Modifications to ART service delivery models by health facilities in Uganda in promotion of intervention sustainability: a mixed methods study
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Implementation Science
Abstract
In November 2015, WHO released new treatment guidelines recommending that all diagnosed as HIV
positive be enrolled on antiretroviral therapy (ART). Sustaining and expanding ART scale-up programs in resource-limited
settings will require adaptations and modifications to traditional ART delivery models to meet the rapid increase in
demand. We identify modifications to ART service delivery models by health facilities in Uganda to sustain ART
interventions over a 10-year period (2004–2014).
Methods: A mixed methods approach involving two study phases was adopted. In the first phase, a survey of a
nationally representative sample of health facilities (n = 195) in Uganda which were accredited to provide ART
between 2004 and 2009 was conducted. The second phase involved semi-structured interviews (n = 18) with ART
clinic managers of 6 of the 195 health facilities purposively selected from the first study phase. We adopted a
thematic framework consisting of four categories of modifications (format, setting, personnel, and population).
Results: The majority of health facilities 185 (95%) reported making modifications to ART interventions between 2004
and 2014. Of the 195 health facilities, 157 (81%) rated the modifications made to ART as “major.” Modifications to ART
were reported under all the four themes. The quantitative and qualitative findings are integrated and presented under
four themes. Format: Reducing the frequency of clinic appointments and pharmacy-only refill programs was identified
as important strategies for decongesting ART clinics. Setting: Home-based care programs were introduced to reduce
provider ART delivery costs. Personnel: Task shifting to non-physician cadre was reported in 181 (93%) of the health
facilities. Population: Visits to the ART clinic were rationalized in favor of the sub-population deemed to have more
clinical need. Two health facilities focused on patients living nearer the health facilities to align with targets set by
external donors.
Description
Keywords
Sustainability, Adaptation, Implementation, ART scale-up, Health systems, Health services delivery
Citation
Zakumumpa, H., Bennett, S., & Ssengooba, F. (2017). Modifications to ART service delivery models by health facilities in Uganda in promotion of intervention sustainability: a mixed methods study. Implementation Science, 12(1), 1-14.10.1186/s13012-017-0578-8