HIV incidence and factors associated with seroconversion in a rural community home based counseling and testing program in Eastern Uganda.

We estimated HIV incidence and identified risk factors for seroconversion following a rural community home based HIV counseling and testing program in Uganda. We analyzed data from two rounds of testing at least a year apart. Of 19,401 initially seronegative participants, 106 seroconverted in Round 2. Overall HIV incidence was 0.55 per 100 person years (95 % CI: 0.45 -0.66) with no gender difference. Among men, being widowed or divorced (aRR 4.4), and having HIV related symptoms (aRR 11.5) were associated with seroconversion; having primary level education (aRR 0.2) was protective. Among women, being aged 35-59 years (aRR 2.3) and having HIV related symptoms (aRR 9.2) were associated with seroconversion; having couples' posttest counseling in Round 1 (aRR 0.4) was protective. HIV incidence is lower than estimates from elsewhere in Uganda. Nevertheless, focused prevention programs are still needed, targeting previously married men and older women, and including couples' counseling.

Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence.

Inequalities in the burden of disease and access to health care is a prominent concern in Uganda and other sub-Saharan African countries. This is a systematic review of socio-economic differences in morbidity and access to health care in Uganda. It includes published studies from electronic databases and official reports from surveys done by government, bilateral and multilateral agencies and universities. The outcome measures studied were: the distribution of HIV/AIDS; maternal and child morbidity; and access to and utilisation of health services for people belonging to different socio-economic and vulnerability groups. Forty-eight of 678 identified studies met our inclusion criteria. Results indicate that the poor and vulnerable experience a greater burden of disease but have lower access to health services than the less poor. Barriers to access arise from both the service providers and the consumers. Distance to service points, perceived quality of care and availability of drugs are key determinants of utilisation. Other barriers are perceived lack of skilled staff in public facilities, late referrals, health worker attitude, costs of care and lack of knowledge. Longitudinal and controlled studies are needed to see if strategies to improve access to services reach the poor.

Uganda: improving maternal health care efficiency and financing.

PIP: This article presents the findings of the Partnerships for Health Reform on the efficiency and financing issues of maternal health services of the Ugandan Ministry of Health. A comparison was made between provider and consumer maternal health service expenditures provided by a public and a mission hospital and center, and by 17 private midwives and 20 traditional birth attendants (TBAs). The six areas covered by the study include antenatal care, normal deliveries, cesarean deliveries, postabortion care and postpartum hemorrhage and eclampsia complications. Greater health service cost was noted among mission hospitals compared with public hospitals and health centers, while prices for cesarean deliveries and treatment of obstetrical complications are higher compared with other maternal health services. Records show relative efficiency indications of the various providers, while quality of services were noted among midwives working in hospitals and centers compared with TBAs. Most consumer costs were observed to be lower compared with other care-related expenses except for mission health care cost. Thus, mission facilities recover more financially compared with public health centers and hospitals. Key actions suggested include: increasing health service utilization, streamlining staffing, improving the drug supply, employing midwives, assessing prescription practices, establishing specific times for check-ups, regulating consumer fees and provision of contracting arrangements, intensifying performance incentives, and evaluating user incomes and the ability of the public to pay for health care services.^ieng