Patient-level benefits associated with decentralization of antiretroviral therapy services to primary health facilities in Malawi and Uganda

George Abongomera, Levison Chiwaula, Paul Revill, Travor Mabugu, Edward Tumwesige, Misheck Nkhata, Fabian Cataldo, J van Oosterhout, Robert Colebunders, Adrienne K Chan, Cissy Kityo, Charles Gilks, James Hakim, Janet Seeley, Diana M Gibb, Deborah Ford

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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.
Original languageEnglish
Pages (from-to)8-19
JournalInternational Health
DOIs
Publication statusPublished - 1 Jan 2018

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