Zakumumpa, HenryPaina, LigiaWilhelm, JessSsengooba, FreddieSsegujja, EricMukuru, MosesBennett, Sara2022-03-112022-03-112021Zakumumpa, H., Paina, L., Wilhelm, J., Ssengooba, F., Ssegujja, E., Mukuru, M., & Bennett, S. (2021). The impact of loss of PEPFAR support on HIV services at health facilities in low-burden districts in Uganda. BMC health services research, 21(1), 1-12.https://doi.org/10.1186/s12913-021-06316-4https://doi.org/10.1186/s12913-021-06316-4https://nru.uncst.go.ug/xmlui/handle/123456789/2770Although donor transitions from HIV programs are more frequent, little research exists seeking to understand the perceptions of patients and providers on this process. Between 2015 and 2017, PEPFAR implemented the ´geographic prioritization´ (GP) policy in Uganda whereby it shifted support from 734 ‘lowvolume’ facilities and 10 districts with low HIV burden and intensified support in select facilities in high-burden districts. Our analysis intends to explore patient and provider perspectives on the impact of loss of PEPFAR support on HIV services in transitioned health facilities in Uganda. Methods: We report qualitative findings from a larger mixed-methods evaluation. Six facilities were purposefully selected as case studies seeking to ensure diversity in facility ownership, size, and geographic location. Five out of the six selected facilities had experienced transition. A total of 62 in-depth interviews were conducted in June 2017 (round 1) and November 2017 (round 2) with facility in-charges (n = 13), ART clinic managers (n = 12), representatives of PEPFAR implementing organizations (n = 14), district health managers (n = 23) and 12 patient focus group discussions (n = 72) to elicit perceived effects of transition on HIV service delivery. Data were analyzed using thematic analysis. Results: While core HIV services, such as testing and treatment, offered by case-study facilities prior to transition were sustained, patients and providers reported changes in the range of HIV services offered and a decline in the quality of HIV services offered post-transition. Specifically, in some facilities we found that specialized pediatric HIV services ceased, free HIV testing services stopped, nutrition support to HIV clients ended and the ‘mentor mother’ ART adherence support mechanism was discontinued. Patients at three ART-providing facilities reported that HIV service provision had become less patient-centred compared to the pre-transition period. Patients at some facilities perceived waiting times at clinics to have become longer, stock-outs of anti-retroviral medicines to have been more frequent and out-of-pocket expenditure to have increased post-transitionenHealth systemsHIVPEPFARUgandaHealth servicesDonor transitionArticle