Dispensing Antiretrovirals During Covid-19 Lockdown: Pathways to Health System Resilience in Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Research Square
Abstract
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.
Description
Keywords
Covid-19 pandemic, Health services, Lockdown restrictions, health system resilience
Citation
Zakumumpa, H., Tumwine, C., Milliam, K., & Spicer, N. (2021). Dispensing Antiretrovirals During Covid-19 Lockdown: Pathways to Health System Resilience in Uganda. https://doi.org/10.21203/rs.3.rs-334243/v1