A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda.

<h4>Introduction</h4>Since 2017, Uganda has been implementing five differentiated antiretroviral therapy (ART) delivery models to improve the quality of HIV care and to achieve health-system efficiencies. Community-based models include Community Client-Led ART Delivery and Community Drug...

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Autores principales:	Henry Zakumumpa, Kimani Makobu, Wilbrod Ntawiha, Everd Maniple
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6fc7ecefcf114928a2662ed297d80ce9
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spelling	oai:doaj.org-article:6fc7ecefcf114928a2662ed297d80ce92021-12-02T20:06:38ZA mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda.1932-620310.1371/journal.pone.0254214https://doaj.org/article/6fc7ecefcf114928a2662ed297d80ce92021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254214https://doaj.org/toc/1932-6203<h4>Introduction</h4>Since 2017, Uganda has been implementing five differentiated antiretroviral therapy (ART) delivery models to improve the quality of HIV care and to achieve health-system efficiencies. Community-based models include Community Client-Led ART Delivery and Community Drug Distribution Points. Facility-based models include Fast Track Drug Refill, Facility Based Group and Facility Based Individual Management. We set out to assess the extent of uptake of these ART delivery models and to describe barriers to uptake of either facility-based or community-based models.<h4>Methods</h4>Between December 2019 and February 2020, we conducted a mixed-methods study entailing a cross-sectional health facility survey (n = 116) and in-depth interviews (n = 16) with ART clinic managers in ten case-study facilities as well as six focus group discussions (56 participants) with patients enrolled in differentiated ART models. Facilities were selected based on the 10 geographic sub-regions of Uganda. Statistical analyses were performed in STATA (v13) while qualitative data were analysed by thematic approach.<h4>Results</h4>Most facilities 63 (57%) commenced implementation of differentiated ART delivery in 2018. Fast Track Drug Delivery was the most common facility-based model (implemented in 100 or 86% of health facilities). Community Client-Led ART Delivery was the most popular community model (63/116 or 54%). Community Drug Distribution Points had the lowest uptake with only 33 (24.88%) facilities implementing them. By ownership-type, for-profit facilities reported the lowest uptake of differentiated ART models. Barriers to enrolment in community-based models include HIV-related stigma and low enrolment of adult males in community models.<h4>Conclusion</h4>To the best of our knowledge this is the first study reporting national coverage of differentiated ART delivery models in Uganda. Overall, there has been a higher uptake of facility-based models. Interventions for enhancing the uptake of differentiated ART models in for-profit facilities are recommended.Henry ZakumumpaKimani MakobuWilbrod NtawihaEverd ManiplePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254214 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Henry Zakumumpa Kimani Makobu Wilbrod Ntawiha Everd Maniple A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda.
description	<h4>Introduction</h4>Since 2017, Uganda has been implementing five differentiated antiretroviral therapy (ART) delivery models to improve the quality of HIV care and to achieve health-system efficiencies. Community-based models include Community Client-Led ART Delivery and Community Drug Distribution Points. Facility-based models include Fast Track Drug Refill, Facility Based Group and Facility Based Individual Management. We set out to assess the extent of uptake of these ART delivery models and to describe barriers to uptake of either facility-based or community-based models.<h4>Methods</h4>Between December 2019 and February 2020, we conducted a mixed-methods study entailing a cross-sectional health facility survey (n = 116) and in-depth interviews (n = 16) with ART clinic managers in ten case-study facilities as well as six focus group discussions (56 participants) with patients enrolled in differentiated ART models. Facilities were selected based on the 10 geographic sub-regions of Uganda. Statistical analyses were performed in STATA (v13) while qualitative data were analysed by thematic approach.<h4>Results</h4>Most facilities 63 (57%) commenced implementation of differentiated ART delivery in 2018. Fast Track Drug Delivery was the most common facility-based model (implemented in 100 or 86% of health facilities). Community Client-Led ART Delivery was the most popular community model (63/116 or 54%). Community Drug Distribution Points had the lowest uptake with only 33 (24.88%) facilities implementing them. By ownership-type, for-profit facilities reported the lowest uptake of differentiated ART models. Barriers to enrolment in community-based models include HIV-related stigma and low enrolment of adult males in community models.<h4>Conclusion</h4>To the best of our knowledge this is the first study reporting national coverage of differentiated ART delivery models in Uganda. Overall, there has been a higher uptake of facility-based models. Interventions for enhancing the uptake of differentiated ART models in for-profit facilities are recommended.
format	article
author	Henry Zakumumpa Kimani Makobu Wilbrod Ntawiha Everd Maniple
author_facet	Henry Zakumumpa Kimani Makobu Wilbrod Ntawiha Everd Maniple
author_sort	Henry Zakumumpa
title	A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda.
title_short	A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda.
title_full	A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda.
title_fullStr	A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda.
title_full_unstemmed	A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda.
title_sort	mixed-methods evaluation of the uptake of novel differentiated art delivery models in a national sample of health facilities in uganda.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/6fc7ecefcf114928a2662ed297d80ce9
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A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda.

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