Understanding implementation barriers in the national scale-up of differentiated ART delivery in Uganda

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dc.contributor.authorZakumumpa, Henry
dc.contributor.authorRujumba, Joseph
dc.contributor.authorKwiringira, Japheth
dc.contributor.authorKatureebe, Cordelia
dc.contributor.authorSpicer, Neil
dc.date.accessioned2023-01-29T09:22:15Z
dc.date.available2023-01-29T09:22:15Z
dc.date.issued2020
dc.description.abstractAlthough Differentiated Service Delivery (DSD) for anti-retroviral therapy (ART) has been rolled-out nationally in several countries since World Health Organization (WHO)‘s landmark 2016 guidelines, there is little research evaluating post-implementation outcomes. The objective of this study was to explore patients’ and HIV service managers’ perspectives on barriers to implementation of Differentiated ART service delivery in Uganda. Methods: We employed a qualitative descriptive design involving 124 participants. Between April and June 2019 we conducted 76 qualitative interviews with national-level HIV program managers (n = 18), District Health Team leaders (n = 24), representatives of PEPFAR implementing organizations (11), ART clinic in-charges (23) in six purposively selected Uganda districts with a high HIV burden (Kampala, Luwero, Wakiso, Mbale, Budadiri, Bulambuli). Six focus group discussions (48 participants) were held with patients enrolled in DSD models in case-study districts. Data were analyzed by thematic approach as guided by a multi-level analytical framework: Individual-level factors; Health-system factors; Community factors; and Context. Results: Our data shows that multiple barriers have been encountered in DSD implementation. Individual-level: Individualized stigma and a fear of detachment from health facilities by stable patients enrolled in communitybased models were reported as bottlenecks. Socio-economic status was reported to have an influence on patient selection of DSD models. Health-system: Insufficient training of health workers in DSD delivery and supply chain barriers to multi-month ART dispensing were identified as constraints. Patients perceived current selection of DSD models to be provider-intensive and not sufficiently patient-centred. Community: Community-level stigma and insufficient funding to providers to fully operationalize community drug pick-up points were identified as limitations. Context: Frequent changes in physical addresses among urban clients were reported to impede the running of patient groups of rotating ART refill pick-ups. Conclusion: This is one of the first multi-stakeholder evaluations of national DSD implementation in Uganda since initial roll-out in 2017. Multi-level interventions are needed to accelerate further DSD implementation in Uganda from demand-side (addressing HIV-related stigma, community engagement) and supply-side dimensions (strengthening ART supply chain capacities, increasing funding for community models and further DSD program design to improve patient-centeredness).en_US
dc.identifier.citationZakumumpa, H., Rujumba, J., Kwiringira, J., Katureebe, C., & Spicer, N. (2020). Understanding implementation barriers in the national scale-up of differentiated ART delivery in Uganda. BMC health services research, 20(1), 1-16. https://doi.org/10.1186/s12913-020-5069-yen_US
dc.identifier.urihttps://doi.org/10.1186/s12913-020-5069-y
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/7368
dc.language.isoenen_US
dc.publisherBMC health services researchen_US
dc.subjectHIV treatmenten_US
dc.subjectHealth systemsen_US
dc.subjectDifferentiated service deliveryen_US
dc.subjectHealth servicesen_US
dc.subjectResource-limited settingsen_US
dc.titleUnderstanding implementation barriers in the national scale-up of differentiated ART delivery in Ugandaen_US
dc.typeArticleen_US
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