A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
PloS one
Abstract
Since 2017, Uganda has been implementing five differentiated antiretroviral therapy (ART)
delivery models to improve the quality of HIV care and to achieve health-system efficiencies.
Community-based models include Community Client-Led ART Delivery and Community
Drug Distribution Points. Facility-based models include Fast Track Drug Refill, Facility
Based Group and Facility Based Individual Management. We set out to assess the extent of
uptake of these ART delivery models and to describe barriers to uptake of either facilitybased
or community-based models.
Methods
Between December 2019 and February 2020, we conducted a mixed-methods study entailing
a cross-sectional health facility survey (n = 116) and in-depth interviews (n = 16) with
ART clinic managers in ten case-study facilities as well as six focus group discussions (56
participants) with patients enrolled in differentiated ART models. Facilities were selected
based on the 10 geographic sub-regions of Uganda. Statistical analyses were performed in
STATA (v13) while qualitative data were analysed by thematic approach.
Results
Most facilities 63 (57%) commenced implementation of differentiated ART delivery in 2018.
Fast Track Drug Delivery was the most common facility-based model (implemented in 100
or 86% of health facilities). Community Client-Led ART Delivery was the most popular community
model (63/116 or 54%). Community Drug Distribution Points had the lowest uptake
with only 33 (24.88%) facilities implementing them. By ownership-type, for-profit facilities
reported the lowest uptake of differentiated ART models. Barriers to enrolment in community-
based models include HIV-related stigma and low enrolment of adult males in community
models. Conclusion
To the best of our knowledge this is the first study reporting national coverage of differentiated
ART delivery models in Uganda. Overall, there has been a higher uptake of facilitybased
models. Interventions for enhancing the uptake of differentiated ART models in forprofit
facilities are recommended.
Description
Keywords
Novel, ART delivery models, Health facilities
Citation
Zakumumpa H, Makobu K, Ntawiha W, Maniple E (2021) A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda. PLoS ONE 16(7): e0254214. https://doi. org/10.1371/journal.pone.0254214