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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dc.contributor.authorZakumumpa, Henry
dc.contributor.authorMakobu, Kimani
dc.contributor.authorNtawiha, Wilbrod
dc.contributor.authorManiple, Everd
dc.date.accessioned2023-01-27T14:58:18Z
dc.date.available2023-01-27T14:58:18Z
dc.date.issued2021
dc.description.abstractSince 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.en_US
dc.identifier.citationZakumumpa 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.0254214en_US
dc.identifier.urihttps://doi. org/10.1371/journal.pone.0254214
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7333
dc.language.isoenen_US
dc.publisherPloS oneen_US
dc.subjectNovelen_US
dc.subjectART delivery modelsen_US
dc.subjectHealth facilitiesen_US
dc.titleA mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Ugandaen_US
dc.typeArticleen_US
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