Understanding implementation barriers in the national scale-up of differentiated ART delivery in Uganda.
BMC Health Serv Res
; 20(1): 222, 2020 Mar 17.
Article
en En
| MEDLINE
| ID: mdl-32183796
ABSTRACT
BACKGROUND:
Although Differentiated Service Delivery (DSD) for anti-retroviral therapy (ART) has been rolled-out nationally in several countries since World Health Organization (WHO)'s landmark 2016 guidelines, there is little research evaluating post-implementation outcomes. The objective of this study was to explore patients' and HIV service managers' perspectives on barriers to implementation of Differentiated ART service delivery in Uganda.METHODS:
We employed a qualitative descriptive design involving 124 participants. Between April and June 2019 we conducted 76 qualitative interviews with national-level HIV program managers (n = 18), District Health Team leaders (n = 24), representatives of PEPFAR implementing organizations (11), ART clinic in-charges (23) in six purposively selected Uganda districts with a high HIV burden (Kampala, Luwero, Wakiso, Mbale, Budadiri, Bulambuli). Six focus group discussions (48 participants) were held with patients enrolled in DSD models in case-study districts. Data were analyzed by thematic approach as guided by a multi-level analytical framework Individual-level factors; Health-system factors; Community factors; and Context.RESULTS:
Our data shows that multiple barriers have been encountered in DSD implementation. Individual-level Individualized stigma and a fear of detachment from health facilities by stable patients enrolled in community-based models were reported as bottlenecks. Socio-economic status was reported to have an influence on patient selection of DSD models. Health-system Insufficient training of health workers in DSD delivery and supply chain barriers to multi-month ART dispensing were identified as constraints. Patients perceived current selection of DSD models to be provider-intensive and not sufficiently patient-centred. Community Community-level stigma and insufficient funding to providers to fully operationalize community drug pick-up points were identified as limitations. CONTEXT Frequent changes in physical addresses among urban clients were reported to impede the running of patient groups of rotating ART refill pick-ups.CONCLUSION:
This is one of the first multi-stakeholder evaluations of national DSD implementation in Uganda since initial roll-out in 2017. Multi-level interventions are needed to accelerate further DSD implementation in Uganda from demand-side (addressing HIV-related stigma, community engagement) and supply-side dimensions (strengthening ART supply chain capacities, increasing funding for community models and further DSD program design to improve patient-centeredness).Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Actitud del Personal de Salud
/
Actitud Frente a la Salud
/
Infecciones por VIH
/
Personal de Salud
/
Atención Dirigida al Paciente
/
Atención a la Salud
/
Antirretrovirales
Tipo de estudio:
Guideline
/
Prognostic_studies
/
Qualitative_research
Límite:
Humans
País/Región como asunto:
Africa
Idioma:
En
Revista:
BMC Health Serv Res
Asunto de la revista:
PESQUISA EM SERVICOS DE SAUDE
Año:
2020
Tipo del documento:
Article
País de afiliación:
Uganda