Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda.
Int Health
; 10(1): 8-19, 2018 01 01.
Article
em En
| MEDLINE
| ID: mdl-29329396
ABSTRACT
Background:
The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities ('hubs') and lower-level health facilities ('spokes') in Phalombe district, Malawi and in Kalungu district, Uganda.Methods:
We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46).Results:
In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1-Q2); patients at spokes were poorer than at a hub (57% vs 23% in Q1-Q2; p<0.001). In Uganda, 7% of patients mapped to Q1-Q2; patients at the rural spoke were poorer than at the two peri-urban facilities (15% vs 4% in Q1-Q2; p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30-120) in Malawi and 30 min (IQR 20-60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs.Conclusions:
Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Política
/
Atenção Primária à Saúde
/
Infecções por HIV
/
Antirretrovirais
/
Acessibilidade aos Serviços de Saúde
Tipo de estudo:
Observational_studies
/
Prevalence_studies
/
Risk_factors_studies
Limite:
Adult
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Female
/
Humans
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Male
/
Middle aged
País/Região como assunto:
Africa
Idioma:
En
Revista:
Int Health
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Uganda