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Title
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Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda
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Author
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Institution/Organisation
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Lablite Project Team
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Abstract
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| 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. |
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Language
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English
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Source (journal)
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International health. - Oxford, 2009, currens
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Publication
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Oxford
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Elsevier
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2018
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ISSN
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1876-3413
[print]
1876-3405
[online]
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DOI
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10.1093/INTHEALTH/IHX061
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Volume/pages
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10
:1
(2018)
, p. 8-19
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ISI
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000426073900003
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Pubmed ID
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29329396
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Full text (Publisher's DOI)
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Full text (open access)
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