RESUMO
Awareness of HIV serostatus helps individuals calibrate behaviour or link to care. Globally, young people (15-24years) contribute over 30% of new HIV infections. Despite progress in enhancing access to HIV services, HIV testing among young people in Uganda is below target. We determined the prevalence and factors influencing HIV testing among young people in a peri-urban district with the highest proportion of young people. We conducted a nested explanatory sequential mixed-methods study from March to May 2019 in Wakiso district. We used stratified cluster random sampling to select 397 rural and 253 urban young people from eight parishes. We collected data using questionnaires and subsequently conducted in-depth interviews with 16 purposively selected survey participants. The prevalence of testing for HIV was 80.2%. Young people related their decisions about HIV testing to self-evaluation of their risk and perceived ability to manage the consequences of a positive result. Participants reported high levels of support for HIV testing from peers, partners, and family members. They perceived health facilities as confusing, distant, expensive, and staffed by judgmental, older health workers as barriers. They felt that mobile testing points solved some of these problems, but introduced less privacy and greater confidentiality concerns. The prevalence of HIV testing among young people in Wakiso district was low compared to the UNAIDS 2030 target but among the highest in sub-Saharan Africa. Community-based programs resolve many concerns about testing at health facilities. However, there is a need to make these programs more comfortable and private.
RESUMO
BACKGROUND: To address challenges in public health supply chain performance, Tanzania invested in a national logistics management unit (LMU) and a national electronic logistics management information system (eLMIS). This evaluation examined the impact of those 2 key management upgrades approximately 1 year after they were introduced. METHODS: We used a nonexperimental pre-post study design to compare the previous system with the upgraded management system. We collected baseline data from August to November 2013. We conducted round 1 of post-implementation data collection during April and May 2015, about 1 year after implementation of the upgrades. We evaluated key indicators of data use and reporting; supply chain management practices such as storage and supervision; supply chain performance including stock-out and expiry rates; and supply chain cost and savings. We analyzed the data using a range of techniques including statistical testing of baseline and round-1 results, and cost, cost-effectiveness, and return on investment analysis. RESULTS: The upgrades were associated with improvements in data use, accessibility, visibility, and transparency; planning, control, and monitoring; support for quantification; stock-out rates; stock-out duration; commodity expiry; and forecast error. The upgraded system was more costly, but it was also more efficient, particularly when adjusting for the performance improvements. The upgrades also generated substantial savings that defrayed some, but not all, of the investment costs. CONCLUSION: Upgrades to Tanzania's supply chain management systems created multiple and complex pathways to impact. One year after implementation, the LMU and eLMIS brought about performance improvements through better data use and through improvements in some, but not all, management practices. Furthermore, the upgrades-while not inexpensive-contributed to greater system efficiency and modest savings.