. PEPFAR. Country/Regional Operational Plan (COP/ROP) 2015 Guidance. 2015 Fenruary 15, 2015.

5. Institute of Medicine. Evaluation of PEPFAR. Washington (DC): Institute of Medicine; 2013 February 20, 2013.

6. Lohman N, Hagopian A, Luboga SA, Stover B, Lim T, Makumbi F, et al. District Health Officer Perceptions of PEPFAR's Influence on the Health System in Uganda, 2005–2011. Int J Health Policy Manag. 2016;6(2):83–95.

7. Kates J, Wexler A, Lief E. Financing the Response to HIV in Low- and Middle-Income Countries in 2016. Kaiser Family Foundation, UNAIDS; 2017 July 21, 2017.

8. Silverman R. Projected Health Financing Transitions: Timeline and Magnitude Washington, D.C.: Center for Global Development; 2018 [Available from: https://www.cgdev.org/sites/default/files/projected-health-financing-transitions-timeline-and-magnitude.pdf.

9. Bennett S, Ozawa S, Rodriguez D, Paul A, Singh K, Singh S. Monitoring and evaluating transition and sustainability of donor-funded programs: Reflections on the Avahan experience. Eval Program Plann. 2015;52:148–58. doi: 10.1016/j.evalprogplan.2015.05.003 26099560

10. Binagwaho A, Kankindi I, Kayirangwa E, Nyemazi JP, Nsanzimana S, Morales F, et al. Transitioning to Country Ownership of HIV Programs in Rwanda. PLoS Med. 2016;13(8):e1002075. doi: 10.1371/journal.pmed.1002075 27505355

11. Burrows D, Oberth G, Parsons D, McCallum L. Transitions from donor funding to domestic reliance for HIV responses: Recommendations for transitioning countries APMGlobal Health; Aidspan; 2016.

12. Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, Weigel JL, et al. Reduced premature mortality in Rwanda: lessons from success. BMJ. 2013;346:f65. doi: 10.1136/bmj.f65 23335479

13. Freeman A, Kiumbu M, Mwamba B, Atibu J, Mukumbi H, Mwila L, et al. Patient outcomes in Lubumbashi, Democratic Republic of Congo after a disruption in HIV care due to decreased global fund appropriations. AIDS Behav. 2014;18(11):2135–43. doi: 10.1007/s10461-014-0761-8 24699713

14. Katz IT, Bogart LM, Cloete C, Crankshaw TL, Giddy J, Govender T, et al. Understanding HIV-infected patients' experiences with PEPFAR-associated transitions at a Centre of Excellence in KwaZulu Natal, South Africa: a qualitative study. AIDS Care. 2015;27(10):1298–303. doi: 10.1080/09540121.2015.1051502 26300297

15. Patcharanarumol W, Thammatacharee N, Kittidilokkul S, Topothai T, Thaichinda C, Suphanchaimat R, et al. Thailand's HIV/AIDS program after weaning-off the global fund's support. BMC Public Health. 2013;13:1008. doi: 10.1186/1471-2458-13-1008 24156606

16. Rodriguez DC, Whiteside A, Bennett S. Political commitment for vulnerable populations during donor transition. Bull World Health Organ. 2017;95(2):121–7. doi: 10.2471/BLT.16.179861 28250512

17. Sgaier SK, Ramakrishnan A, Dhingra N, Wadhwani A, Alexander A, Bennett S, et al. How the Avahan HIV prevention program transitioned from the Gates Foundation to the government of India. Health Aff (Millwood). 2013;32(7):1265–73.

18. Vogus A, Graff K. PEPFAR Transitions to Country Ownership: Review of Past Donor Transitions and Application of Lessons Learned to the Eastern Caribbean. Glob Health Sci Pract. 2015;3(2):274–86. doi: 10.9745/GHSP-D-14-00227 26085023

19. Bennett S, Singh S, Rodriguez D, Ozawa S, Singh K, Chhabra V, et al. Transitioning a Large Scale HIV/AIDS Prevention Program to Local Stakeholders: Findings from the Avahan Transition Evaluation. PLoS One. 2015;10(9):e0136177. doi: 10.1371/journal.pone.0136177 26327591

20. Oberth G, Whiteside A. What does sustainability mean in the HIV and AIDS response? Afr J AIDS Res. 2016;15(1):35–43. doi: 10.2989/16085906.2016.1138976 26785676

21. Cloete C, Regan S, Giddy J, Govender T, Erlwanger A, Gaynes MR, et al. The Linkage Outcomes of a Large-scale, Rapid Transfer of HIV-infected Patients From Hospital-based to Community-based Clinics in South Africa. Open Forum Infect Dis. 2014;1(2):ofu058. doi: 10.1093/ofid/ofu058 25734128

22. Freeman A, Kiumbu M, Mwamba B, Atibu J, Mukumbi H, Mwila L, et al. Patient Outcomes in Lubumbashi, Democratic Republic of Congo After a Disruption in HIV Care Due to Decreased Global Fund Appropriations. Aids and Behavior. 2014;18(11):2135–43. doi: 10.1007/s10461-014-0761-8 24699713

23. Gulliford M, Figueroa-Munoz J, Morgan M, Hughes D, Gibson B, Beech R, et al. What Does “Access to Health Care” Mean? J Health Serv Res Policy, 2002. doi: 10.1258/135581902760082517 12171751

24. Ministry of Health of Uganda. National Health Facility Masterlist 2018. [Internet]. Available at: http://library.health.go.ug/sites/default/files/resources/National%20Health%20Facility%20Master%20List%202018.pdf [Accessed 24 Jun. 2019].

