Understanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectives

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dc.contributor.authorZakumumpa, Henry
dc.contributor.authorRujumba, Joseph
dc.contributor.authorKwiringira, Japheth
dc.contributor.authorKiplagat, Jepchirchir
dc.contributor.authorNamulema, Edith
dc.contributor.authorMuganzi, Alex
dc.date.accessioned2023-01-29T09:28:16Z
dc.date.available2023-01-29T09:28:16Z
dc.date.issued2018
dc.description.abstractAlthough there is mounting evidence and policy guidance urging the integration of HIV services into general health systems in countries with a high HIV burden, vertical (stand-alone) HIV clinics are still common in Uganda. We sought to describe the specific contexts underpinning the endurance of vertical HIV clinics in Uganda. Methods: A qualitative research design was adopted. Semi-structured interviews were conducted with the heads of HIV clinics, clinicians and facility in-charges (n = 78), coupled with eight focus group discussions (64 participants) with patients from 16 health facilities purposively selected, from a nationally-representative sample of 195 health facilities across Uganda, because they run stand-alone HIV clinics. Data were analyzed by thematic approach as guided by the theory proposed by Shediac-Rizkallah & Bone (1998) which identifies; Intervention characteristics, organizational context, and broader environment factors as potentially influential on health programme sustainability. Results: Intervention characteristics: Provider stigma was reported to have been widespread in the integrated care experience of participating health facilities which necessitated the establishment of stand-alone HIV clinics. HIV disease management was described as highly specialized which necessitated a dedicated workforce and vertical HIV infrastructure such as counselling rooms. Organizational context: Participating health facilities reported health-system capacity constraints in implementing integrated systems of care due to a shortage of ART-proficient personnel and physical space, a lack of laboratory capacity to concurrently conduct HIV and non-HIV tests and increased workloads associated with implementing integrated care. Broader environment factors: Escalating HIV client loads and external HIV funding architectures were perceived to have perpetuated verticalized HIV programming over the past decade. Conclusion: Our study offers in-depth, contextualized insights into the factors contributing to the endurance of vertical HIV clinics in Uganda. Our analysis suggests that there is a complex interaction in supply-side constraints (shortage of ART-proficient personnel, increased workloads, laboratory capacity deficiencies) and demand-side factors (escalating demand for HIV services, psychosocial barriers to HIV care) as well as the specialized nature of HIV disease management which pose challenges to the integrated-health services agenda.en_US
dc.identifier.citationZakumumpa, H., Rujumba, J., Kwiringira, J., Kiplagat, J., Namulema, E., & Muganzi, A. (2018). Understanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectives. BMC health services research, 18, 1-13. https://doi.org/10.1186/s12913-018-3500-4en_US
dc.identifier.urihttps://doi.org/10.1186/s12913-018-3500-4
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7370
dc.language.isoenen_US
dc.publisherBMC health services researchen_US
dc.subjectHealth systemsen_US
dc.subjectService deliveryen_US
dc.subjectHIVen_US
dc.subjectImplementation researchen_US
dc.subjectAntiretroviral therapyen_US
dc.subjectIntegrationen_US
dc.subjectGlobal health initiativesen_US
dc.titleUnderstanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectivesen_US
dc.typeArticleen_US
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