Browsing by Author "Milliam, Kiconco"

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    Dispensing Antiretrovirals During Covid-19 Lockdown: Pathways to Health System Resilience in Uganda
    (Research Square, 2021) Zakumumpa, Henry; Tumwine, Christopher; Milliam, Kiconco; Spicer, Neil
    Although there is an emerging evidence base on the impact of Covid-19 pandemic on access to health services in low-and middle-income countries, the related notion of health system resilience has received little empirical attention. The objective of this study was to explore health system resilience at the subnational level in Uganda with regard to strategies for dispensing of antiretrovirals during Covid-19 lockdown restrictions. METHODS We conducted a qualitative case-study of eight districts from Eastern Uganda (Mbale, Sironko, Manafwa, Bulambuli, Bududa) and Western Uganda (Kabarole, Kyegegwa, Kyenjonjo) purposively selected due to having a relatively high HIV burden. Between June and September 2020, we conducted key informant interviews with district health team leaders (n=9), with ART clinic managers (n=36), representatives of PEPFAR implementing organizations (n=6) and six focus group discussions with recipients of HIV/AIDS care (48 participants). Qualitative data were analyzed using thematic approach. RESULTS Five broad strategies for distributing antiretrovirals during ‘lockdown’ emerged in our analysis: accelerating home-based antiretroviral therapy (ART) deliveries,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; an increased reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported benefiting from the Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities. CONCLUSION Although Covid-19 ‘lockdown’ undoubtedly impeded access to facility-based HIV services, it unraveled new possibilities and innovations in the distribution of antiretrovirals in the predominantly rural settings of our case-study districts. Further research is recommended to evaluate the potential of home-based deliveries as an alternative differentiated ART delivery model in Uganda and other countries with a high HIV burden.
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    Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda
    (BMC health services research, 2021) Zakumumpa, Henry; Tumwine, Christopher; Milliam, Kiconco; picer, Neil S
    The notion of health-system resilience has received little empirical attention in the current literature on the Covid-19 response. We set out to explore health-system resilience at the sub-national level in Uganda with regard to strategies for dispensing antiretrovirals during Covid-19 lockdown. Methods: We conducted a qualitative case-study of eight districts purposively selected from Eastern and Western Uganda. Between June and September 2020, we conducted qualitative interviews with district health team leaders (n = 9), ART clinic managers (n = 36), representatives of PEPFAR implementing organizations (n = 6).In addition, six focus group discussions were held with recipients of HIV care (48 participants). Qualitative data were analyzed using thematic approach. Results: Five broad strategies for distributing antiretrovirals during ‘lockdown’ emerged in our analysis: accelerating home-based delivery of antiretrovirals,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; increasing reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported leveraging Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities. Conclusion: While Covid-19 ‘lockdown’ restrictions undoubtedly impeded access to facility-based HIV services, they revived interest by providers and demand by patients for community-based ART delivery models in case-study districts in Uganda.