25. Chaulagai CN, Moyo CM, Koot J, Moyo HB, Sambakunsi TC, Khunga FM, et al. Design and implementation of a health management information system in Malawi: issues, innovations and results. Health Policy Plan. 2005;20(6):375–84. doi: 10.1093/heapol/czi044 16143590

26. Gething PW, Noor AM, Gikandi PW, Ogara EAA, Hay SI, Nixon MS, et al. Improving imperfect data from health management information systems in Africa using space-time geostatistics. Plos Medicine. 2006;3(6):825–31.

27. Kiberu VM, Matovu JKB, Makumbi F, Kyozira C, Mukooyo E, Wanyenze RK. Strengthening district-based health reporting through the district health management information software system: the Ugandan experience. Bmc Med Inform Decis. 2014;14.

28. Mate KS, Bennett B, Mphatswe W, Barker P, Rollins N. Challenges for routine health system data management in a large public programme to prevent mother-to-child HIV transmission in South Africa. PLoS One. 2009;4(5):e5483. doi: 10.1371/journal.pone.0005483 19434234

29. Mpimbaza A, Miles M, Sserwanga A, Kigozi R, Wanzira H, Rubahika D, et al. Comparison of routine health management information system versus enhanced inpatient malaria surveillance for estimating the burden of malaria among children admitted to four hospitals in Uganda. Am J Trop Med Hyg. 2015;92(1):18–21. doi: 10.4269/ajtmh.14-0284 25422396

30. Luboga SA, Stover B, Lim TW, Makumbi F, Kiwanuka N, Lubega F, et al. Did PEPFAR investments result in health system strengthening? A retrospective longitudinal study measuring non-HIV health service utilization at the district level. Health Policy Plan. 2016;31(7):897–909. doi: 10.1093/heapol/czw009 27017824

31. Kruk ME, Jakubowski A, Rabkin M, Elul B, Friedman M, El-Sadr W. PEPFAR programs linked to more deliveries in health facilities by African women who are not infected with HIV. Health Aff (Millwood). 2012;31(7):1478–88.

32. Kruk ME, Jakubowski A, Rabkin M, Kimanga DO, Kundu F, Lim T, et al. Association between HIV programs and quality of maternal health inputs and processes in Kenya. Am J Public Health. 2015;105 Suppl 2:S207–10.

33. Matsubayashi T, Manabe YC, Etonu A, Kyegombe N, Muganzi A, Coutinho A, et al. The effects of an HIV project on HIV and non-HIV services at local government clinics in urban Kampala. BMC Int Health Hum Rights. 2011;11 Suppl 1:S9.

34. Wollum A, Dansereau E, Fullman N, Achan J, Bannon KA, Burstein R, et al. The effect of facility-based antiretroviral therapy programs on outpatient services in Kenya and Uganda. BMC Health Serv Res. 2017;17(1):564. doi: 10.1186/s12913-017-2512-9 28814295

35. Angrist J. PJS. Mostly Harmless Econometrics: Chapter 5.2. Mostly Harmless Econometrics. Princeton, NJ: Princeton University Press; 2008.

36. StataCorp. Stata Statistical Software: Release 15. College Station, TX: StataCorp LLC; 2017.

37. Staveteig S, Croft TN, Kampa KT, Head SK. Reaching the 'first 90': Gaps in coverage of HIV testing among people living with HIV in 16 African countries. PLoS One. 2017;12(10):e0186316. doi: 10.1371/journal.pone.0186316 29023510

38. Bean MC, Scott L, Kilby JM, Richey LE. Use of an Outreach Coordinator to Reengage and Retain Patients with HIV in Care. AIDS Patient Care STDS. 2017;31(5):222–6. doi: 10.1089/apc.2016.0318 28488904

39. Boeke CE, Nabitaka V, Rowan A, Guerra K, Nawaggi P, Mulema V, et al. Results from a proactive follow-up intervention to improve linkage and retention among people living with HIV in Uganda: a pre-/post- study. BMC Health Serv Res. 2018;18(1):949. doi: 10.1186/s12913-018-3735-0 30522484

40. AidsInfo Estimates: UNAIDS; 2018. Available from: http://aidsinfo.unaids.org/.

41. Boeke CE, Nabitaka V, Rowan A, Guerra K, Kabbale A, Asire B, et al. Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study. BMC Infect Dis. 2018;18(1):138. doi: 10.1186/s12879-018-3042-8 29566666

42. van der Kop ML, Nagide PI, Thabane L, Gelmon L, Kyomuhangi LB, Abunah B, et al. Retention in clinic versus retention in care during the first year of HIV care in Nairobi, Kenya: a prospective cohort study. J Int AIDS Soc. 2018;21(11):e25196. doi: 10.1002/jia2.25196 30489698

43. McCreesh N, Andrianakis I, Nsubuga RN, Strong M, Vernon I, McKinley TJ, et al. Universal test, treat, and keep: improving ART retention is key in cost-effective HIV control in Uganda. BMC Infect Dis. 2017;17(1):322. doi: 10.1186/s12879-017-2420-y 28468605


Článek vyšel v časopise

PLOS One


2019 Číslo 10
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

plice
INSIGHTS from European Respiratory Congress
nový kurz

Současné pohledy na riziko v parodontologii
Autoři: MUDr. Ladislav Korábek, CSc., MBA

Svět praktické medicíny 3/2024 (znalostní test z časopisu)

Kardiologické projevy hypereozinofilií
Autoři: prof. MUDr. Petr Němec, Ph.D.

Střevní příprava před kolonoskopií
Autoři: MUDr. Klára Kmochová, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#