The Lablite project: A cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe

BMC Health Services Research

Diana M Gibb¹  Charles F Gilks⁸  Sumeet Sodhi⁵  Elly Katabira²  Andrew Reid⁴  Cissy Kityo³  Janet Seeley^1,10  James Hakim⁴  Fabian Cataldo⁷  Levison Chiwaula⁷  Travor Mabugu⁴  Caroline Grundy¹  Paul Revill⁶  Annabelle South¹  Ivan Mambule²  George Abongomera³  Misheck J Nkhata⁷  Margaret Muzambi⁴  Harriet Namata³  Deborah Ford¹  Adrienne K Chan⁹ 

[1] MRC Clinical Trials Unit at University College London, London, U.K;Infectious Diseases Institute, Makerere University, Mulago, Uganda;Joint Clinical Research Centre, Kampala, Uganda;University of Zimbabwe, Harare, Zimbabwe;Department of Family and Community Medicine, University of Toronto, Toronto, Canada;Centre for Health Economics, University of York, York, UK;Dignitas International, Zomba, Malawi;School of Population Health, University of Queensland, Queensland, Australia;Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada;MRC/UVRI Uganda Research Unit of AIDS, Entebbe, Uganda

关键词: Decentralization;    Stock-outs;    Primary care health facilities;    Antiretroviral therapy rollout;    Sub-Saharan Africa;    HIV services;   

Others  :  1126687
DOI  :  10.1186/1472-6963-14-352

 received in 2014-02-16, accepted in 2014-07-29,  发布年份 2014

【 摘 要 】

Background

In sub-Saharan Africa antiretroviral therapy (ART) is being decentralized from tertiary/secondary care facilities to primary care. The Lablite project supports effective decentralization in 3 countries. It began with a cross-sectional survey to describe HIV and ART services.

Methods

81 purposively sampled health facilities in Malawi, Uganda and Zimbabwe were surveyed.

Results

The lowest level primary health centres comprised 16/20, 21/39 and 16/22 facilities included in Malawi, Uganda and Zimbabwe respectively. In Malawi and Uganda most primary health facilities had at least 1 medical assistant/clinical officer, with average 2.5 and 4 nurses/midwives for median catchment populations of 29,275 and 9,000 respectively. Primary health facilities in Zimbabwe were run by nurses/midwives, with average 6 for a median catchment population of 8,616. All primary health facilities provided HIV testing and counselling, 50/53 (94%) cotrimoxazole preventive therapy (CPT), 52/53 (98%) prevention of mother-to-child transmission of HIV (PMTCT) and 30/53 (57%) ART management (1/30 post ART-initiation follow-up only). All secondary and tertiary-level facilities provided HIV and ART services. In total, 58/81 had ART provision. Stock-outs during the 3 months prior to survey occurred across facility levels for HIV test-kits in 55%, 26% and 9% facilities in Malawi, Uganda and Zimbabwe respectively; for CPT in 58%, 32% and 9% and for PMTCT drugs in 26%, 10% and 0% of facilities (excluding facilities where patients were referred out for either drug). Across all countries, in facilities with ART stored on-site, adult ART stock-outs were reported in 3/44 (7%) facilities compared with 10/43 (23%) facility stock-outs of paediatric ART. Laboratory services at primary health facilities were limited: CD4 was used for ART initiation in 4/9, 5/6 and 13/14 in Malawi, Uganda and Zimbabwe respectively, but frequently only in selected patients. Routine viral load monitoring was not used; 6/58 (10%) facilities with ART provision accessed centralised viral loads for selected patients.

Conclusions

Although coverage of HIV testing, PMTCT and cotrimoxazole prophylaxis was high in all countries, decentralization of ART services was variable and incomplete. Challenges of staffing and stock management were evident. Laboratory testing for toxicity and treatment effectiveness monitoring was not available in most primary level facilities.

【 授权许可】

   
2014 Chan et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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